Episode 65 | Jan 11, 2024

Why Technology Won’t Replace Human Connection, With Casey Hughes

How can we keep the human connection in healthcare while still taking advantage of modern technologies? Dr. Sandi and her guest, Casey Hughes explore answers to that important question this week.

After completing a degree in psychology and working for both Stanford and Apple, Casey turned her attention to the importance of human connection within healthcare and behavior change. She understands how new technologies like data tracking, while powerful, can have unintended consequences. Without receiving the personal connection a health coach offers, technology in isolation can be detrimental to client change. But should health coaches throw away this technology altogether? While it can be incredibly effective for some, it lacks a key aspect to creating lasting change – social support.

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Episode Transcript

Dr. Sandi: Welcome back to “Health Coach Talk.” You are in for such a delight today because this guest is someone I want you all to know about. Her name is Casey Hughes, and I actually learned about her through LinkedIn. I had posted about the Medicare announcement because Medicare has approved health and wellness coaching as an approved telehealth service for 2024, and you had written a post saying that it’s time to come out of the shadows. And that really resonated with me.

So, before I turn it over to Casey, I just wanted to say that she is so accomplished and such a leader in digital health. She has worked for Stanford. She has worked for Apple. She has developed apps from the ground up, and she has literally helped hundreds of thousands of people enhance their mental well-being and achieve weight loss and get into a better state of health. So, welcome, Casey.

Casey: Thank you so much for having me, Sandi, and hello to everybody listening. It’s really a joy to be here. As Sandi mentioned, for the past 15 years, I’ve really been working at the intersection of health coaching and applied behavioral science and trying to figure out how to scale that through digital experiences while keeping the human connection present because that’s really difficult. And in this day and age, it is being threatened by AI chatbots and things where the human is taken out of it. So, those are the things I’ve been passionate about.

And I have worked as a health coach. I have helped train health coaches, and I’m very passionate about building health coaching programs and advocating for health coaches. And the reason I wrote that post and I use those specific words is because I do feel like coaches have been in the shadows for too long. They are such a critical part of healthcare teams, of well-being institutions, of employers. They work day in and day out, and I don’t feel they’ve been recognized as much as they should be. So, I am an advocate for coaches for people and so grateful to be in this field.

Dr. Sandi: Well, that quote really resonated because, yes, it is time for coaches to emerge from the shadows because I believe they are key to lifestyle change, which is going to be the key if we ever solve this growing epidemic of lifestyle-driven chronic disease. Can you tell us a little bit more about your background? How did you get started and how did you decide to become a health coach and use that training in your work?

Casey: Yes. I have an interesting story. I grew up in a household that was complex. Both of my parents were high-performing professionals, VPs, and presidents of companies and unfortunately, they each experienced problems with addiction and substance use disorder. So, my childhood was spent trying to solve the complexities of human behavior even before I knew I wanted to be a scientist or a health coach.

And during my childhood in adolescence and young adulthood, I really got a front-row seat to behavior change, and how difficult it can be, and just the complexity of wanting to change so much and trying so hard but facing enormous barriers to do so. And that’s really when I decided… I think I was 17 years old. I graduated high school. I knew that I wanted to help people overcome those obstacles. I didn’t know what that would look like at the time. I started as a personal trainer. I said, “Okay, this is possible for me.” I bought myself a few textbooks, and then I sat for the ACSM exam, and I started working as a personal trainer right out of high school. And I fell in love with the relationships I was forming with my clients.

And then I kept saying, “Okay, I’m still curious about this,” because some of my clients will say, “Hey, I’m so ready to change. Like, let’s do this. I’m ready to change everything I eat and how I work out.” And I would have a handful of people say that, but then maybe half of them would actually follow through with their plans and do it. And then the other half, I’d never hear from them again. So, again, I was at this pivotal moment of, “Why? Why is that happening?” So, I did my undergraduate degree in psychology. And then soon after that, I did my master’s degree in health promotion science. And during this time, I transitioned from being a personal trainer to being a health and wellness coach.

So, I was working for various companies at the time. I’m still working for a gym, which still exists today all over the place called Anytime Fitness. But I said to them, “Hey, I want to do this health and wellness coaching thing in addition to personal training.” So, I started to blend that a bit. And back then, there weren’t as many formal training programs as there are today. So, I remember ordering Meg Jordan’s book on…I think it’s called “How To Be A Health Coach.” I read it a hundred times. And then I just learned as I went.

Then, I got hired at Stanford, which was a really pivotal point in my career. Stanford wanted to build their first virtual primary care clinic, and they wanted it to be a slightly different model where it wasn’t just traditional primary care, but there was a health and wellness coach in the mix who could be a longitudinal partner for patients. So, I was brought on as Stanford’s first health and wellness coach and was tasked with building the program from the ground up. I partnered with some incredible physicians. We brought on some incredible coaches. And for three years, we saw thousands of patients virtually. And we established that, hey, you can help people get healthy and improve their well-being in a model of care that prioritizes holistic health, that prioritizes relationships, and understanding obstacles and barriers. So, that’s up to the point that I got to at Stanford.

And then after a few years, Apple, who was down the street, said, “Wow, what you guys are doing is really interesting.” And I was working under Dr. Sumbul Desai, who was recruited over to Apple, and we formed a new team on the Apple health special projects team. And that’s when I started transitioning a bit from just developing brick and mortar or virtual…excuse me, health and wellness coaching programs to, “Okay, how do we design now really digital experiences that can scale this while also retaining that important relationship?” So, that’s a little bit up to that point.

Fast forward, I went to work for a payer because I said, “I have to know what that’s like. I want to build a digital clinical strategy there.” And so it’s been a wonderful journey. It’s been a wonderful journey. I spent now the last two years at a startup called Fresh Tri, building a digital app for patients with cardiometabolic disease, helping them to form lasting habits through applying neuroscience to digital product design. So, yeah, lots of different experiences, but they’ve really shaped me in profound ways and the way that I serve the community.

Dr. Sandi: Yeah, it sounds like each experience would build so that you’d have a next one where you’d apply your prior learning to the next challenge or the next venture. And so we’re talking about this merger between the benefits of technology. I love my Apple Watch and tracking, and I have my Oura Ring to track my sleep and have that quantified self-mentality. But I also know that if we go too far, we lose the human element, and I get pitched left and right coaches that will not be a human being but will be just programmed enough to have that connection. In fact, the Carepod is the one where you could be walking in the mall and there’s no doctor, there’s no nurse. You just come in, you can get your tests and get a diagnosis without having any human interaction whatsoever. So, I wonder if you can comment how can we preserve that human connection while still benefit from all that technology has to offer us?

Casey: Right. I have to be honest, it’s something that scares me a bit. I think there’s so much potential with AI to improve health care, to improve health and wellbeing, but there are also risks, and there are also limitations and nuances that we have to be really aware of. Even from the lens of behavior change, we know that social support is a key mechanism of action for lasting change. And you look at a lot of studies where they’re examining, for example, weight loss among low socioeconomic populations. And they find that even the relationship between primary care provider and patient can make a difference and whether or not someone achieves lasting weight loss versus transitory or episodic weight loss. It comes and goes.

And so that mechanism of social support is so critical in behavior change. That is what scares me is losing that. So, I just read a few articles on Carepod, and these things popping up in the malls. And a few thoughts that went through my mind are, wow, for access for people who cannot get into their primary care provider, cannot afford to have healthcare in that way, this could be a really great opportunity. It could reach rural areas. It could reach areas where we lack maternal healthcare, right? There’s women all over the country who are facing disproportionate levels of morbidity and mortality because they don’t have access to care. What scares me about it is removing the person from the relationship and what that could look like. It’s possible, and I could see a future, but it’s still something to be considerate of.

When it comes to health and wellness coaching, focusing a little bit more on that, where I see AI and data taking centerstage is supporting health coaches in providing insights to deliver better care. For example, there’s an emerging field of behavioral intervention called adaptive interventions, just-in-time adaptive interventions, stepped care interventions where we’re essentially using someone’s data to help predict what might be the next best thing for them. Because in today’s… I’m just going to be real and honest right now. A lot of coaching training programs teach you… You have a patient, get to the end of the session, set smart goals, send them on their way, have them come back, assess goals, repeat, do it again. So, it’s very protocolized, and that’s okay, but it’s also not okay because you miss out on that adaptability, the flexibility in knowing what may be best for this one person in this moment.

So, where data and AI can support that is by saying, “Okay, Coach Casey, your client had some difficulties and faced some barriers with overeating or wasn’t able to go for that walk three days the past week. They reported this and that experience.” The coach can get a snapshot of that and use that to tailor the conversation. That to me is beautiful and where a lot of these digital experiences and programs should go.

Dr. Sandi: I love that, and it really is in line with what we’re teaching in functional medicine coaching. It’s personalized, and it’s based on precision medicine from functional medicine. They’re not practicing medicine, but those principles and they might be able to take data from a continuous glucose monitor or Function Health, which is Mark Hyman’s new direct-to-consumer lab that will be AI-driven. And so they can tailor the discussion and help people to create that plan that is fitting with what’s right for them, not just some generic coach approach. So, that makes perfect sense.

Casey: Right. And the one other thing to be aware of, and I always like to tell coaches is the quantified self can be a barrier in itself. So, when we’re asking patients or clients to track their data continuously, keep in mind that can be more harmful for some people than it can be helpful. There are a lot of studies coming out in the field of neuroscience demonstrating certain parts of the brain that change in the face of perceived failure.

So, I was introduced to the role of the lateral habenula at my last company, Fresh Tri. The CEO, Kyra Bobinet, introduced me to some of these studies that are coming out on the lateral habenula, showing that when you face failure over and over again, your lateral habenula becomes very active, and it starts keeping you from those dangers and those threats. So, what happens is, if you ask someone to repeatedly track their calories every single day and they’re constantly not meeting their goal or they’re becoming obsessed in a way that’s harmful for them, their brain’s likely going to say, “Hey, let’s not do that anymore.” Or, if they’re setting a step goal of 10,000 steps and they’re meeting 8,500, the likelihood is for a lot of people, they look at that and say, “I didn’t make my step goal,” when they should be saying, “Wow, I walked 8,500 steps. That’s incredible.” But the human brain doesn’t always do that and then it says, “Danger. You are failing. You are not succeeding. Turn around. Don’t do it again.” We see this regression of effort because of these perceptions of failure.

So, a big role of the coach is to set expectations that they can’t fail and to set expectations that any effort is progress. Whether you meet that arbitrary line you made up, whether it was 10,000 steps or 9,432, right, that’s somewhat arbitrary. What really matters to your brain for lasting behavior change is the effort that you keep putting in, the way you talk to yourself about that effort, and how much you promote your resilience and adaptability in life’s changing circumstances.

Dr. Sandi: I think that’s brilliant. It really resonates because I see it with people with their Oura Ring. I’m guilty of it too like, “Oh, wait a minute. I thought I was really well-rested. I got a lot of sleep, and it shows my deep sleep was off. What could that have been about?” And now I’m focused there. Whereas, if I didn’t have that data, it would be just I wake up, and I’m feeling refreshed, and I have the sense that I got a good night’s sleep. So, that can backfire, and that’s why working with a coach is so critical to help you to interpret the data.

We see that with direct-to-consumer labs as well. They get a result back. They’re Googling what this could mean. All of a sudden, they’re thinking that they have a life-threatening condition, and the coach can really help apply perspective and sometimes, for some of those people, to put it away.

Many years ago, when I was a psychologist, I specialized in biofeedback, and I was doing all kinds of biofeedback training, but there were some people where we had to turn off the computer. It was not right for them. And it was just guiding them through a relaxation process as opposed to seeing it on the screen where they’d say, “Wait a minute, why is my temperature going this way? Why do I have more muscle tension? I thought I was relaxed.” And now it gets in the way because now they’re in their thoughts, and they’re evaluating their performance, and that’s creating a stress response. So, what lies ahead? What lies ahead for you personally? What do you see for this field of health and wellness coaching?

Casey: Oh, it is a question I think about every day, Sandi. So, another thing to know about me is I am a lifelong learner. So, I decided to go back to school because I have an interest in taking applied behavioral science bigger and farther than it is today. So, I went back to school. I’m at Johns Hopkins University Bloomberg School of Public Health doing my doctorate in social and behavioral sciences with a goal to eventually re-enter the healthcare system. And actually, in my application to Johns Hopkins, I said, “Tell me one major healthcare system that has a chief behavioral officer and is helping to guide health education, health coaching programs in line with the evidence from behavioral science and all that we’re learning about behavior change.” There really aren’t any, maybe one or two that are exceptionally advanced or moving in the right direction, but they really don’t exist.

You look at major healthcare systems, and you see they have very traditional health education programs. A group of people come in, they provide a class. I am a health educator by training, right? I have my Master Certified Health Education Specialist training. I love health education, but it has its limits. I want to see health coaches in every major healthcare system across America. I want to see health coaches on every primary care team. I want to see health coaches everywhere because I believe in them. I believe that they serve such a pivotal role in supporting patients.

So, I’m doing this doctorate. That is my long-term goal. Right now, I started my own behavioral science and design consulting agency called Adapt Sciences, and I’m working with startups of various stages and healthcare clinics and systems do somewhat of what I just said, right? Think about their behavioral strategy. How do we help our patients, our clients achieve optimal health and well-being through behavioral science and design, building health coaching programs and such?

So, that’s what’s on the horizon for me. I’m really passionate and excited about it. Other than that, I’m planning to do some research to investigate actually the role of hope in behavioral weight loss interventions. Snyder’s hope theory is one that really interests me. It’s hope as a cognitive process, hope as a pathways thinking back to that conversation we were having earlier about adaptability, flexibility, and perceptions of failure, and the role that plays in helping people who have experienced failures over and over again. How do we design interventions that help them reignite that hope in a way that sets them off on a positive path? So, little snapshot of the things I’m interested in and where I’m going.

Dr. Sandi: Oh, well, I love, love, love that. The importance of hope. Hope is one of the character strengths in positive psychology that is most closely connected with good physical and emotional health. And I’ve seen doctors dash hopes, giving these sentences like, “Oh, you’ll have to be on this medication for the rest of your life,” or, “There’s no way that you can treat this condition. It’s just permanent.” And so many times when that just is like they’re doomed. That’s how they feel. And when someone gives them hope or not giving them hope, someone is in that process of talking with somebody where they find hope and they’re able to evoke that, it is so healing and it is just powerful. I mean, you can’t even quantify the power of that. And often doing group coaching is one way to do that. It’s where others, the power of the group can help to give them more hope.

So, yeah, well, your mission is absolutely my mission. We want to see that health coach belongs… I mean, I say health coach is the new primary care because it’s lifestyle medicine, lifestyle change first, and we need our doctors for that relationship and what you talked about earlier. We know, when someone has a consistent relationship with the doctor, who knows them, knows their family history, and their personal history, they’re going to be better taken care of. They’re going to feel supported and be able to make those changes more. But the health coach is the one who’s really their ally and by their side, and it’s accessible and it’s affordable.

Casey: It is all of those things. I will tell you, as someone who works in digital health, I build digital experiences. I still am holding on dearly to my care teams who I see in person sometimes and who I’m able to communicate with because of what you just described. It means a lot to me. And so the best digital experiences are the ones that do what they can in a digital format, and then connect people to other real people when and where it’s needed. You’re so right. Those relationships are really key and I believe in the power of people helping other people.

Dr. Sandi: Absolutely. Yeah. And our new models of care work for some of those acute care cut and dried. If you think you broke your toe and you go to an urgent care, that’s great. It’s specific. You get your diagnosis. You treat me. You know what to do. It could be a bot who is telling you that. You don’t need that interaction. But when you have type 2 diabetes, when you have an autoimmune condition, that is where you need that support. And the health coaches are so good at providing that on that care team. And they relieve the stress of the doctors as well.

Casey: Oh, my gosh, they do. They do. When I mentioned that longitudinal relationship, what that helps solve for is it’s an unfortunate situation, but many times people with chronic health conditions, they come in and a lot of assumptions are made about them, “Oh, they haven’t tried cutting carbs. Oh, they haven’t tried drinking more water. Oh, they haven’t tried this.” And so they end up getting lectured. They end up getting lectured for most of the visit. They sit there and nod their head, and they’re thinking, “Oh, I know this.” And when there’s that longitudinal relationship there who knows you, who’s learned about what you’ve already tried and what you haven’t and where you want to go, that’s so much more fulfilling, and the outcomes are always better, right, because what happens in the former situation is, when people come in and get lectured, and assumptions are made about them, they don’t leave feeling motivated. They don’t leave feeling positive about that experience or what lies ahead of them. They feel opposite. They feel uncared for, and that’s never what we want.

Dr. Sandi: No, it is not. Well, what we want is to stay connected to you. Casey, how can people find you?

Casey: Yes, yes, yes. I would love to stay connected. I love chatting with coaches, I’ll tell you that right now. So, feel free to reach out to me. Let’s grab coffee. That’s a big part of my world is just getting to know people working in the field and learning from each other. So, you can find me on LinkedIn, linkedin.com/in/caseyphughes. I recently started an Instagram. I’m Coach Casey H. on there. So, you could find me there. And then I have a website I’m slowly working on. I have two kids at home and working full-time school. It’s busy, but I mostly use LinkedIn to connect. So, I would love to chat with anybody and get to know you.

Dr. Sandi: Well, this has been an absolute delight getting to know you, and we will support your work. We’d love to have you back again to talk about your doctoral work and how that’s going or any other way that we can support you. So, thank you so much for being with us today.

Casey: Thank you so much for having me.