An article in the San Francisco Chronical that was republished in Kaiser Heath News looked at tech firms that monitor chronic conditions remotely. The firms offer both digital or human health coaches to help patients better manage their care. There are approximately 50 different firms designed to help patients adhere to treatment programs or deal with chronic conditions.
These startups offer people or software to provide motivation, direction, or moral support for managing what goes awry with the human body, including chronic conditions, musculoskeletal ailments, obesity — even attention-deficit/hyperactivity disorder and eczema. Business models vary. Some startups take payments directly from consumers; “anti-diet” app Wellory asks for $45 a month. Other startups get monthly per-member funding from companies to offer regular coaching for their employees. Some services tout 24/7 access and average connection times of 60 seconds. With some, coaches escalate serious issues to more highly credentialed clinicians.
Health coaching has a lot of potential. Prescription medication non-adherence ranges from 30% to 50% for of U.S. adults by some estimates. Doctors are busy and don’t really have additional time to monitor patients between visits. If physicians were called on to monitor patients between visits the costs would likely exceed benefits and exceed what patients are willing to pay.
Coaches — whether they’re people or software — can support patients between formal visits to the doctor. That kind of encouragement can be important for sticking to a care plan — a critical thing in a world where good habits mean a lot for keeping healthy. Whether a patient needs a team to assist with the physical aspects of recovering from orthopedic surgery or help avoiding triggers for behavioral health conditions, these coaching companies are an app or a website away.
People in the health care industry are of two different minds regarding health coaching. Some see it as a human touch in an industry defined by hurried doctors, faceless hospital administrators and health plans with lots of rule. Others wonder if it isn’t just leveraging cheaper labor patient care. Perhaps it’s both and there’s nothing wrong with improving care while trying to hold costs down.
I can see the merit of a coach that keeps seniors out of the hospital and advises them when to see their doctors. I can see a need to help diabetics better control their blood sugar levels. At the same time, I see health coaching as an unsought good; something nobody wants to pay for. Some health startups charge consumers a direct fee, while others are paid by employers to keep workers healthy. If it requires human interaction using a social worker the cost will be higher but the quality likely higher as well. If it’s merely a computer algorithm, the cost would be lower while the effectiveness would likely be lower.
I once wrote about a remote monitoring program for diabetes where patients were instructed to take a blood sample at certain times a day and send the value to the monitoring agency via computer. If blood sugar had spiked, the program would alert someone like a diabetes nurse, who would call the patient to see what they had just eaten and advise them to avoid that food in the future. Many startups work with coaches similar to a call center, hiring social workers to deliver episodic care and advice when needed.