By William Appelgate, PhD
Set in 2054, Steven Spielberg’s science fiction masterpiece Minority Report depicts a landscape where homicide is no longer punished because it doesn’t occur. Instead, talented staff, hi-tech systems, and advanced procedures are in place prevent it (albeit with the necessary theatrical flourishes and always just in the nick of time.) Prevention is the focus of society’s intention.
The U.S. has the most advanced healthcare system in the world, relying on a similarly sophisticated combination of staff, systems and procedures. It has collectively developed the capacity to fix, heal and restore broken health like no other nation. However, the per capita cost of this sick care system is high, very high—in fact, the highest in the world.
One powerful contributing factor in this incomparable high per capita cost is an approach to health that is essentially pathogenic. Healthcare professionals are commonly trained to fix the ill, the sick and the broken. Add to this dilemma a reimbursement system that rewards the volume of fixes rather than either prevention or outcomes and one end of the proverbial teeter totter bangs to the ground.
Frankly, much of the U.S. healthcare system evolved in a manner that depended primarily upon the progression of chronic conditions. This story line is authenticated by facts. More than 80% of health care costs are spent on individuals with chronic conditions, and nearly 80% of those costs come from inpatient admissions and ED visits.
It is time to change our intention. The pivotal transformative approach needed is to shift the focus of healthcare to factors that support human health and well-being rather than on factors that cause disease. Quite the opposite of pathogenesis, this approach termed ‘salutogenesis’ considers each individual along a continuum, more or less healthy rather than more or less ill. Taking individuals where they are and engaging them on a path toward health is a challenge upon which the healthcare system has seldom focused, but must now exploit as a golden opportunity.
How do we mitigate the predictable trend toward increasing health risks and decreasing health status as society ages? Our health behaviors and environment shape major portions of our health risks and health status. If we can maintain health (prevent deterioration, often considered ‘zero trend’) or ideally build it among whole populations, dramatic cost savings and improved quality of life are the inevitable result.
The supporting transformative approach is to consider individuals as capable, build patient-centric processes, and activate patients to reclaim accountability for their own health futures. When healthcare professionals are trained to partner with patients, coaching them to positive health behaviors and active self-care, the patient takes that knowledge and motivation with them. To their bedrooms, bathrooms, and kitchens, where most healthcare is actually delivered. Engaged, accountable self-care. And the results of that care delivery transformation can be profound.
The Iowa Chronic Care Consortium is committed to transform healthcare and believe that the best way to accomplish that is by dramatically improving the communication between caregiver and patient. We created the Clinical Health Coach training curriculum to do just that, by: 1) transforming the conversations between healthcare professionals and patients—developing communication and coaching skills to engage and activate patients toward new levels of self-care and prevention; and, 2) transforming the care processes — aligning evidence-based practices with patient-centered resources to facilitate health-building behaviors.
It is no surprise that the Patient-Centered Medical Home is an ideal arena for these significant transformative processes to evolve—improving the health of whole populations, one person at a time. Can the U.S. healthcare system evolve from its present sick care practices to a health-building system that focuses on prevention? Yes, but only if we recognize patients as the greatest untapped resource in healthcare and make prevention the focus of our intention.