The Evolution of Primary Care


In the next five years, expect your primary care visits to look very different than they do now. Your primary care experience will likely involve more time and attention from your healthcare team. In today's healthcare climate, that seems to be wishful thinking, but there are several drivers that I believe will contribute to this unexpected trend. Several key areas are fueling the need for a much more robust and meaningful primary care experience:

The Rise of Chronic Disease

We have seen volume in our healthcare system increase exponentially over the years because of the rise of more and more chronic disease in our society. "Chronic diseases and conditions—such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis—are among the most common, costly, and preventable of all health problems. As of 2012, about half of all adults—117 million people—had one or more chronic health conditions", according to the Centers for Disease Control (CDC). Health risk behaviors are behaviors that contribute to disease that you can change. Four of these health risk behaviors—lack of exercise or physical activity, poor nutrition, tobacco use, and drinking too much alcohol—cause much of the illness, suffering, and early death related to chronic diseases and conditions, per the CDC. In fact, they note that eighty-six percent of the nation’s $2.7 trillion annual health care expenditures are for people with chronic and mental health conditions. The current model of treating chronic disease is too costly and too little time is available in primary care visits to address the lifestyle factors that are driving disease. Telling patients what they need to do is not enough. Sharing the consequences of not changing lifestyle is demotivating and demoralizing to many patients. Change is extremely hard without adequate support.

Patient-Centered Care

Intuitively, everyone in healthcare knows that patients are the most important part of the equation of care. But, as patients, do we always feel that our wellbeing is a focal point of our care? I greatly value and appreciate the time I spend with my healthcare providers. I'm thankful for their expertise, their insight and their compassion. I appreciate that my provider takes a personal interest in what's wrong with me. And as expected, generally, my visits focus around just that- what's wrong with me. And I'm thankful that when something is wrong, I can reach out to my provider for their help. But who can help me ensure that I'm doing the right things for my health day-to-day? That I'm doing the things that minimize my health risk. Clearly, there is a missing link with what actually happens on the many days, weeks and months between primary care visits. Many of those decisions fall within my own sphere of influence, not my provider's. And honestly, I don't think those should fall within my provider's sphere of influence because he or she needs to attend to other patients who have things wrong that need to be fixed immediately. 

Time Constraints and Healthcare Provider Burnout

Which leads me to my next point- a provider's time is much more limited now. So much has changed in terms of administrative, management and leadership responsibilities for providers in the last 10 years. This challenge became especially apparent with the inception of the electronic health record (EHR). For providers, this adds an administrative layer to their responsibilities that is not only time-consuming, but also has providers scratching their heads as to how to get it all done. Do they park their computer between them and their patient to collect the EHR on the spot and risk the ever-present physical barrier to patient care? Or, do they spend 10+ additional hours a week at home catching up on patient records, when they really want to be with their families? I, for one, don't prefer either scenario. I want a provider who is thriving. When he or she thrives in their life, their patients will thrive too. I want a provider who is present during my visit, but also one who is present for the things that matter to them when they're away from their work. Current estimates show that burnout affects over 60% of primary care physicians according to the American Medical Association.  Healthcare provider burnout is a growing problem that affects the quality, safety and efficiency of patient care. Providers need greater support in the clinical setting to accomplish the excellent care of the patient. 

A New Breed of Healthcare Professional

There is a new type of healthcare professional that is evolving and rising up to help meet the chronic disease challenge. Meet the professional Health and Wellness Coach- the new face you will begin to see as part of your healthcare team within the next five years. According to the International Consortium for Health and Wellness Coaches (ICHWC), Health and Wellness Coaches partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being. In the course of their work, Health and Wellness Coaches display unconditional positive regard for their clients and a belief in their capacity for change, and honoring that each client is an expert on his or her life, while ensuring that all interactions are respectful and non-judgmental. ICHWC is ensuring a new standard of professionalism and competency with professional Health and Wellness Coaches through a new credentialing process that now recognizes a coach as a National Board Certified Health and Wellness Coach.

When you reach out to see a primary care doctor in the future, you will most likely be connected early on in that process to a professional Health and Wellness Coach who will work with you to, first and foremost, co-create your health and wellness goals based on your unique vision for health. They may even conduct much of the new patient intake process at the practice. You will most likely see your Health and Wellness Coach at each of your primary care appointments, and even stay connected with them even between your visits through phone, video chat or instant messaging. Your Coach will have the time to support you in changing your lifestyle, because that is their primary purpose. They will celebrate your accomplishments with you and inspire you to use your strengths to reach your full vision for health. Your Coach will connect you with the resources you might need to make the changes you desire. Your Coach will focus on what's right with you, while your doctor focuses his/her expertise on fixing what might be wrong when those times come. 

And from a cost standpoint, the entire healthcare system wins because Coaches are a much more affordable option for contributing to the overall management of chronic disease. Coaches support a primary care practice in many ways that can reduce burden on other providers- from scheduling, new patient intake, medical records, education and follow up. And finally, because chronic disease is fueled by lifestyle factors which require sustained behavior change, Health and Wellness Coaches represent one missing link in the chronic disease care equation. They are the experts who have the skill, time and knowledge to support this behavior change process. Research also shows that Health and Wellness Coaches, as part of the healthcare team facilitate greater trust between patients and their providers. 

Early outcomes for research on integrating Health and Wellness Coaches in primary care models are promising, demonstrating the value of health coaching in terms of improved clinical outcomes, which persisted one year after the completion of the health coaching intervention. The study's author encourages primary care clinics to hire Health and Wellness Coaches to equip and encourage patients to self-manage their chronic diseases. 

So, prepare to meet your new Health and Wellness Coach during a future visit to your primary care provider and get ready to create your very best health yet!