One of the major problems in medicine today is the
explosion of knowledge. A "coach" in medicine would
have a very difficult time keeping up with a single
speciality - hell, doctors have problems keeping up.
There is simply no way that a coach could keep up
(maintain efficiency) in multiple fields and remain
effective for the individual patient.
What would it take to be a coach? First let's have some
formal medical training. RN or PA would be a good
basic level to start with. Now let's add in some solid
experience actually working with patients, while
maintaining continuing education.
Then at some point they need to be trained to be a
coach for the patients. And some basic criteria also
needs to be established. Should the coach be totally
focussed on taking care of the patient, or will the
insurance companies get their nose under the edge of
the tent and ensure they indirectly run the programs.
Should a coach be required to get a license? Should
they specialize, or be restricted to the PCP level - or
both?
That's a lot of disruption. But then so is the flow of information that flooding into the hands of patients via
the internet. Talk about disruption and chaos.
This year’s hot economist is Dr. Clayton Christensen of Harvard Business School, and just in time for our health reform debate he has a book out on the health care market. (Amazon has it for 33% off.)
Christensen is famous for his idea of “disruptive innovation,” describing how and why new technologies impact markets.
Simpler and cheaper destroys by creating new markets among people who previously did not buy an industry’s product or by taking the low end of the market away from existing vendors.
Consider the PC. It was first seen as a cheaper spreadsheet and word processor, but eventually created a host of new markets. Companies rose, and fell, as new players “disrupted” the old game’s assumptions.
What does this have to do with health care? Plenty.
Christensen’s new book, The Innovators Prescription, applies his concepts to the health care market, and in the process casually dismisses medicine’s latest and greatest business model, the medical home.
I’ve called this the coach approach. You have a relationship with someone who gets to know you and becomes your advocate with the rest of the system.
Unfortunately, as Vince Kuraitis and David Kibbe noted recently at The Healthcare Blog, Christensen dismisses this in two sentences, saying giving the medical home role to physicians would mean “comingling business models.”
He’s right. My internist has too much training, and makes too much money, to spend more than a few hours per year on me. The numbers don’t work. And we’re so short on internists and other primary care physicians in any case it can’t work.
This does not mean that a medical home model for health care won’t work. If just means that the coaching role needs to be systematized. It needs to become simpler, so other people can take it on, and so patients can have a choice of coaches and coaching styles, with the coaches closely supervised.
Maybe the real model for doctors in this system is the NFL. Steeler coach Mike Tomlin didn’t get this team ready to play by himself. He had coordinators, and position coaches, and scouts — a whole infrastructure.
For doctors to justify their skills and pay in the 21st century they need to be head coaches, leading teams of people and not working alone.
