Transformation Requires Reinvention
By Mike Eisenhart, PT
The health care environment is changing, and it seems increasingly clear that there is no going back. Although none of us knows exactly how the landscape will look when we get to the end of this journey, the high cost and comparatively low return nature of our current models of care, coupled with the need to service many more consumers, make it clear that a fundamental shift in the way we do things will be required.
I believe there are opportunities for physical therapists (PTs) to take the lead in this shift—including a project I'm calling the "employer initiative." I'll get to that later.
But first: what kind of shift am I talking about?
It's a shift that's not solely an "us" (PTs) or even an "US" (our nation) thing. Global megatrends, most notably the rising dominance of noncommunicable diseases as the leading causes of death and disability worldwide, are pushing all stakeholders (payers, providers, governments, and end-users) to find better ways to, at a minimum, evolve current systems to enable consistent delivery of better outcomes at a lower burden.
The thought of continuing to lose ground in the management of modern chronic conditions by trying to leverage tools better suited to infectious diseases of the industrial age while being paid less and less has contributed to more error and burnout than we can in good conscience allow. The outcome is not good for users, providers, or those, such as employers, who ultimately pay for this "care-of-diminishing-returns."
Since the current model seems ill-equipped to meet the need, and the current trajectory appears to miss the target, it is quite possible we will need to reinvent things entirely.
For example, we currently apply treatment approaches that severely limit the number of lives we can interface with and thus our likelihood of success in our quest to transform society, but we can change this. We can move toward population health models in which cohorts of individuals are impacted by not only the techniques and interventions we apply but also the knowledge we have gained.
It will require a reexamination of our policies, consideration of how we can best work with other providers in teams, a research agenda that empirically validates our effectiveness in these approaches, and, likely, fairly aggressive funding of projects that can demonstrate how we can leverage the rather nuanced skills required to work at the population level in a way that yields dramatic, life-altering results for our clients and a challenging yet fulfilling work life for our peers.
This may not feel comfortable, and, admittedly, it is certainly not what we're used to. However, we can start by continuing to refine models that reward providers who help people stay healthy, such as the ones employers are increasingly seeing strategic value in and paying for directly, the same type that a few of us have been delivering and advocating for for many years. If as a profession we are willing to recognize and react to the urgency, we can begin to reposition ourselves to actually deliver on the mandate of our vision and, in so doing, deliver on the essential promise that we help individuals and populations alike move away from disease and toward improved health and quality of life.
To that end, and with the help of a great group of APTA members and staff, I have begun working on an initiative that aims to help our profession gain some much needed traction in this area. The purpose of employer initiative is to build both a demand (increase the number of employers who want to work with PTs) and supply (increase the resources available for PTs who are interested in population health approaches). We recognize that although they are not the only avenue, employers may be the ideal starting point as they have a direct interest in lowering health care costs and maintaining a productive workforce—2 goals that we know can be achieved with better health.
You will hear more from the work group as we continue ramp up our efforts and connect with various stakeholders in this process. However, as an initial step, a free-to-members webinar-style presentation was launched recently on the APTA Learning Center, and we are following that up with a live Q-and-A session on March 9. We hope you join the discussion!
Undoubtedly the effort required to make a fundamental change in the way we do things will be significant. To rework our individual-upward "treat the person in front of you" approach to one that features a population-downward "manage resources in the most efficient way possible" approach is a major shift in the way we do things. Moving from a conceptual framework of physical therapy as a service (to be marketed) to one of physical therapy as a solution to a societal problem will not be a simple plug-and-play for us.
And yes, this may seem daunting (as fundamental change sometimes does), but it is not entirely different from the change we promote when asking our patients and clients to move differently, to thoughtfully consider lifestyle choices like eating better, or to quit smoking as a means to improve their healing rate, prognosis, and ultimately their health arc.
Professionals who minimize the total cost of care by effectively providing conservative (lifestyle) interventions such as exercise, nutrition, and recovery strategies—early enough in the health continuum to prevent, slow, or ultimately reverse the progression of noncommunicable disease—will more effectively deliver on our ultimate brand promise: to help individuals live the best possible version of themselves.
Mike Eisenhart, PT, is the managing partner of Pro-Activity Associates, a prevention and population health practice located in Lebanon, New Jersey, and a founding member of the Academy of Prevention and Health Promotion Therapies. Eisenhart is also the president of APTA of New Jersey and a member of several sections. You can follow him on Twitter @MikeEisenhart or email him at Mike.Eisenhart@aphpt.org.