Recently, FMCA was lucky enough to catch some time with healthcare media thought leader Roger Holstein. Between his past work as head of WebMD and Healthgrades, and his current role leading investing in healthcare technology as Managing Director with Vestar Capital, Holstein has seen (and driven!) many of the changes that shape the healthcare field. Since Functional Medicine Health Coaches are driving another healthcare change, we were interested in his perspective on how our role fits into the shifting landscape.
As it turns out, three significant aspects of a Health Coach’s role uniquely position them to address outages in the system and inspire real, long-term changes in their clients: the ability to counteract cognitive biases, earn trust, and interact with frequency.
PUSHING BACK ON BIAS
Health Coaches hold significant power when it comes to challenging clients’ ways of thinking, and thought patterns called unconscious biases are particularly important to recognize and address. Fully understanding the power of bias can be a revelation, as Holstein himself has experienced. He had always believed that when provided with evidence, people will make rational, informed decisions. Smoking causes cancer? Okay, time to quit. But, as he came to learn, “having information is one thing. Whether you act upon it is something completely different.” And as Health Coaches are well aware, when it comes to health behaviors, people often prioritize immediate gratification, even when they know that these choices do them no good in the long run.
Why do we do this? Chalk it up to unconscious bias—specifically, a phenomenon called hyperbolic discounting: choosing an immediate benefit over a delayed benefit. Sticking with our smoking example, hyperbolic discounting is choosing the immediate benefit of smoking a cigarette over the delayed benefit of lung health and reduced cancer risk. “When decisions and their consequences are separated in time,” Holstein explains, “we underinvest in things like exercise or diet or stress reduction—which would lead in the long term to better outcomes—and we overinvest in ‘bad carbs,’ ‘bad fats,’ soda, lack of exercise, in the short term, because they give us instant pleasure and gratification.”
Health Coaches are no stranger to this idea; it’s part of why long-term lifestyle change is so difficult. And so a Health Coach who is armed with the ability to recognize biases like hyperbolic discounting is better able to help their clients become aware of that bias, and to find counter-biasing strategies to overcome it.
CONNECTING THROUGH TRUST, REINFORCING THROUGH FREQUENCY
So how can a Health Coach influence clients to prioritize those longer-term benefits and their longer-term pay-offs? As Holstein sees it, it comes down to how often, and from whom, a client receives the message to make healthy choices. A client’s “inner circle,” the sources whom they trust and from whom they receive regular health-related messages, often tempt them to instant gratification, to putting off a healthy choice rather than prioritizing it. And in the traditional model, physicians tend to see patients only a few times a year, leaving an outage: who is advocating for healthy choices on a regular basis?
As healthcare professionals who are both trusted and accessible, Health Coaches can provide that regular reinforcement of longer-term, quality of life choices. Holstein calls on Health Coaches to be a bias-fighting resource “with whom you can communicate, who can assess your need and create a mutually-agreed upon plan, who let you self-manage and provide encouragement and motivation.” Health Coaches are unique in that they are both trusted and seen with frequency, and this feature can help us further define our role in the changing healthcare landscape.
KEEPING PROGRESS TOP-OF-MIND
But even coaches can’t be with their clients all the time. So we asked Holstein what he recommends for helping clients stay focused and accountable. Progress-tracking apps are a great start; they exist for just about everything, from sleep trackers and activity monitors to food journals and diabetes management. They can help clients zero in on their focus areas or issues, and they can be valuable sources of data for Coaches as well. He also called out Healthie, the practice management and telehealth platform (and new FMCA resource!). Healthie’s telehealth capability in particular makes it easy for coaches to interact with patients on-demand, whenever they need to touch base for information or support. Simply finding a way to “be there” for your clients when they need you can help bring Health Coaches into the inner circle, and both earn and keep clients’ trust.
The big takeaway for Coaches: simply being aware of unconscious biases, and helping clients become aware of them, is the first step in overcoming them to reach long-term health goals. “The more you’re aware of biases and how easily they distort our view,” Holstein observes, “the better you will be as a coach. If you’re not aware of what these biases are, you won’t be able to overcome them.” His advice on building that awareness: read. Specifically, read The Undoing Project by Michael Lewis, Thinking Fast and Slow by Daniel Kahneman, and Nudge by Richard Thaler and Cass Sunstein. These books can help Health Coaches become aware of biases, understand how they work, and learn how to use counter-biasing practices in order to help clients set themselves up for success.
Even with the trust and frequency that are unique to Health Coaching relationships, it’s through addressing the real problem that we can take the appropriate steps to overcome it. In that way, overcoming biases has a lot in common with Functional Medicine’s root-based healing approach: identify and treat the real problem to truly resolve the symptoms. “Functional Medicine,” Holstein says, “helps create that awareness of what needs work, so you can identify obstacles and develop a plan.” Luckily for us, Health Coaches are experts at doing just that.