Healthcare is broken – there’s no system in the world that’s keeping up with the surge of chronic diseases. The only way to fundamentally change this is to broaden how we think about healthcare and how it’s delivered to people. That’s why this paper in the journal NEJM Catalyst by Dr. Kevin Volpp and Alisa Camplin-Warner is so important. Dr. Volpp is the Director of the Penn Center for Health Incentives and Behavioral Economics and a Professor of Medicine and Health Care Management at the School of Medicine and the Wharton School of the University of Pennsylvania, and Camplin-Warner is a two-time Olympic medalist in skiing. The two make the case that we can improve health outcomes by using the lessons of elite athletic coaching. The key now is democratizing those lessons so that we can scale them and have the widest impact on health outcomes that are so urgently needed.
For Volpp and Camplin-Warner, the elements of the elite sport playbook we can apply to healthcare include focusing on purpose, goal planning, learning from setbacks, building better habits, leveraging social networks and creating an environment that sets us up for success. “Could working with health coaches become a standard approach to help high-risk patients to embrace positive health goals and achieve positive health outcomes?” they ask. Yes, but that will require a “shift in mindset that recognizes that to be proactive in preventing disease, health systems need to place more of an emphasis on helping patients identify and then work toward the achievement of their own goals.”
That’s clearly not the system we have now. As Volpp and Camplin-Warner write, the U.S. currently ranks first in per capita healthcare spending (at $12,318), but last in life expectancy in a group of 11 peer countries. As they note, patients are expected to figure out which medical resources they need or what they need to do to stay healthy. A recent survey by CharityRx found that 65% of Americans turn to Google for health advice — but only 40% find online health information reliable. People want to be empowered to take charge of their health, but currently they’re being forced to, as the authors put it, “swim upstream to improve their health.” In this system, clinical visits are the central focus. But as we say at Thrive, health is what happens between doctor visits.
“The U.S. healthcare system is not set up to steer and support patients practically, mentally, and emotionally to achieve their personal health goals,” the authors conclude. One solution, they argue, is giving ordinary people the same tools that are routine for elite athletes: attention not just to strength and conditioning but to psychological needs, encouragement and feedback, and, crucially, support in creating “repeatable life skills.”
What would that look like at scale? The core of Thrive’s behavior change platform is Microsteps – small, science-backed actions that we can incorporate into our daily lives to build healthier habits. Likewise, Volpp and Camplin-Warner write that coaches break down goals “to a point that the first levels of goal achievement are almost guaranteed.” Or, as we say about our Microsteps, they’re too small to fail.
A large part of the paper focuses on routines and habits. As the latest science shows, our genes account for less than 10% of our health outcomes. It’s our daily behaviors that have the power both to prevent disease and — together with life-saving drugs and medical treatment — optimize the management of disease. But as the authors note, forming new habits is challenging. Here, however, the lessons from coaching also apply. “Just as athletes train to improve and ingrain better habits, so should anyone wanting to achieve a new outcome that requires certain types of behavior and ongoing effort,” the authors write.
Athletes don’t just magically create those routines and habits. They’re supported by coaches who use the principles of behavioral science to set them up for success. That means techniques to reduce decision fatigue, lower stress, and recognize emotional needs. “We should always be asking: Is there a way to make the healthy choice the path of least resistance and more automatic?” Volpp and Camplin-Warner write.
In a patient context, this would mean finding ways to “reshape the patient’s day to decrease friction. For example, heading straight to the gym after work rather than going home first.” Or “temptation bundling,” like making a plan to go to the gym with a friend to make sure there’s something pleasurable in the process. And “trigger and response” — for example, putting medications and a water glass next to a toothbrush. This is a version of a behavioral concept behind many of Thrive’s Microsteps: habit stacking – adding a new habit to an existing one, like thinking of three things you’re grateful for while brushing your teeth.
Another major pillar for Volpp and Camplin-Warner is social support. “It is difficult to succeed alone,” they write. “Historically, the health care delivery system has been configured around a clinician-patient relationship that typically does not invite or may not easily allow others to participate.” And yet we know that creating healthier daily behaviors is deeply connected to social support, which is why community is one of the core elements of Thrive’s platform.
Dr. Volpp is also the scientific lead on the Food is Medicine initiative, a program of the American Heart Association, with support from the Rockefeller Foundation, exploring ways to use food to improve health outcomes. (You can read a recent report on the project, co-authored by Dr. Volpp, here.)
What’s so exciting about this moment is how many elements of the same core principle — using the miracle drug of behavior change to improve health outcomes — are coming together. And AI is going to dramatically accelerate this movement. Because healthcare is not a product – it’s a way of living.
As Volpp and Camplin-Warner write, “While achieving Olympic-level performances is not a realistic goal for most people, achieving the highest possible level in terms of health and health behavior is both high stakes and attainable....each of us can attain elite levels of health without any restriction on how many people can achieve success at once.”