Sickcare to Healthcare

In review from my prior piece, we provided the hard data outlining the current “healthcare” misnomer, incongruity, and misinterpretation. As it stands, the United States “sickcare” equation is

Highest GDP + Most Resources spent on “Healthcare” = Highest Lifestyle Disease rate.

We detailed the varying levels of Preventative Care.

• Primordial
• Primary
• Secondary
• Tertiary

We concluded that there is a disproportionate amount of resources invested in the latter stages of disease care. We will theorize some alternative sustainable options to the current model. We will attempt to answer the question.

“How can we lower the lifestyle disease rate with the wealth of resources at our disposal?”

The first point of contact for Preventative Care is the Primary Care Doctor’s office. What tends to happen is.

Scenario 1

A patient ideally shows for their annual medical check-up and presents with:

- Higher than average fasting blood sugar levels

- Bloodwork shows their blood sugar marker level, A1C, is borderline “ok.”

According to the National Diabetes Association, An A1C of 5.7 or less is considered optimal and normal. A range between 5.8 and 6.5 is considered trending into high risk of diabetes or considered pre-diabetes. Anything past 6.5 is considered diabetes.

The Physician typically recommends “watching your diet and exercise more” and sends the patient home to interpret and act on the soft recommendation subjectively.

Scenario 2

The same patient returns either within the same year for follow up visit or a year later for the next year’s Annual Checkup and presents with:

• Higher than average fasting blood sugar levels
• An A1C closer to 7

The Physician, nine times out of ten at that point, will prescribe some form of first-line medication. A pill. The insurance and sick care machine kick into gear. The cascading effect is initiated. A second and even 3rd pill will be added to the regimen sooner than later, and then injectable insulins would be introduced and even further visits to a disease Specialist/Endocrinologist. An accompanying rising medical bill for the patient and taxpayers and an increasingly clogged and burdened medical system as a result.

What if that soft recommendation in scenario 1 had some structure and systems around it to emphasize “watch your diet and exercise more” a little more emphasis, practical, and impactful for the patient?

Solution 1

Increase the fitness reimbursement offered thru insurance companies.

The typical fitness reimbursement offered by most insurance companies is $200 per year. The one time Join Fee at the Local YMCA is $49, after which the monthly fee is $40. Past month 3 of the membership, you have maxed out your reimbursement. The $200 will be spent ten times over further down the line when the patient eventually becomes sick. Companies sourcing an insurance vendor for their staff are no longer forced to pick a from a terribly limited handful of legacy companies. Several Health Tech startups offer proper Preventative care that can be coupled with existing insurance offerings independently. If there were an opportune time to leverage for an increased fitness reimbursement by traditional insurance companies, it would be now. Spend the corporate dollars with the right “healthcare” startups.

Solution 2

Primary Care Office and Fitness Facility partnerships.

Incentivized partnerships between Local fitness facilities and Primary Care Clinics where both entities benefit from being affiliated. For example, If I get a premium membership at YMCA X, I have certain advantages at Clinic X in my zip code or vice versa. The soft recommendation in Scenario 1 should be replaced with a YMCA referral for an entry-level group class. After the Doctor’s visit in the early stages, the first point of contact should be an affiliated and accredited fitness facility, not the pharmacy, or at least both. Seven years of running a gym have proven to me that the General Public isn’t aware of the value of impactful variables like:

• Steps taken daily,
• Resting heart rate and heart rate variability
• NEAT, Non-Exercise Activity Thermogenesis (calories burned during non-exercise activity).

Solution 3

Inhouse Nutrition Classes at the Primary Care Office level.

How an in-house nutritionist is not currently a mandatory part of the supporting staff of any Medical Practice in the country with one of the highest obesity rates and the highest lifestyle disease prevalence is supremely baffling. I have seen it time and time again in the day to day running of my fitness space; the average person does not fully grasp nutrition as it relates to healthy and sustainable ways to manage weight. I encounter persons who jump from fad diet to fad diet, persons who under-eat, persons who over-eat, and persons who cannot discern the importance of food quality or the energetics of essential nutrition. This is half of the puzzle, the nutrition. Real-world basics like the following should be taught and reviewed within the Primary Care setting.

• Grocery shopping dos and don’ts
• Quality snacking
• Dietary tweaks
• Basic understanding of metabolism and the body
• Questions to ask on their Annual physicals
• What the results and terms mean on their Annual Physical results.

Solution 4

Overhaul Primary Care Doctor payment and boost their support structure.

The current system pays the Primary Care Doctor based on a service provided (Fee for service model). It requires as many “butts in seats,” meaning, for the Primary Care Physician to make a living; it requires a packed waiting room and a high turn over of patients seen by the Doctor per hour. What this has evolved into is

• High waiting room times for the patient to see the Doctor
• Increasingly less actual face to face/consult patient to Doctor time
• Physician burnout
• Patient reluctance to go to the Doctor for preventative check-ups and only to go when absolutely dire.

Suppose a Primary Care Doctor takes his time to genuinely consultatively care for a patient in his practice. In that case, his waiting room becomes overcrowded, patients become angry, and he makes less money. Though paid the least, the Primary Care Doctor is the first line of care for anyone that falls ill, and the system is currently set for their demise and, as a result, Joe and Jane Public’s demise.

There is a complete deviation in how the Primary Care Physician is trained to be proactive in the care of human health and how they are paid. These two counterintuitive acts need to be disconnected. Possibly:

• A team-based model of care where the Physician is part of a cohort. For example, Physician, Nutritionist, and Trainer.
• A tiered subscription-based model of sort puts the patient at different points of connection with their “cohort,” whether by email, text, zoom, or in person. The Health Providers have different avenues to be paid from, not just in person, and the patient has different points of contact with their healthcare team.

Solution 4 honestly should be listed as the first. Still, the Healthcare system overhaul in terms of Doctors’ reimbursement is a breathing entity on its own, and I didn’t want to get lost in theorizing and devalue the other solution proposals.

In closing, one should ask themselves,

“what is it I can do day to day to ensure I take ownership of my healthcare?”

The major takeaway points are simple.

• Educate yourself on food and nutrition
• Work towards incorporating some sort of fitness regimen into your lifestyle
• Ask your Doctor a ton of questions, be inquisitive about your Doctor's Visit and don’t just go when sick.

Be proactive in the true care of your health. You only have one.