Time to Stop Problems Before They Start: Online Behavioral Health

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By Eve Phillips (Co-Founder & CEO, Empower Interactive) The biggest chunk of US healthcare spending –- about 75% -- is on individuals with chronic diseases: issues like diabetes, obesity, heart disease, lung disease, and high blood pressure. And the majority of those illnesses are directly related to individual lifestyle choices.

Yet, instead of helping teach people how to make better choices about stress, food, smoking, and exercise, our healthcare system has focused on treating people after they’re sick –- the much more expensive option. While those efforts are very important, wouldn’t it also make sense to try to avoid those outcomes in the first place?

There are currently a number of companies –- large and small –- exploring ways to inform, incent, and educate consumers on their healthy choices. Innovators are working with consumers, employers, insurers and providers with systems to increase awareness of healthcare spend, incentives to make better health choices, and education on best practices to make long-lasting behavior changes.

Below is a review of a sampling of the initiatives in these areas –- many of which are led by female co-founders.

  • Inform -- Before we can solve these problems, consumers (and their employers) must be made aware of them. A new crop of companies is illuminating the cost of healthcare and providing tools to individuals to make better health and spending choice.Startups like Cake Health (founded by Rebecca Woodcock) and Simplee aim to provide better mechanisms for consumers to manage healthcare expenses. Another company, Castlight Health, offers a solution to employers that provides employees with more price transparency when selecting providers and procedures.As an example, Cake Health, by resolving the security, integration and user experience challenges, provides an easy-to-understand interface to your healthcare expenses by both integrating into leading insurer websites and providing mechanisms to upload documents directly into their site (much like Mint.com does for your financial accounts). If you’ve ever logged into your insurer’s site, you’ll be very pleasantly surprised by the UI on the Cake Health site, which actually provides insight into what your expenses are and where your money is going.
  • Incent -- While it would be nice if, for each individual, better health was its own reward, often we respond much better to changing behaviors if social and gaming incentives are provided to direct our decision making. To that end, a number of companies are providing services that enable individuals to structure incentives to help them change their behaviors. One such startup, HealthRally, will be launching soon to provide consumers directly with an application to get and stay motivated to reach their goals.
  • Two other examples focus on providing incentive tools for employers to offer to employees. HumanaVitality, a joint venture between Humana and Discovery Holdings, lets employers offer points-based rewards systems for healthy behaviors.

    The startup Vivecoach (co-founded by Jennifer Gill Roberts) works with employers to let employees and families establish healthy personal and group challenges. Vivecoach has combined innovative gaming and social technologies to let organizations create challenges for employees around healthy behaviors. In a recent engagement, their customer Brocade ran a 500+ person challenge and saw a 97% completion rate amongst participants and 200 of the individuals met the challenge’s goal of 30 minutes of activity for 14 days. The challenge’s “Wall” received more than 600 posts from participants. Using their unique blend of social and incentive features, Vivecoach made an important impact on employee health.

  • Educate -- While awareness and incentives are key to helping individuals decide to engage in healthier behaviors, a third area, education, is often needed to help them do so successfully.
  • Changing behaviors –- as anyone who has tried to eat healthier or stop smoking knows -– is hard.

    However, there exist evidence-based techniques that can successfully help people learn how. Many of these techniques are based on the widely-tested psychotherapy methodology called Cognitive-Behavior Therapy (CBT), which helps people learn to recognize and change distorted thinking and behaviors.

    Since CBT is based on teaching concepts, its translation to an e-learning format is a natural fit. Using online CBT tools can drastically improve their cost and scale.

    The challenge in this space, however, has been delivering these evidence-based approaches in an easy-to-use, engaging format. New companies and projects creating online CBT tools for a wide variety of behavioral and mental health issues are taking on these challenges.

    Empower Interactive, the company I co-founded, provides these services for sufferers of stress, anxiety and depression. Empower’s clinical evidence shows our software, combined with a reduced amount of talk therapy, can achieve the same reduction in depression symptoms as a full traditional talk therapy experience, with just half the clinician hours.

    Other innovators in the space include Dr. Ricardo Munoz at UCSF who developed an online smoking cessation self-help programs and Dr. Barr Taylor’s Student Bodies program at Stanford for eating disorder prevention.

These approaches have exciting potential for changing the cost trajectory of our current health system. And while they may take on different aspects of driving behavior change, they are all focused on the same target: the individual. Creating easy-to-use, engaging and effective solutions in each of these areas is not easy, but the rewards for the companies, our healthcare system and the individual for being successful will be huge.

We would love to hear from readers of this blog the online tools and techniques that they have found useful in getting healthier and happier.

Editor’s note: Got a question for our guest blogger? Leave a message in the comments below. About the guest blogger: Eve Phillips is the Co-Founder & CEO of Empower Interactive, provider of online service for managing stress, anxiety and depression. Previous experience includes software strategy and product management (at eCert, Chirp, Zazzle, Microsoft, and Trilogy), and technology investing (Greylock, Vector, Amadeus, and Inflection). Eve holds a B.S. & M.Eng in Computer Science from MIT, and an MBA from Stanford. Follow her startup on Twitter at @empowerco.