It’s been more than two years since President Obama signed his comprehensive healthcare reform into law. Most of the provisions under the Patient Protection and Affordable Care Act (ACA) go into effect in 2014, and here in Connecticut we are already seeing the implications of what promises to be a massive transformation of our healthcare system.
This new legislation will invest heavily in state and community-based efforts that work to improve public health, prevent disease, and protect against public health emergencies. It requires most U.S. citizens and legal residents to obtain healthcare insurance, and includes a number of provisions that target underserved communities. In other words, the Affordable Care Act strives to lower healthcare costs while making insurance more accessible to Americans of diverse racial, ethnic, and financial backgrounds.
But what does this huge paradigm shift in healthcare policy mean for Connecticut?
Here in our state, it is projected that between 120,000 and 140,000 previously uninsured people will become insured under this new law. A significant majority of this population’s current access to medical care is limited strictly to the Emergency Room. Many are suffering from chronic illness but are unable to afford the medical care that is necessary to aid in their treatment and recovery. This means that in 2014, we are likely to see a surge in the demand for medical care at all levels – including primary care, behavioral health providers, and specialists.
The bottom line is that physicians alone will not be able to respond to this increased demand on our state’s medical care. Nor will they be equipped to ensure successful patient outcomes in a system that is already constrained by ballooning healthcare costs and limited time for face-to-face interactions.
What are some of the solutions to these anticipated problems?
One potential answer can be found in the ACA itself. According to Section 4001, President Obama will establish the “National Prevention, Health Promotion, and Public Health Council.” The role of this council will be to provide leadership “with respect to prevention, wellness and health promotion practices, the public health system, and integrative health care in the United States.” This includes developing a strategy to promote preventative healthcare practices and incentivizing patient care so that doctors are rewarded for moving healthy patients in and out of the system, instead of reaping the insurance benefits of patients who remain embedded in a cycle of chronic treatment and lack of recovery.
Perhaps the greatest implication of the ACA’s commitment to wellness and preventative care is the rise of a new and vital occupation in the healthcare system – the Health Coach and Patient Navigator.
Coaching (i.e., Health, Executive, and Life) is one of the most rapidly growing professions in the United States and around the world. In fact, The U.S. Department of Labor’s O-Net (i.e., Occupational Trends) analysis of current market trends cites the vocation of coaching as a “red hot” (i.e., “high growth”) area that will sustain occupational growth over the next decade. Today, several thousand health and wellness coaches work in many diverse settings, including corporate wellness centers, health clubs, medical fitness facilities, hospitals, clinics, and private practices. This growing profession also includes the integration of coaching competencies into many existing health professions, including nursing, primary care, exercise and mental health intervention, and physical and occupational therapy.
Patient navigation, also a growing field, is an occupation of growing importance as more previously uninsured individuals enter the healthcare arena. Patient navigators serve an important role in guiding patients through an increasingly complex system – which includes everything from accompanying them on doctor’s visits to filling out insurance and reimbursement paperwork, to communicating with specialists and pharmacies to maintaining their health records.
Taken together, Health Coaching and Patient Navigation is a rapidly emerging field that facilitates sustainable lifestyle change, supports wellness and disease prevention, provides individual assistance to patients and caregivers to help overcome health system barriers, and enables timely access to quality medical psychosocial care. It connects the dots between two distinct practices – coaching and navigating – by encompassing the preventative aspects of patient care (i.e. wellness, nutrition, emotional, spiritual, and psychological health) and integrating them with the daily functions of navigating a changing healthcare system.
In addition to communicating on the patient’s behalf with physicians, insurance companies, and across all aspects of the patient’s network of care, the Health Coach and Patient Navigator will work with patients one-on-one to make behavioral and lifestyle changes that will ensure greater emotional, spiritual, psychological, and physical health. Here is a model where educating the patient becomes as important as treating the patient. Businesses as well as healthcare organizations will make a good investment by hiring health coaches/patient navigators who can work at the front end of keeping people healthy and insurance premiums low.
For those of us who have long been promoting the benefits of a more systemic and holistic approach to patient care, none of this should come as a surprise. However, rather than approaching integrative healthcare as supplemental to traditional healthcare, the ACA is finally demanding that hospitals and physicians be rewarded for making behavior, lifestyle, and wellness a core part of their approach to effective treatment. There is already evidence that the rise of this profession will contribute to decreased healthcare spending in 2013, according to the Centers for Medicare and Medicaid Services.
One thing is clear: when the dust settles in the aftermath of these huge structural changes, there is going to be a real need for certified health coaches and patient navigators.
Christi Holmes is a Connecticut Health Foundation Health Leadership Senior Fellow. Christi has worked with The Graduate Institute of Bethany, CT to develop the state’s first Health Coaching and Patient Navigation Certificate program. Enrollment is now open for the first session, which begins October 2013. For more information call (203) 874-4252 or visit www.learn.edu. Email Christi at The Graduate Institute at [email protected].