Healthcare is a disaster, and coaches and fitness professionals are the best possible solution. In this video, I’m going to explain to you why healthcare is a disaster, how it got that way and why coaches are the perfect fit to solve the problem.
It all starts with the way that doctors are paid. And we’re talking about doctors who are managing musculoskeletal pain, so issues with joints, ligaments, tendons, muscles. The reason why, the way that those doctors are paid is a big part of the problem, is because the reason that people enroll in the schools that allow them to have the licensure to treat patients; chiropractic schools, physical therapy schools, medical schools, massage school, those schools all attract students with the promise of a reasonable certainty of financial return upon graduation. What that means is that people don’t just become doctors because they want to help people. Certainly that is a part of the reason. The other part of the reason is because they believe that it’s likely if they become a doctor, they’re going to be able to make a good living doing it.
What happens next is we look at how doctors are paid. Doctors are paid by insurance companies based on their ability to help their patients reach what are called A-D-Ls. ADL stands for activities of daily living. Examples of ADLs are your ability to go to work, your ability to sleep through the night, cook food, drive your car. The way that ADLs are measured is your deficiency from what is considered normal and your ability to do them.
So maybe you should be able to sleep through the night without waking up at all, for an example. The doctor would write into the notes that you are currently only able to sleep for 30 minutes at a time due to the pain that you’re having. That sets the baseline for how the insurance company decides how many visits they expect you to need before you no longer need care because they have evaluated millions upon millions of cases, just like the patient in question. And they have algorithms that let them know based on how the incident occurred, how long a person’s been dealing with the problem, what the severity of the problem is, what interventions they’ve had in the past, they know about how many visits they think it should take to resolve the problem.
What happens now is the insurance company will allot your chiropractor or your physical therapist X number of visits based on their algorithmic math. What the doctor now has to do is treat the patient within those visits or ask the insurance company for more visits, which by the way, makes it appear is if the doctor is less efficient to treating patients than their peers. So what actually ends up happening is doctors ask for less visits because they don’t want to get slapped on the wrist by the insurance company and told that they can’t have patients come to them for payment without extensive documentation of what’s going on because the insurance company wants to understand why they’re so inefficient.
What happens next is doctors are accountable to helping their patients achieve ADLs, like we described before. So once the patient has achieved their ADLs, the doctor will no longer be paid. And if it takes the doctor too long to help the patient achieve their ADLs, the doctor will be inundated with paperwork and eventually cut off anyway. So it’s in the doctor’s best interest to see the patient as few times as possible to get into good standing with the insurance company who’s cutting them the checks.
The problem is many of the patients who walk into the doctor’s office, aren’t actually there for ADLs at all. They’re there for what we call ADIs, activities of daily interest. Schools who educate the students, who come through them to become the licensed professionals, are counting on those students becoming licensed professionals who will get paid by the insurance companies. What that means is instead of teaching those students how to treat for ADIs, activities of daily interest, they are teaching their students how to treat for ADLs, because that will be predictably paid for by the insurance companies in the professional world on the backside of their education. After all, nobody is going to take out 150 to $300,000 in student loans if there isn’t a reasonable expectation that they’re going to make that money back after they get the education done.
So what ends up happening? What ends up happening is there is nobody whose job it is to help you get back to the things that you’re interested in. Once you can go back to work, sleep through the night, change the channel, drive your car, insurance companies stop paying. So schools only educate their students largely to get their patients to be able to do those things. Sure, there are elective classes and there are some schools that go above and beyond, but we’re talking about the rule here, not the exceptions.
So schools are teaching their students how to get their patients back to their ADLs; driving their car, going to the bathroom, sleeping through the night, doing their job. Doctors are taught to stop treating the patient after they’ve achieved their ADLs. But your interests lie, your client’s interests lie in being able to lift heavy weights and being able to run five miles at a time and being able to play pickup sports on the weekend and being able to play with their kids and chase them around the yard and being able to go fishing. No one’s teaching doctors how to help patients with that problem. The unfortunate opposite side of this is that coaches aren’t really taught how to help people with that either. So whose problem is it really?
We believe at Active Life that while medical professionals could be retrained on how to do this for their patients, that is the wrong place for us to be focusing. Medical professionals, doctors are the people who should be there to restore one’s ability to regain access to activities of daily interest. It’s the coach’s job to be able to take the client, who just finished being a patient all the way across the finish line. No insurance company is going to reimburse a doctor who says that their patient feels fine, except when they’re dead lifting over 200 pounds. No insurance company is going to reimburse a doctor who says that their patient is fine, except when they run five miles or more. No insurance company is going to reimburse the doctor when their patient says, “They’re fine,” unless they’re throwing the ball as hard as they can.
These are things that do not classify as activities of daily living. They classify as activities of daily interest. Therefore, they will never fall into the purview of the medical professionals. The best people in the world to grab this slack and do something of meaning with it are coaches. The problem that coaches are facing today is that the amount of education that a coach has is so variable. It could be a textbook and a test. It could be a weekend seminar. It could be an extensive course load. No matter what it is, there is a wide array of inconsistency that is there. And most coaches who are getting the certification are doing it either by the textbook variety or by the weekend certification.
Most coaches don’t know the difference between the function of the gluteus maximus and the gluteus medius. But these are things that they need to know if they’re going to be able to help their clients bridge the gap between ADLs and ADIs. Most coaches aren’t even educated on the various planes of motion; frontal, transverse, sagittal. So they don’t know how to address problems that only exist in one, but not the other two.
At Active Life it’s our ambition to humanize the doctor, professionalize the coach by providing them this education, and empower the individual by affording them the opportunity to go to a doctor who has been humanized, who understands that their role is to help with ADLs and then refer to the coach whose job it is to help with ADIs, so that the individual can get the outcomes that they want. I believe that we can fix healthcare if we start looking at it for what it is, incentivizing people who need education to be able to fill in what it is not, and that’s our mission.