Having spent seven years as a consultant at the Mayo Clinic in Rochester, I read the Mayo Clinic Proceedings with interest. Especially interesting to me in the February 2019 Proceedings’ issue was a special article by Boehmer and colleagues entitled, Capacity Coaching: A New Strategy for Coaching Patients Living With Multimorbidity and Organizing Their Care. It provides information about the increasing societal burden of individuals with multiple chronic health conditions, coupled with their need for coaches to help them navigate the journey to better health.
Immediately striking to me is a concept found at the tail-end of the title. That is, patients need to be organizing their care when faced with multimorbidity; perhaps better termed those with multiple chronic conditions. The Mayo Clinic has always been known for coordinated care, and perhaps that is why an article arising from three different areas of Mayo Clinic: the Knowledge and Evaluation Research Unit, the Dan Abraham Healthy Living Center, and the Department of Cardiovascular Medicine, all at Mayo-Rochester, was so remarkable.
During my years at Mayo, one of the hallmarks of the system’s design was the focus on defragmenting a quite large medical center for patients. This was especially true for patients who traveled some distance to get to Rochester, and often lived in small Midwestern communities. One of the central features of care design during those years were general internists who acted as coordinating physicians for these patients. They integrated and made decisions with the patient about the sometimes conflicting, and alternative approaches recommended by subspecialists for that particular patient’s problem.
Thus, returning to the title suggest that some of these integration functions of a coordinating internist may have changed. Admittedly, as a physician caring for patients, it is always best for individuals to “own” their healthcare in order to have real changes in their health maximally effective. Yet, an alternative interpretation of the title is that even at Mayo, patients may need added coaching to help them organize their own care. My personal experience is that healthcare has become mostly located within specialty and subspecialty silos, and coordination of care does fall to the individual – or the patient.
Our primary care colleagues, whether they be in pediatrics, internal medicine or family medicine, have unique skills in care coordination, yet the production pressure of clinical delivery systems and the ever-present electronic health record that demand their key strokes, often gets in between the time needed for coordination and the individual. Boehmer and colleagues deserve our thanks for presenting this special article, and it validates that even at a health care center renown for care coordination, coaches may be required. Our firm’s focus on those with advanced or complex illness in our current healthcare delivery system brings a physician brain to the coordination of care.