The World Masters Athletics Championships were held the past couple of weeks in Sacramento. I headed out to sunny California to support one of the Smart Sport athletes that I coach – Canadian team member Rita Quibell. Two events – the F55 800m and 1500m - would be the culmination of a lot of hard work and training on her part.
The World Masters Athletics championships are held annually, with indoor championships alternating with outdoor championships. This event attracts the world’s best athletes age 35 years and older. Athletes compete in 5 year age groups – for example, F55 is women age 55 to 59. Age groups this year extended up to age 100! I can say without hesitation that there is something absolutely surreal and exhilarating watching a 90 year-old athlete run for his country. It speaks to the power of human will and the wonder of human physiology.
Rita and I have been working together for 3 years. It was evident from the outset that there was one primary goal: a gold medal at the World Championships in 2012. Better yet, how about doubling in the 800m and 1500m?
In our current health care system, physicians (and now, to some degree, chiropractors) serve as the gatekeepers. They refer patients for medications, for imaging, and for the services of other health care providers. Patients then enter the system via the bottom end of the funnel. Access to care is, by and large, controlled by the gatekeeper.
But the current system is severely handicapped by this funnel. Patients are demanding access to care, access to a clinician’s skills, and access to information.
There was a time and place when this gatekeeper model made sense. A physician has training in differential diagnosis and in the prescription of medication and imaging studies. They receive fairly extensive training in these areas, thus it makes good sense for them to know when either is appropriate given the patient scenario.
We now have far more health care options available to the patient – but the same gatekeeper is still controlling all of them. A prime example is physical therapy. The funnel effect still exists for the patient.
The question then becomes quite compelling. Who knows which patients are appropriate for physical therapy – and should that decision be made by the physician, or the physical therapists themselves?
The alarm went off at 3:15 am. It was time to wake up, down a cup of coffee, and get Josh to the starting line in Squaw Valley.
It was a brisk 32 degrees on the drive from Truckee to Squaw Valley. The temperature was expected to rise some 60 degrees over the course of the day. Temperature swings like that don’t even happen in Texas!
When there are only 400 or so competitors, there really isn’t a lot of pre-event drama. With little fanfare, the race started at 5:00 am with the sound of a shotgun blast. The start is a bit anti-climactic. The runners actually run for about 50 to 100 m, then they immediately start up the mountain – power hiking for most of it. It’s a long day, and this isn’t the time to use up all your resources – because you will pay for it later in the day.
It was going to be a long wait before I would catch Josh at the first crew access aid station at mile 55.7.
Imagine running 100 miles. Crazy, yes? That’s a long way to drive a car, let alone run. Extend that thought a little further: imagine running 100 miles on the trails of the Sierra Nevada, on the original trails used by the gold and silver miners of the 1850s. Now give the event a name: the Western States 100 Mile Endurance Run.
No, I didn’t run those 100 miles. But I did have the opportunity to experience the 2011 WS100 as a coach and crew member for Josh Kennedy of Huntsville, Alabama.
Preparing for this event – and then running it – is tough. There is no doubt about it. But being a crew member for an athlete participating in any ultra endurance event isn’t an easy task by any stretch of the imagination either.
At this point, we are three-quarters of the way through a four part series on an EPIC solution for health care reform. We’ve examined the issues of Evidence, Payment, and Incentives. But there is one absolutely critical pillar remaining – Choice.
Choices, choices, choices. It’s the American way, the way of a free marketplace. In order for any competitive market place to be effective, consumers must be able to find the best product for the best price, or the best product for the best outcome. They also need to have the decision-making capacity in order to select their desired product.
This should extend not only to purchasing a car or a house. It should be a foundation upon which health care is built.
In the US, you have countless choices for everything in life – except for health care. So how do we provide choices?
Two of the more extreme endurance events are Ironman Hawaii in Kona, HI – the Ironman World Championship – and the Western States 100 Mile Endurance Run in Auburn, CA. One has you swimming, cycling, and running 140.6 miles on the lava fields of the Big Island, the home of the first Ironman triathlon. The other has you running 100 miles - with 18,090 feet of ascent and 22,970 feet of descent - on the original trails used by gold and silver miners of the 1850s. Both have long, storied traditions. Either one could be considered the most demanding single day event, the “Big Dance”, in their respective sport. Athletes covet the opportunity to experience either of them simply because of their illustrious history and daunting challenges.
But it is more than just the challenge involved. Events like these bring with them a purity and simplicity, a back-to-the-essence-of-the-sport vibe. They are surreal to some, and tantalizing to others. And they have a deeper inner meaning to many.
I have coached athletes in both events. I have heard countless reasons for taking on these adventures. As an Ironman triathlon finisher myself, one thing has become crystal clear: there are a number of life lessons that can be learned through sport in general, and through endurance sports such as these in particular. Sport does, in fact, become a metaphor for life.
We are now halfway through a four part series that provides an EPIC solution to health care reform. Thus far, the series has discussed the first two pillars: Evidence and Payment.
Many people have theorized that if universal health coverage makes an appearance in this country, then the level of care and ingenuity of providers (i.e. the brain-trust behind health care) will diminish. Would the brightest minds move away from a career in health care? I would suggest that the answer is “no”. Entry level requirements in many health care provider educational programs are higher now than they were 20 years ago, and I don’t foresee that changing just because we change our reimbursement structure. In fact, I would project exactly the opposite.
Why? Because of the “I” in our EPIC solution: Incentives. Changing the incentives will actually promote having the brightest minds using the best techniques to then earn a healthy living doing what they do best.
In Part 2, I mentioned that part of the problem with our current health care delivery and payment model is that it is built around the wrong incentives. Providers are reimbursed by the number of procedures performed, not by the outcome or concordance with clinical guidelines. Patients are seeking health care, and not disease prevention or health promotion. These factors promote the wrong incentives - by definition.
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.