In 2011, Sean Duffy and Adrian James were sitting in Dolores Park in San Francisco discussing what to call some workers at the company they founded, Omada Health.
Omada, which was launched that year, provides a virtual cure for chronic conditions. The company handles the conditions through a team of employees – some traditional doctors and others aiming to encourage patients as they deal with their daily high blood pressure, diabetes and other conditions. They thought this second group was crucial. The founders ended up asking patients for their job title.
Was this person a “janitor”? Patients think this sounds like someone is helping with their bills. A guide? To which destination? The founders settled on a “coach.” Patients loved the term: He suggested someone who could provide support and make them “feel less lonely,” Duffy said, as they dealt with their health challenges.
This decision was an early sign of the eventual tech company. Since then, dozens of similar startups focused on health coaching have sprung up, often backed by big bucks. A review by KHN — of news releases, the industry database Crunchbase, and sites like LinkedIn — found nearly 50 companies with nearly $7 billion in venture capital funding.
These startups offer people or programs to provide motivation, guidance or moral support to manage what goes awry with the human body, including chronic diseases, musculoskeletal diseases, obesity – even attention-deficit/hyperactivity disorder and eczema. Business models vary. Some startups get payments directly from consumers; Wellory’s “anti-diet” app charges $45 per month. Other startups get monthly funding for each corporate member to provide regular training for their employees. Some services promote 24/7 access and average call times are 60 seconds. With some, coaches escalate serious issues to highly certified physicians.
The enthusiasm behind the training is, on the face of it, an intriguing turnaround in an industry that loves to flaunt its multi-billion dollar pills and frighteningly sophisticated AI.
“As these digital health startups start out in the digital health space, they realize that technology is not enough to drive change,” explained Michael Yang, managing partner at OMERS Ventures, who has invested in training startups. Patients may need to eat better food, follow a physical therapy plan, talk through emotional turmoil, and more.
Coaches – whether they are people or software – can support patients between formal doctor visits. This kind of encouragement can be important to sticking to a care plan – crucial in a world where good habits mean so much to maintaining health. Whether a patient needs a team to help with the physical aspects of recovering from orthopedic surgery or to help avoid triggers for behavioral health conditions, these coaching companies are an app or website away.
“The model has become very strict,” Yang said. At many startups, coaches do “the lion’s share of the work.”
However, many healthcare workers remain ambivalent about this trend. Some believe it adds a human touch to a part of the economy that can be defined by rude doctors and incomprehensible billing. Others wonder if this is just a way to take advantage of cheap labor.
Proponents say coaches are deeply involved, even performing tasks they would otherwise undo. “We need an alternative workforce to fill some of these gaps,” Duffy said. At Omada, coaches wear a lot of hats: They review glucose data while tracking patients’ lifestyle changes and can provide empathy in a way that other people in the health care system don’t. Coaches are “people who ask questions before making judgments,” Duffy said.
Duffy said that providing clerical care to people with diabetes — or others with chronic conditions — requires more staff than the health care system. So a coach—whose salary is typically tens, not hundreds, thousands of dollars—seems like a solution for many startups.
“The ‘training’ is a way to avoid having to get clinical licenses or FDA approvals,” Bob Kocher, an investor in Venrock, wrote in an email. “It allows you to start serving patients faster.”
Coaches already play a role in existing institutions.
Peers play a prominent role at VA, said Dr. Pushpa Raja, a psychiatrist with the Department of Veterans Affairs’ Greater Los Angeles System. Often, people with a particular condition interact with veterans with the same disease. “They can communicate with patients in a different way,” she said. “They can encourage patients toward goals. They can train patients to plan and strategize.”
They are also teamed with psychiatrists and primary care physicians, which means they can pass on feedback – for example, if someone’s depression is getting worse over time.
Some observers of health training startups worry they may not have the same ability. Liz Chiarillo, a sociologist at St. Louis University in Missouri who studies medical organizations, said coaches may be able to “do a lot of annoying nitty-gritty” to doctors, but that increasing the number of these workers could “further fragment our health system.” A behavioral health coach at a particular startup may need to take a case to a psychiatrist or primary care physician — and it is often unclear whether startup coaches have close ties to organizations that offer next-level expertise.
Moreover, trainers may not be well trained – and they may serve too many patients to do too much good.
“I get upset when I get start-ups like, ‘We’re going to hire 100 people and train them for two weeks,’” Yang said. “You won’t learn anything in two weeks.” As for training for some companies, “It’s very scary, the lack of nuance and depth,” like he said.
Training qualifications may not be all they appear to be, either.
Wellory promises to match users with a nutrition coach after taking a test. These coaches, in turn, suggest healthy foods to users. But some test takers—like Dr. Seth Troger, an emergency room physician at Northwestern Medicine; and a KHN reporter – they were matched with a trainer who described herself as an “RDE,” short for Qualified Registered Dietitian. It’s a term for dietitians who have completed most, but not all, of the requirements to qualify as a registered dietitian.
But the RDE is not a professional designation, according to the Committee on Diet Registration, and anyone using it should stop “immediately.” The committee is the accrediting agency for the Academy of Nutrition and Dietetics, a trade group for food and nutrition professionals. Wellory removed the reference after KHN contacted the company about the issue.
Yang said that some start-ups view the coaches as almost a “call center model,” with plans to hire dozens of coaches who support tens of thousands of patients.
Some startups are already using small teams. Take Homethrive, the new company that raised $20 million to support caregivers of the elderly or other sick. The company aims to use a combination of technology tools and social workers to provide caregivers with everything from emotional support and communication to recommendations for wheelchairs and walkers.
There is a huge opportunity for these companies to fill, said David Grabowsky, a professor at Harvard Medical School who specializes in aging and long-term care. Caregivers may be unsure of how to complete some daily tasks, such as showering or picking up patients. But he said, equally, “It’s loneliness, it’s the feeling that you feel this alone.”
However, Homethrive still relies on a small workforce. Co-founder Dave Jacobs said the company serves about 20,000 members. It currently employs 40 social workers who provide “episodic” support during “most severe” situations, such as deciding whether to move patients home, Jacobs said. For everyday situations, he relies on technology to connect patients with resources.
Grabowski has questions about such models. “I definitely wonder if 40 social workers are enough” to handle such situations, he said.
Training for startups is a very heterogeneous field. Yang said he’s seen start-ups doing the good training, but he’s not sure how much the audience will benefit from. “Do we serve the residents well at the end of the day?”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and survey, KHN is one of the three major drivers of KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.
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