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New Products Can Help Our Field, But Be Wary of Market Forces
Therapy substitutes are fine in moderation. Yet they can proliferate in certain business climates and gradually crowd out traditional services. We are in the early stages of this today. Everything from cognitive behavior therapy (CBT) exercises to mindfulness practices are available on digital platforms. Similarly, behavioral problems of every sort are being broken down into small, achievable goals for coaching services.
Convenient, low-cost services may improve care access and yet also distort our field in some ways. Do we want our field dominated by partial (i.e., inferior) solutions at scale with lower costs? Who benefits from such growth? It is typically not our core programs and clinicians, but more likely entrepreneurs, investors, and the big companies that acquire startup ventures.
New digital and virtual products are valuable and should be integrated with our traditional services. However, beware of market forces. Consider the anxiety within health systems today. Innovative startups have given way to big technology and retail companies that are now focusing on healthcare and competing for market share with health systems. The HIMSS 2022 meeting noted this:
The digital health competitive landscape is shifting rapidly, and more than one-third (35%) of health system executives now see large tech companies like Apple, Microsoft and Google as their highest competitive threat. Providers are also feeling the pinch from retail care providers as 23% of executives identified these companies, such as CVS, Walmart and Walgreens, as competitive rivals.
We can follow the pathway to this competitive threat. Digital and virtual products arose as isolated capabilities. We then saw the rise of virtual-first healthcare services, meaning that primary care providers (PCPs) were seen in their offices after a virtual contact, if at all. When every major health plan began to offer virtual-first products, it was clear a new threshold had been crossed. Traditional services were under attack.
A similar path has been taken by retail care providers. Nurse practitioners were first credentialed in the spirit of expanding access for simple healthcare services. Nurse-in-a-box retail operations were low-cost, convenient alternatives. Now, CVS owns a national health plan, and retail care is expanding its services. Once a service model is established, it beckons for new types of services to be added.
This is a business issue, not a moral one. Entrepreneurs are guided by noble goals and intentions as they pursue convenient, lower-cost healthcare alternatives. Those with capital can help expand such alternatives to more people. A field’s leadership must analyze consequences. Leaving everything to the outcome of competition in a free marketplace is nothing more than a strategy of hope.
The risks and rewards of digital technology have been well dissected, and so it may be more useful to examine the path behavioral coaching is taking. We have long had coaches focused on disease management and health improvement. We now have people getting credentials to coach explicitly in the area of behavioral health. They support people in attaining specific behavioral goals.
If encouraging people to achieve small goals seems far removed from therapy, consider the claims by new behavioral companies like Ginger. Their professional coaches, credentialed by ICF or NBHWC, offer “new labor pools to overcome the shortage in licensed providers.” These coaches can “support emotion management, challenge support relationships and communication skill-building.”
No need to worry they are treating behavioral health disorders, right? They just “apply tools to reduce stress, anxiety, and depression.” If you are confused about the difference, then you get the marketing point. These well-intended efforts to rectify our labor shortage could cannibalize therapy, leaving us, at worst, with mostly low-cost, quasi-professional staff. The field would be transformed.
Consider the state of primary care, specifically, US versus global investment in it. While PCPs in our country face an erosion in their practices due to competition with retail clinics and virtual care products, other wealthy nations have long invested twice as much in primary care services as this country. This heavier use of primary care is thought to be one of the key drivers of their superior health outcomes.
We need lower-cost options. Substitutes for therapy help people. However, we must actively shape our field’s future and not just leave it to market forces. Those forces may rightly target cost concerns, but they could chip away at the importance of therapy and therapists. PCPs have seen this—primary care is in crisis and many solutions constrain them to lesser roles. We are far from this but should remain wary.
Let us solve care access issues in a way that preserves the foundation of healthcare, namely, trusted professional relationships. It is tempting to disassemble therapy and sell its component parts at lower cost—a technique here, a coaching strategy there. Yet we can innovate and keep our foundation intact. Let us not follow in the footsteps of primary care and find ourselves in a fight to save our field.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
References
Ginger. Making mental health part of your DEI strategy. Accessed May 20, 2022.
