What Preventative Care Looks Like
It may come as a surprise, but I have been thinking a lot about 44 year old women recently. This seems like an odd confession for a 30 year old male, but I swear it is for my job.
For more than two years, I have been having a recurring conversation with my business partner, Richard, about how to create a business where an individual has a comprehensive health coach. Not a primary care provider ("PCP") as they exist today, but someone that approaches the person's life with a wide angle lens that is set toward prevention rather than treatment. Someone that looks at wearable device data, diet, fitness regimen, medical history, genetic baseline, and environmental factors to optimize the person's health and assist in selecting the right providers and best health and wellness products.
The lifeguard is the equivalent of the average primary care provider. Waiting to respond to a situation because that is what the healthcare system calls for.
What we have today is a treatment based system where primary care providers act as reactive lifeguards, rather than preventative swim coaches . Given a choice, I know I would choose a swim coach that empowers me to swim in open waters, over a lifeguard on duty sent in after I am drowning.
Richard’s and my conversations have gone a number of directions over many iterations. However, there were a set of underlying assumptions that we got wrong. The erroneous assumptions were that the swim coach was absent from most families and that the swim coach is primarily a commercial venture. This is not true.
Anyone running a home health practice or your primary care provider will tell you that the swim coach more often than not is a woman, likely in her early to mid-forties. She:
The swim coach in the current healthcare system tends to be a women coordinating care for her family. What more can be done to help aid them and gear them towards prevention?
- likely has a career;
- often has kids;
- likely makes the doctor appointments for the kids;
- is responsible for filling out all the health forms for school;
- significantly consults or manages numerous aspects of her parents' elderly care;
- is conscious of what the family eats and often chooses where the family eats; and
- is not a medical professional.
In short, she is the self-taught swim coach, learning the finer points of any given stroke (diet, exercise, pharmacology, diagnostic medicine, elderly care, etc.) in the water, often in choppy or heavy seas.
The 44 year old woman, in my mind, is trying to stay on top of all aspects of care for her immediate and often extended family in the face of innumerable time constraints. She is trying to maintain her own health and wellness. She might practice yoga, hit up a cycling class, or go for early morning jogs before the kids run off to school and she heads into work. The constraints on her time are considerable.
For the more affluent, concierge medicine may offer support to the family’s swim coach. In most cases, the patient, independent of age and gender, subscribing to a concierge medical practice is buying convenience and access to care. The average primary care provider in this country has about 2,300 patients; while the average PCP within a concierge practice has 300 to 600 patients. As such, wait times for appointments are getting longer for those not seeing a concierge physician. The amount of time spent with the patient and the swim coach is truncated as well.
The future of healthcare in a PCP’s office will be the nurse practitioner helping to mitigate the time constraints and bring down patient wait times. However, this does little to empower patients and swim coaches to be more proactive and geared toward prevention. Knowledge acquisition still has to come elsewhere.
Services like Teledoc and Healthcare Magic, which give the healthcare consumer remote access to medical professionals to answer questions, are a start but falls short in presenting an integrated answer. I personally am a fan of what Richmond, Virginia-based fitness app Nudge is doing, integrating data capture with access to health, fitness, and wellness coaches. However, the remote coaching / doctoring assumes a base level of knowledge of the healthcare consumer that ask the right set of questions and established a defined goal or outcome.
For those swim coaches handling aging parents and their corresponding growing need for assistance, home healthcare businesses offer assistance. However, there is still a lot of time that goes into acquiring said help through an agency. That is time away from family, work, and that daily yoga session. There is no dominate DIY analog like OKCupid or Uber for those seeking home health providers in their ever chaotic lives. Businesses like CareFamily.com are working on this DIY model that will bring more choice and control to the swim coach and family, while lowering costs in yet another facet of consumer healthcare.
Complementary and alternative medicine companies offering products to lower stress, increase immunity, and assist in prevention and treatment regularly market to the 44 year old woman. The time constraints often make products such as essential oils, prebiotics and probiotics, and various supplements attractive to the family swim coach. Yet, efficacy and quality of these often undifferentiated products are frequently called into question. Once again, a burden of education is placed on the healthcare consumer independent of gender and age.
How does the private market fix this? How will individuals, entrepreneurs, and healthcare providers respond with coordinated and profitable solutions? I for one am excited to see where this goes and hope to play a part in finding solutions to some of these questions. After all, women have played the role of the de facto swim coach for some time. It would be great to give them some help, so they do not have to simultaneously learn and teach the strokes (diet, exercise, pharmacology, diagnostic medicine, elderly care, etc.) in those choppy waters.
While I pose more questions and criticism than answers here I am not down trodden or being a contrarian. Rather I hope the readers take this as a call for dialogue, brainstorming, and discourse. I welcome comments, questions, quandaries, ideas, and discourse. Drop me a line at:email@example.com.
 Analogy liberally borrowed from CrossFit founder Greg Glassman, who said "Physicians are lifeguards. Trainers are swim coaches. When you need a lifeguard, you need a lifeguard...if you need a lifeguard, then you probablyneeded a swim coach and didn't get one." See:https://www.youtube.com/watch?v=6YPeiodLpoA.
 I recommend taking a read through Ezekiel Emmanuel’s Reinventing American Health Care. It provides a nice overview of historic forces influencing the current healthcare system and how policy and the private sector are shaping the future of healthcare in this country.
 It also is intermittent care, where the coach or doctor might not have a breath of history or be incented to do a deep dive with that individual on his/her history and goals.
 The level of training and quality of screen vary by home health agency, price points, etc. Some services require little or no training and clearing of a simple background check.
 For more on quality control in the dietary supplements industry check out the following article: http://well.blogs.nytimes.com/2015/03/09/safety-of-herbal-supplements-pulls-prosecutors-together/.