Latest / CareTalk: Healthcare. Unfiltered. / Building the Future of Health Coaching w/ Eugene Borukhovich, COO & Co-Founder, YourCoach Health

Transcript

Building the Future of Health Coaching w/ Eugene Borukhovich, COO & Co-Founder, YourCoach Health · CareTalk: Healthcare. Unfiltered.

• 0:07
  John: Welcome to CareTalk, America's forum for incisive debate on healthcare policy, business and politics.
• 0:15
  John: I. Today our guest, Eugene Borukhovich of one of my old friends who's gonna tell us a little bit about the impact of coaching and the new insights he's found through the business he and his wife Marina, have founded in how to really drive the behavior change that all of us need to see in the healthcare system if we're gonna be move beyond a healthcare system that spends too much and does too little.
• 0:40
  John: Eugene, welcome and welcome to CareTalk.
• 0:43
  Eugene: John, great to see you and, uh, happy to be here on Care Talk.
• 0:47
  Eugene: I've been, uh, following the podcast show for quite a while.
• 0:52
  John: Well, and the great thing is since you shamelessly post everything you do, we will get some extra promotion regardless of how we do in this conversation.
• 1:00
  John: Um, absolutely.
• 1:01
  John: So, I, I, so, I, I, I'd, I'd love you to, you know, coaching is one of those areas where.
• 1:07
  John: People sort of poo poo it, uh, in the same or, or don't take seriously necessarily all of the, the human.
• 1:19
  John: Changes, uh, the behavior changes, uh, and hence the role of coaching counseling that could be critical to change.
• 1:30
  John: Um, that's why I'm so excited about you and your business and, and what your early results show.
• 1:36
  John: Patients, but maybe let's start, go back a little bit because I, I knew you as the, uh, as the healthcare IT guy who got us out of trouble or could build stuff from scratch.
• 1:47
  John: But maybe tell, tell, tell, tell our audience a little bit about how did you get here, where, where did you grow up, what got you into healthcare?
• 1:55
  John: Yeah.
• 1:55
  John: And, and, and then the arc of how you got there.
• 1:58
  Eugene: No, listen, uh, ab absolutely.
• 2:00
  Eugene: And by the way, when we did work together, I still had a lot of hair.
• 2:03
  Eugene: Uh, and I think to a certain extent healthcare, well, okay.
• 2:06
  Eugene: Not a lot, but I had, I had some, some hair.
• 2:09
  Eugene: Um, so very short, geographical, um.
• 2:13
  Eugene: Kind of frame here.
• 2:15
  Eugene: Born in Ukraine, my parents immigrated.
• 2:17
  Eugene: Um, so I'm a son of immigrants.
• 2:20
  Eugene: Uh, grew up in New York, New Jersey area, and, you know, spent half of my career at the time with A PBM and then, um.
• 2:29
  Eugene: We actually moved, uh, to Amsterdam now 14 years ago, and, uh, now been kind of hopping around Europe.
• 2:38
  Eugene: Uh, and you know, your coach is a
• 2:40
  John: but you were, but you were, but you were, but you were building digital businesses, helping digital businesses start when we worked together in New Jersey and then when you went to Europe to help us launch our European businesses.
• 2:51
  John: And so you've got a deep.
• 2:52
  John: Background in healthcare and, and, and healthcare technology for, and, and, and, and what I remember about you, Eugene, is that you, you were quite talented and, and, and creative with sort of a, a, a build from scratch that that did not intimidate you.
• 3:08
  John: Other folks were looking for sort of large tech or conventional solutions.
• 3:12
  John: You'd be looking for the innovative entrepreneurial ones.
• 3:15
  John: And so how did you get, I mean, that strikes me as a really good way to build a living.
• 3:20
  John: How did you end?
• 3:22
  Eugene: Um, yeah, so let, let's fast forward through all of that and, and, and indeed I love building from zero to one, one to 10, you know, 10 to a hundred.
• 3:31
  Eugene: Uh, I, you know, self admittedly, I'm not the, you know, the incremental innovation guy, right?
• 3:38
  Eugene: Um, but let's back up.
• 3:40
  Eugene: Uh, this was almost a decade ago, uh, and I was actually still spending.
• 3:44
  Eugene: I was still working, um, you know, with a large pharma company where I was doing quite a lot of digital therapeutics.
• 3:51
  Eugene: And so again, a big believer in interventions that are driven, you know, software driven interventions, um, and just, and my wife just explain to
• 3:59
  John: the audience kind of what a, yeah, but maybe slow down one second.
• 4:01
  John: Sorry to interrupt.
• 4:03
  John: What is a digital therapeutic?
• 4:05
  Eugene: Yeah, so a digital therapeutic, think a bit, think of this as a digital medicine.
• 4:10
  Eugene: So instead of swallowing a pill, you're actually using your iPhone or any other, you know, digital device to take a load of medicine.
• 4:19
  Eugene: And again, there is a Digital Therapeutics Alliance.
• 4:21
  Eugene: That's actually great news for everybody.
• 4:23
  Eugene: It's been merged into the A TA American Telemedicine Association, so together.
• 4:29
  Eugene: You know, they are in Washington, DC and kind of making sure that both telemedicine as well as digital therapies, and by the way, digital therapies can be along with the molecule in a drug or standalone intervention as well.
• 4:43
  Eugene: So that hopefully that explains digital therapies.
• 4:46
  Eugene: But for, for, for those, for those that don't.
• 4:49
  Eugene: I've actually had three seasons of a Digital Therapeutics podcast, a shameless plug with some founders there.
• 4:57
  Eugene: Um.
• 4:59
  Eugene: So digital therapy.
• 5:00
  Eugene: So I was, I was, you know, uh, helping, uh, get those off the ground with working with a number of startups.
• 5:06
  Eugene: Um, you know, if I rewind even a little bit further back, so my wife Marina, she is my boss in real life and now in business.
• 5:13
  Eugene: Uh, she was diagnosed with breast cancer 10 years ago.
• 5:17
  Eugene: Uh, went through that crazy, crazy, crazy time, you know.
• 5:22
  Eugene: You know, obviously as an individual, but we as a family and upon her recovery, you know, and this is her words, you know, she thanks the healthcare system and the medical community for saving her life.
• 5:34
  Eugene: But when everybody said, you're good to go, in her own words, she said, I was the most broken I've ever been.
• 5:41
  Eugene: And that's how she discovered health coaching.
• 5:43
  Eugene: She became a health coach herself.
• 5:46
  Eugene: Uh, she started practicing with, uh, her clients.
• 5:50
  Eugene: Given what we just talked about, you know, my health tech background, um, I kind of said to Maureen, I'm like, well, you can't manage your business, you know, one with WhatsApp, one with, you know, uh, Facebook Messenger, et cetera.
• 6:02
  Eugene: You need a platform to manage your business.
• 6:04
  Eugene: Um, and so that's how your coach was originally born.
• 6:08
  Eugene: Uh, but at the same exact time as we were spinning it up.
• 6:11
  Eugene: We saw that American Medical Association together with the National Board of Health and Wellbeing Coaching, uh, issued level three for our listeners here, those test codes, um, that the EMA issued, that means that I.
• 6:27
  Eugene: It needs more data to move them to level one, at which point health coaching could become reimbursable
• 6:33
  John: and, and codes.
• 6:34
  John: JI mean, just, yeah, just to be clear, the, that what you're talking about is the arc of of progress in terms of taking a novel idea.
• 6:42
  John: I. That may or may not help patients figuring out a way to test it before it becomes something that A, that a, that a licensed provider could then charge, um, Medicare, Medicaid, and commercial payers to reimburse.
• 6:59
  John: But maybe, maybe you could little deeper, because I know Marina felt this very personally, she felt broken.
• 7:04
  John: But normally isn't, isn't now the, the time at the end of a, an illness.
• 7:09
  John: And obviously I'm asking a rhetorical question.
• 7:11
  John: I. Lauren, as you know, went through this as well.
• 7:13
  John: Yeah.
• 7:14
  John: Uh, what, what did the healthcare, what did the healthcare system not provide that it should have provided?
• 7:21
  Eugene: Yeah.
• 7:22
  Eugene: Um, and to be frank, we actually were living in Amsterdam and got unbelievable health.
• 7:28
  Eugene: Uh.
• 7:29
  Eugene: Services surrounding it.
• 7:30
  Eugene: Um, you know, as the Dutch said, uh, we don't advertise it as well as Americans, but we're really great at it.
• 7:37
  Eugene: Um, and it was more around the recovery and it cost a hell of a lot less.
• 7:40
  Eugene: And yeah, and it cost a lot less.
• 7:42
  Eugene: And I think for, for many of the listeners, uh, that know that, you know, we rewind back.
• 7:47
  Eugene: Obamacare was supposed to be really modeled against the Dutch system.
• 7:51
  Eugene: I know the Obama administration at the time actually spent quite a lot of time in Netherlands, and then it got kind of.
• 7:56
  Eugene: Sort of butchered along the way, but, but that's, uh, we're, we're not jumping into the politics just yet.
• 8:03
  Eugene: Um, and, you know, I think on, on her recovery mode, uh, sh they wanted her to see therapists and her comment around it was that I actually don't want to navigate therapy and go back in time.
• 8:16
  Eugene: I actually wanna.
• 8:17
  Eugene: Face the future and work on my physical and mental health.
• 8:20
  Eugene: And a lot of that was outside of, uh, you know, outside of therapy that typically starts going backwards and then starts looking forward.
• 8:30
  Eugene: There was nothing else available, right?
• 8:32
  Eugene: And so she kind of became the health coach herself.
• 8:34
  Eugene: But
• 8:34
  John: you're on a really important point, Eugene, because cognitive behavioral therapy, which is the convention, uh, you know, non, um, drug non, you know, d not, not, not.
• 8:45
  John: Pharmacy supportive therapy is typically one where you do go back and you explore, uh, uh, elements of your psychology.
• 8:54
  John: I'm not gonna get into it 'cause neither of you're qualified there.
• 8:57
  John: Whereas coaching is typically, and people should think about a sports analogy here.
• 9:04
  John: It's where you're, it is, it is focused obsessively on today and tomorrow.
• 9:10
  John: And what, what tools support.
• 9:14
  John: Systems can that, that you need to actually take advantage of to, to optimize today and prepare for tomorrow.
• 9:22
  John: And that is a very different approach than the conventional healthcare system, which is either, it's either fixed or, or, or, uh, uh, or, or, um, I guess, uh, rear view, mirror oriented.
• 9:37
  Eugene: And I would also, one key thing is, you know, a healthcare system is prescriptive and it is prescriptive for a reason.
• 9:43
  Eugene: You know, health coaching is a nonclinical profession.
• 9:46
  Eugene: And by the way, just to rewind back, it's been around for 20 odd years.
• 9:50
  Eugene: It's only in the last six or seven because of the lack of.
• 9:56
  Eugene: Uh, you know, clinical staff just in our system, uh, because of lack of preventative measures, only in the last six or seven years we've actually been seeing studies upon studies of health coaching interventions across the continuum of care, right?
• 10:11
  Eugene: And this is exist.
• 10:13
  Eugene: You know, if you look at health coaching, um, and, and how it uses, actually, interestingly enough, similar techniques as therapy, right?
• 10:21
  Eugene: It's cognitive behavioral coaching.
• 10:24
  Eugene: Uh, it's using a motivational interviewing.
• 10:27
  Eugene: It's using, you know, aspects of trans theoretical model of change.
• 10:31
  Eugene: Um, but this is, you know, in a way, again, to your point, it, it is looking very much forward and I, I would say preventative in a way.
• 10:40
  Eugene: You know, how can I help myself stay consistent?
• 10:42
  Eugene: How do I, we all know what we need to do on a daily basis, right?
• 10:47
  Eugene: It's how do we stick to that routine and what's the psyche behind it?
• 10:51
  Eugene: Why.
• 10:51
  Eugene: Right.
• 10:52
  Eugene: Um, so that's, you know, that's a big component.
• 10:56
  Eugene: And again, the industry has been here, but we've seen kind of resurrection of it, if you will.
• 11:02
  Eugene: Um, which is, you know, I think part of the A-M-A-C-P-T codes in 2019 was still a little bit.
• 11:09
  Eugene: You know, far away in our belief system, probably another couple of years as the studies come out.
• 11:15
  Eugene: But the positive thing is also, and I'll pause after this, is CMS and let's see where, where it goes with the new administration.
• 11:24
  Eugene: But CMS also included a health coaching pilot against those same three codes in the physician fee schedule in last year and into in 2025 as well.
• 11:34
  Eugene: And,
• 11:35
  John: and for Medicare and just to be.
• 11:36
  John: Yeah.
• 11:36
  John: Yeah.
• 11:37
  John: And just to be clear, the Center for Medicare Medicaid studies, uh, or uh, the Center for Medicaid Medic Medicare and Medicaid studies these issues and generally looks to prevent new codes to, to restrict, right, right.
• 11:51
  John: 'cause of the, the, all of the cost pressures.
• 11:54
  John: Um, but you touched on something a couple of paragraphs back, Eugene, that I think is really important over the next.
• 12:00
  John: 10 or 15 years, we're gonna be about a million clinicians short relative to the doctors and the nurses we need.
• 12:09
  John: And that's because of the, a appropriately deep education and practice that's required, the limited number of schools and universities and colleges that provide those nurses and doctors and, and the expected current and expected restrictions on immigration.
• 12:27
  John: And yet the aging of the American.
• 12:30
  John: Population.
• 12:31
  John: And so one of the interesting things about coaching a registered dietician is these lower of bottom of the pyramid licensure, where it's a lot easier to engage, get trained, and support, actually may provide some ability for us to manage some of the needs because I don't, I think we're still just scratching the surface of what some of the, the, the, the, the, uh.
• 12:58
  John: The just as talented but less licensed labor could potentially do to help us potentially change the arc of chronic disease and suffering in America.
• 13:09
  John: Maybe you could talk a little bit about that and why we should be both.
• 13:13
  John: I. Potentially optimistic about recruiting more people to help us get healthier and what should we need, what we need to worry about.
• 13:21
  John: What might be the risks there about increasing the role of coaching in healthcare?
• 13:26
  Eugene: Yeah, and, and I know I said this before and we're very, very clear.
• 13:30
  Eugene: You know, health coaching is not there to replace doctors and nurses, right?
• 13:34
  Eugene: Everybody has a role and unfortunately, you know, in our healthcare system, I as a patient have only.
• 13:42
  Eugene: Eight minutes to visit my doctor, right?
• 13:44
  Eugene: And I get a, some kind of a care plan, and then I go back into my normal life that has all the stressors and all the things that just, unfortunately I start falling off my care plan now.
• 13:57
  Eugene: So I think this is a workforce that is well-trained, trained, but.
• 14:03
  Eugene: You are one of few people that actually know what health coaching is.
• 14:06
  Eugene: If I go out on the street and ask 10 different people, I will get 10 different answers because health coaching is still an unregulated profession.
• 14:14
  Eugene: Yes.
• 14:14
  Eugene: There's a National Board of Health and Wellbeing coaching that is setting standards that it has now something like 150 plus schools accredited.
• 14:24
  Eugene: For health coaching, and this is undergrad, graduate, and continued education schools.
• 14:29
  Eugene: But we very strongly believe, and this is a bit of our uniqueness in the model, is that we also need real world data on how these coaches are really doing in quote unquote, in the wild, right?
• 14:40
  Eugene: And that's part of our platform.
• 14:42
  Eugene: And we have now 4,000 plus coaches practicing with their own clients and we're adding that extra level of validation and verification
• 14:49
  John: and, and just maybe double click on that, Eugene.
• 14:52
  John: Yeah.
• 14:54
  John: What's a client like?
• 14:55
  John: Who?
• 14:55
  John: Who would hire you to do what?
• 14:57
  Eugene: Yeah, so typically our coaches bring their own individual clients.
• 15:01
  Eugene: They use our platform, right?
• 15:03
  Eugene: And they charge whatever they want to charge, and we leverage a lot of the data to understand, and we track coaches across 16 or 17 categories, everything from heart health to mental health.
• 15:13
  Eugene: You know, women's health, name it.
• 15:15
  Eugene: And leveraging that data we get, we contract with the best of the best coaches where our revenue stream comes from our clients.
• 15:23
  Eugene: We're about 75% of our business is a white label solution.
• 15:28
  Eugene: These are companies that range from.
• 15:31
  Eugene: Digital therapeutics companies.
• 15:33
  Eugene: So again, self-paced content, whether it's validated by FDA or not.
• 15:38
  Eugene: Um, we have, um, cons direct to consumer companies.
• 15:42
  Eugene: So think of like intermittent fasting.
• 15:44
  Eugene: Um, as, as a, as an example, we have medication adherence companies.
• 15:50
  Eugene: Again, these are mostly software type of companies that realize that they need a human in a loop, uh, to help these individuals with their behavior change along the way.
• 15:59
  Eugene: That's about 75% of our business.
• 16:02
  John: So what you're creating, just to put it in my words, is a tech enabled platform that connects that, that qualifies, connects, and supports the.
• 16:15
  John: Pretty massive growth in individual coaching.
• 16:18
  John: Yeah.
• 16:18
  John: Across a number of different domains to connect those coaches to largely digital health companies that need to your point, a human in the loop to to perform that human connection and coaching that they otherwise wouldn't be able to do because their expertise is software, clinical data or a particular angle on how to.
• 16:40
  John: How to innovate through digital means, but ultimately that depend on some element of either human connection, communication, or change, and that's how they integrate.
• 16:52
  John: Coaches, is that the right way to think about your plat, about your your coach platform?
• 16:55
  Eugene: Love it.
• 16:56
  Eugene: Uh, absolutely.
• 16:57
  Eugene: And I think we're gonna cut that and use that as our ad from now on, John, so thank you for that.
• 17:04
  Eugene: Uh, but I wa I wanted to also, uh, kind of add, so this was sort of our.
• 17:08
  Eugene: Phase one, you know, go to market as we scale.
• 17:10
  Eugene: We're now navigating health plans.
• 17:12
  Eugene: It's almost like a headless health coaching, um, service as well.
• 17:16
  Eugene: Um, and we are servicing employers direct through brokers as a mental health support
• 17:22
  John: and, okay, so, so now we understand that coaching can help.
• 17:26
  John: It's a different approach than therapy, that you provide the platform, you've got some experience.
• 17:33
  John: What's been the experience of your customers and does this stuff work?
• 17:38
  Eugene: So, uh, we, you know, perfect timing.
• 17:40
  Eugene: Just, uh, literally in the last couple of weeks, we, uh, we went back and randomly selected 150 individuals from all the opt-in transcripts.
• 17:50
  Eugene: Uh, so n equals one 50.
• 17:52
  Eugene: Uh, and yes, it's retrospective and yes, it's observational, but we ran.
• 17:58
  Eugene: Um, you know, the, the, the, this data through and basically the results are honestly exceeded our own expectations, even though we're, we know it's working.
• 18:09
  Eugene: This is, uh, we selected individuals with two or more sessions and typically individuals have a session, and this is a live session, voice or video, um, you know, within, you know, two, within a month or one a month.
• 18:22
  Eugene: Right.
• 18:22
  Eugene: And we didn't, uh, differentiate there.
• 18:25
  Eugene: So two sessions, and within the two sessions we saw average across the 150 individuals, almost an 18% reduction in GAT seven.
• 18:35
  Eugene: Uh, so this is the anxiety and stress score.
• 18:38
  Eugene: Uh, we also measured resiliency, which is another measure called RAC eight.
• 18:44
  Eugene: Uh, RAQ eight, and that increased almost 11%.
• 18:48
  Eugene: The one interesting part, and we've been talking about behavior change through this, um, now 63% of those individuals moved along that trans theoretical model of change.
• 18:59
  Eugene: So from, say, contemplation to action.
• 19:01
  Eugene: As an example, and there's a breakdown of that.
• 19:04
  Eugene: So we saw, you know, honestly, tremendous results.
• 19:07
  Eugene: And this is, you know, I, I think for some of the listeners with a clinical intervention, which could include a drug, uh, you know, a therapy, the kind of, the typical, what we see on average, the, the anxiety and depression scores can go down between, you know.
• 19:23
  Eugene: 20 to 50%, and that's with a clinical intervention.
• 19:26
  Eugene: So with this nonclinical intervention, uh, and again, retro aspect, retrospectively we saw an 18% reduction in just two sessions.
• 19:35
  Eugene: So this is working.
• 19:36
  Eugene: Um, and then, you know, lastly, because we're sort of this white label solution, we're also seeing much higher engagement with either the core content.
• 19:47
  Eugene: 73% of all the users because our coaches see other benefits that are available on the content.
• 19:53
  Eugene: 73% of the individuals were contextually recommended.
• 19:58
  Eugene: So this is not coaching, pushing it, it's as their needs arise.
• 20:02
  Eugene: So, you know, I can use the example of, um, you know, I just need to have my pet surgery and I'm working for an employer.
• 20:08
  Eugene: Well, if there's pet insurance available through the employer, and again, it's very contextual.
• 20:12
  Eugene: This is not something that coaches are.
• 20:15
  Eugene: As their core.
• 20:16
  Eugene: Right.
• 20:16
  Eugene: Which is an important piece of this.
• 20:18
  John: And, and, and so Eugene, do people, do companies need to find you or do individuals need to find you?
• 20:23
  John: Like how does this actually, how do you get, how do you go to market?
• 20:28
  Eugene: Yeah, so we don't do direct to consumer.
• 20:30
  Eugene: Um, you know, we are working through our white label partners and this is, you know, quite a lot of.
• 20:35
  Eugene: Inbound and it is a relatively small community and, and grows and, and word of mouth is working because, you know, our model is working.
• 20:42
  Eugene: And, uh, we are also working with brokers and employers direct as well.
• 20:48
  John: Awesome.
• 20:48
  John: And so maybe as a, as a final question, Eugene, where do you think this can and should go?
• 20:54
  John: What would you like to see?
• 20:56
  John: What would you like to, where would you like to see the market and how would you like to see the market respond here?
• 21:01
  Eugene: Yeah.
• 21:01
  Eugene: So I mean, look, um, the way I look at health tech startups, you can have a product market fit, uh, which we do.
• 21:09
  Eugene: Um, but we also need any startup in health tech also needs like a system product fit, right, if you will.
• 21:17
  Eugene: And you know, I think from perspective of prevention and behavior change, which we've been talking about.
• 21:22
  Eugene: That's a check check.
• 21:24
  Eugene: Um, you know, the urge here to the community and to the decision makers within that system is obviously around the reimbursement and you know, that focus on that human being.
• 21:37
  Eugene: Can I. Be there between your AI chatbots and the clinical staff.
• 21:42
  Eugene: That's just, you know, we talked about the shortage and this is, uh, a human workforce that is here, that's trained, uh, that is empathetic.
• 21:53
  Eugene: And you know, if you talk to many coaches that get into this, they're truly there to help, just like most of the doctor and nursing community.
• 22:03
  Eugene: So it's a perfect system fit.
• 22:05
  Eugene: Minus still the reimbursements.
• 22:07
  Eugene: And so we're, we're looking forward to CMS progressing the pilot and seeing where that lands.
• 22:13
  Eugene: And we are hearing that even some commercial plans are now starting to reimburse against those T codes because they're seeing benefits of this.
• 22:23
  John: So we, you, you basically want the system to embrace what we, what you believe is already.
• 22:28
  John: Working and could change the system.
• 22:31
  Eugene: And we strongly believe that anybody and everybody can use a coach.
• 22:36
  John: I, I, I don't, I I, having just come back from the Yukon, the, the parade for the Yukon Women's, uh, basketball team with Gene built around a, a, a 12 repeat national champion, gene Orma.
• 22:51
  John: I, uh.
• 22:52
  John: Uh, I couldn't agree more.
• 22:53
  John: So that's it for Care Talk.
• 22:55
  John: If you liked what you heard or you didn't, we'd love you to subscribe on your favorite service.
• 22:59
  John: And thank you, Eugene, for joining us.