The health coaching shortage

Former Duke CEO Ralph Snyderman, now heading up a start-up called Proventys, was the featured speaker for the second day of the Emory-Georgia Tech Predictive Health Symposium,

Listening to him for an hour one word kept creeping into my mind.

Coaching.

Snyderman's topic was "putting personalized medicine into practice."

He talked about reimbursement mechanisms, how most efforts by hospitals to stress wellness run into the fact it loses money.

He described how Duke put together a Prospective Health Plan for its employees, cutting nearly $30 million per year from its expected costs for health care over three years, while increasing patient satisfaction.

He also talked about integrating Electronic Medical Records (EMRs) with Personal Health Records (PHRs), and "having patients understand that their health is their responsibility."

But the key person in all this is what he called a "Health Navigator." It could be a doctor, a nurse, or someone else, an advocate to the system with access to your PHR with whom you have a trusting relationship.

In other words, a coach.

Snyderman said the biggest savings we can make in health care lie in identifying people moving from risk of disease to an early chronic condition, and coaching them on how to deal with it.

Patients who get such coaching not only live longer, they cost the health system less. Proper diet and exercise can do a lot to reduce hypertension which leads to diabetes, dialysis, stroke and premature death.

"We don't need to wait for genomic medicine to provide answers," he said. "We can do it already. We can practice in a more prospective way right now."

All that's needed are personalized health plans, transportable PHRs, and a wellness coach, he said.

This caused me to think again about our recent story on alternative medicine, and how so many practitioners, like my own chiropractor, want to be coaches and activists for healthy patient lifestyles.

What they lack, mostly, are access to PHRs and the trust of the medical community. They want to coach, but the profession's gatekeepers won't let them into the game.

During the question period, one gentleman did note that some doctors do perform this coaching role. Pediatricians act as coaches for their young patients. Gerontologists act as coaches for the old.

Once, family doctors did both these roles, and cared for adults. But there is a growing shortage of such physicians, and costs must be cut so there may not be money in the budget for us all to have a physician-coach, as Snyderman noted.

It's ironic. A professional conference dedicated to making others break down their own walls -- insurers, government, hospitals -- may have found that the key to progress lies in breaking down its own.