The Center for Medicare and Medicaid Services (CMS) is the single largest payer in the US healthcare system. So when CMS changes what they agree to pay, or how they pay, whole sections of the healthcare services sector get created or destroyed.
Nandan Rao, Chief Executive Officer of Starlight Healthcare, shares, "In November 2023, CMS made a massive statement in support of preventive and lifestyle medicine: they announced that starting in 2024, they will now reimburse the services of certified health and wellness coaches. And not only will they reimburse, they will reimburse well, the fees came out more than 50% higher than we were expecting."
Why does this matter? The US healthcare system has previously invested heavily in reactive solutions to problems while neglecting spending time and money on prevention. "Spending time and money now for future benefit is preventive," and Rao shares, "while everybody has understood the importance of prevention for a long time, and everybody wants money and energy to go into prevention, it has historically been very hard to actually build a business focused on preventive care."
Until now. Because when CMS agrees to cover services, commercial insurance plans follow suit. This means that most Americans can now have their very own personal health coach, someone they can consult with every month to improve their health habits, entirely covered on their insurance plan.
"Think about this," Rao suggests, "most people in our country have never had a personal health coach that they work with on a regular basis to improve the way they eat, sleep, exercise, or manage stress. And yet, most of those same people will go on to develop a chronic condition that could have been prevented by modifying those lifestyle factors. CMS setting aside a massive pot of money for health coaching shows that they believe the mounting evidence that this is a cost-effective solution to the problem."
Starlight Healthcare is building out the first 50-state solution to take advantage of that pot of money by offering nationally certified telehealth coaching to anyone in the country while accepting all major health plans, including Medicare. Within months of launching their new venture, they already have large health systems on both coasts of the US that have agreed to launch pilot programs that refer patients to Starlight's care team.
Loral Patchen, research director for MedStar Health, a Washington DC-based health system, says that the pilot she has launched with Starlight grew out of her interest in finding ways to support patients outside of the healthcare office:
"In the office setting we don't have the time or the ability or frankly even the training to be able to work with an individual to say, 'so here's the goal and how do you reach it? And what do you do around it?'" Patchen explains, "So there's a real gap in terms of seeing someone as a patient and making recommendations, and then actually talking about things that would help them achieve their health goals when they walk out the door."
Patchen goes on to further explain the importance of coaches being part of the community they serve and understanding the cultural context of their patients, "you see numbers anywhere from 50 to 80% of healthcare outcomes are related to factors that are outside of the clinical environment. It's the social and environmental drivers of health. So if social and environmental drivers of health account for up to 80% of health care outcomes, we better hurry up and get out of the healthcare system if we really want to impact lives. A health coach is going to be much better at supporting people in navigating and problem-solving around social and environmental drivers."
Starlight Healthcare's solution helps large healthcare providers take care of patients at home with the winning combination of culturally competent human coaching, hiring from the communities they serve wherever possible, and technology to support it. They keep track of their patients' health remotely and help them stay healthy with behavioral experts who keep patients motivated, empowered, and engaged.
"Healthcare systems love our solution because building tech-enabled remote services from scratch is expensive, and it aligns with the direction the healthcare system is moving toward-preventing health issues before they become an issue."
Instead of the healthcare system having to figure out how to do this themselves, the team at Starlight Healthcare does it for them as their partner. "We can help take care of their patients at home after they leave the hospital. And we can prevent them from coming back with problems by taking care of them proactively, remotely, virtually and by keeping them engaged and adherent."
Building those capabilities is both costly and challenging. "Rather than invest and do that whole shift themselves, we're coming in and saying, Starlight Healthcare can be that proactive, preventative side, that remote, behavioral engagement for your patients. We can be your partner."
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