On the Health Record — Interview with Eugene Borukhovic, Co-Founder of YourCoach Health

Eugene Borukhovic is a healthcare industry veteran, holding roles that run the gamut from big pharma leadership to digital health startup executive. In this episode of On the Health Record, he breaks down his extensive career history as well as his exciting work with YourCoach Health. You can find the whole podcast here, or you can read the highlights below.

Tell us a little bit about yourself and how you got where you are today as the chief operating officer of YourCoach Health as well as advising digital health companies.

My career up until now was born out of an entrepreneurial bug and a digital health bug. I spent nearly a decade at a pharmacy benefit management company called Medco. Eventually I took a new role with them abroad in Amsterdam to drive their international expansion from an information technology perspective. I was the CIO for their international consulting and digital health for a little over a year.

Then I got to see this entrepreneurial side a bit, and I’ve never looked back. I’ve also previously spent some time in the entertainment and financial industries. To me, however, the healthcare industry is probably the most rewarding because you’re helping individuals to better their health at the end of the day.

After all my time winding between various startups and big pharma, I began working on YourCoach Health. I joined my wife about a year ago on that journey.

What can you tell us about YourCoach Health?

We’re a very early stage company, but I’ll tell you a little bit of the background. My wife [Marina Borukhovich] went through breast cancer while we were living in Amsterdam. Luckily, all is well, but one of the things she realized is that while the healthcare system helped tremendously, they forgot about part of her mind, parts of her body and her soul. She went through everything including chemo, mastectomy and radiotherapy. Marina eventually became a health coach herself and started practicing.

Then we assembled the gang together with Dan [Kogan, Chief Numerati at YourHealth Coach] and decided that you can’t do this on a piece of paper. You need a good practice management solution to manage it. There were a few options out there, but nothing as modern as we needed. While we were developing some components of that system throughout, we officially launched as YourCoach Health in January 2020.

At the core of it, YourCoach Health is a practice management solution for health and wellness coaches to bring on their clients and manage their relationships, as well as create programs and manage everything from tasks to communication.

On the front end, we’re honestly experimenting with a number of revenue streams and models to see what sticks at these early stages, but we’ve been able to get over a thousand coaches on the platform. We did all that in about a year, and we’ve been loving every moment.

Where does health coaching fit into health care and the whole workflow there?

Health coaching as a field actually has been around for 20 years or so. It is a science-backed, behavior-driven way to help you as an individual understand and reach your goals. Despite existing for so long, some of the legitimacy really started coming in towards the end of 2019. That was when the AMA, the American Medical Association, basically announced it as a nonclinical member of a healthcare team and even released some test CPT codes and reimbursement codes for health coaching. These test codes aren’t reimbursable yet, so there are alpha testing in veteran affairs and many other places.

I also think that the term “health coach” requires some extra clarification. When we say “health coach,” we mean a certified health and wellness coach. There’s a standards body called the National Board of Health and Wellness Coaching. They’re a nonprofit organization that qualifies everything from schools to certifications. In order for a health coach to ultimately be reimbursed, they would need to have their national board certification, which is not easy. There’s maybe about 4,000 to 5,000 coaches with that certification to date. We like to say that it’s not necessarily a doctor, but a doctor can certainly go and get their health and wellness coaching certificate.

Likewise, a health and wellness coach is not a dietician, but a dietician can get a health and wellness coaching certification. In fact, I even decided to go through a program which is called Wellcoaches that normally lasts 18 weeks. We did it in nine weeks just because we went online during COVID, so there were more lessons per week. I suppose I would summarize a health coach as a non-clinical psychotherapist, and it takes a lot of empathy and listening. It’s a lot of listening to people, understanding and diving in with lots of questions because the reality is the answers are all in you, as an individual, always.

Would you say the healthcare system has been missing that kind of empathy or listening piece?

Well every doctor has their own bedside manner. We’re all individuals at the end of the day, and there are other factors at play. For example, digital health has plenty of good to it, but I think part of the challenge as we’ve been digitizing the healthcare experience is that the patient-doctor relationship has disappeared. It’s hard to build those relationships regardless when doctors are seeing 40–60 patients a day. Nurses are also there in the hospital setting to help, but at the same time, they’re also doing a lot of administrative work on top of all the patients they see.

Ultimately, we do believe that the healthcare system has been missing some empathy. However, now I think we’re starting to see the health and wellness market and the healthcare market are coming together much closer. We’re seeing health coaches helping patients understand and reach their goals. The two worlds are coming together much closer in the last two or three years.

Where do you think the digital health industry is at in 2021? Tell me about the technology being used in the industry.

First, I’ll rewind back just a few years. Every industry needs a buzzword, and digital health was it. I think everybody packed so much stuff into it. Eventually the industry matured, the models have kind of been figured out, but some of these companies started falling into their own places. To me, it’s very much in how you either digitize or optimize existing processes. How do you enable better communication? On the other side, if I look into pharma, even some of the AI tools and drug discovery were bundled into digital health. Time marched forward, and this influx of startups and companies that pitched ideas across the board across the value chain started falling into place.

Now, I think digital health as a term is actually, in my opinion, starting to disappear, and there may even be sub-segments that are starting to appear. For example, I’m doing a whole podcast on digital therapeutics. That’s a very clear definition and a subset of the overall digital health.

I’ll say the AI chat bots that are servicing primary care markets are not really even AI chatbots. To me, they are a communication tool that fell into place for patients to get quick routing to the right set of specialists on the other side of it.

More succinctly digital health has evolved. It’s no longer enough to just have an idea and one person in a garage working on a tech solution. You’d need to be a very cohesive team with different credibilities and backgrounds. There’s not just investment now; we’ve seen IPOs in the space.

You’ve advised digital health companies, and you’ve mentioned a few emerging technologies like digital therapeutics and even the chatbots. What are a few of the most exciting emerging technologies to keep your eye on in 2021 and moving forward in the industry?

I’m a huge fan of the continuous glucose monitors even though those have been around for a while now. I’ll extend that out to other FDA approved, or in some cases depending on the country, prescription-only monitors of your biological activities. Those will move towards being used on a more mainstream level for performance optimization of individuals.

Secondly, I think we’ll see more clinical validation around self-help tools. Specifically, digital therapeutics are seeing continuous growth, and I’d even call out a company like Happify Health that’s doing great work in the DTx space.

I also think some of those insertables that will actually be monitoring our biological data, and perhaps, at some point, they’ll actually stream into a DrChrono platform for doctors to make sense out of it all.

I think those are three. The theme is all around our own human biology because there’s still so much unknown to it, but we’ve been capturing data inside of our bodies more and more now. I think this is the next frontier, because we’re finding some business models around it now.

What are the trends that concern you the most not just in digital health, but even health care in general?

You may not like my answer, but my cup is always half full. I always try to find the positive in any situation. Obviously we don’t want all of this to turn into Black Mirror. Though I generally believe that more good than evil comes with technology, I do have some concerns around individuals in this world burning out. There’s a mental health crisis that is already hitting us hard, but I think people also forget that you don’t need fancy technology for that. I think something to remember is when you don’t hear from a friend for a long time, just pick up that FaceTime video or whatever works and reach out.

Thank you for that answer because I was actually just going to ask you about your thoughts on the dangers of physician burnout.

Physician burnout is absolutely an issue, but I think we are all human beings, including physicians. Everyone is struggling right now. Even your delivery driver for Uber Eats is literally risking their life as well on the front lines with the crisis. There are folks who don’t know when their next paycheck is coming, and this is happening around the world. It’s not just about physician burnout; it’s a much wider mental health issue.

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