CHANGES IN HEALTHCARE
OPPORTUNITIES IN LIFESTYLE MEDICINE
With change comes opportunity. The best minds in the business of healthcare gathered at the first-ever Lifestyle Medicine Practice Management Workshop to guide Lifestyle Medicine providers in positioning themselves and their practices for success. We asked several of these thought leaders to share their perspective on what they see as critical changes underway in healthcare and how practitioners of Lifestyle Medicine can make the most of these opportunities.
Sandra Lawson, MBA, Executive Director of the Institute of Lifestyle Medicine provides perspective on the changes occurring through healthcare reform, and through increased transparency for all providers - the ability of payers and consumers to understand the value they’re receiving, quality that will be measured in numbers.
“Capitation failed because it was perceived as rationing care. There was no mechanism to quantify quality, no identification of measures of quality. Under new reimbursement models, such as ACO’s, this will change. There will be value and quality metrics and providers will be paid based upon quality. This changes the game as far as how providers are paid.” She describes the Patient Centered Medical Home as a model of care that will measure and require patient engagement as a key component. “This was not measured before and was not considered a metric for how providers perform. Patient engagement is critical within Lifestyle Medicine - a key competency and an area where Lifestyle Medicine providers may outperform other providers.” She also points to the Medicare Annual Wellness Visit as a recent change and potential revenue stream, with 46 million patients now able to schedule a visit strictly to discuss prevention and wellness. “These are new modes of reimbursement. To be successful, providers must be competent in wellness and prevention and must be able to engage patients.”
She goes on to describe how transparency measures such as those currently imposed upon healthcare institutions will affect physicians. “As of yet physicians have not been affected; however, Medicare’s voluntary Physician Quality Reporting System (PQRS), which offers physician’s bonuses for reporting quality measures, will become mandatory with bonuses tied to outcome and will be published on Medicare’s Physician Compare website. Physicians must choose measures relevant to their specialty and to their patient population and with that, consumers and payers will be able to assess the value received.” She describes how insurers will tie measures to reimbursement, offering the example of the Medicare Advantage star rating that now gives insurers bonuses. Members of plans are asked questions such as whether their physician spoke with them about exercise. “This is very relevant to Lifestyle Medicine competencies. We are going to see these measures built into physician ratings and reimbursement. This puts Lifestyle Medicine, especially within the primary care context, in a good position to negotiate favorable contracts with insurers for the Medicare Advantage Plan. Keeping people healthy instead of focusing on treating illness will drive how physicians contract with insurers. Lifestyle Medicine physicians are uniquely positioned to achieve good health outcomes. But keep in mind that we’ve not truly measured Lifestyle Medicine efficacy as of yet. Through transparency, we’ll be able to study and measure the efficacy of Lifestyle Medicine.”
Sandra Lawson sees opportunities in both primary care and specialty practices. “Lifestyle Medicine offered within the primary care context will be able to perform well within the ACO and PCMH systems. And there will be opportunities as well for specialists to contract with ACO’s, especially those specialists who can take on high-risk patients and achieve behavior change.” She envisions opportunities for marketing based on successful outcomes. “As we see numbers - quality measures on true outcomes - we’ll then see marketing opportunities for physician practices to highlight strong ratings in the way that hospitals now use Hospital Compare ratings.
With coming changes, the ability to track outcomes will become paramount for success. “Physicians must prepare themselves to collect information electronically. Information technology will be critical to performance. When sorting out how they will deliver care, physicians must also be prepared to collect and report clinical data. Data management will drive performance.”
The Institute of Lifestyle Medicine helps clinicians get patients healthier. The mission to transform clinical care is achieved through professional education, research, and advocacy. For more information on the ILM, visit: http://www.instituteoflifestylemedicine.org/index.php
Edward Noffsinger, PhD, pioneer of group medical visits and originator of the Drop-in Group Medical Appointment (DIGMA) and the Physicals Shared Medical Appointment (PSMA) models offers his views on key changes that will impact healthcare. “First, we now have an aging population with baby boomers emerging from the pipeline in increasing numbers as the sickest, most multi-morbid, sedentary, obese generation in our nation’s history. Second, we have the most sedentary, obese, and unhealthy pediatric population reaching adulthood – one in which type 2 diabetes is rapidly on the increase. Third, we have fewer medical students choosing primary care while seasoned and experienced internal medicine/family practice/geriatricians are moving into retirement and are not being adequately replaced. And fourth, under the Affordable Healthcare Act, we’ll have an additional twenty to forty million previously uninsured patients with coverage, all of which raise the question of who is going to take care of these patients? We’re also seeing a shift in the last century from acute to chronic care with the vast majority of our nation’s healthcare dollars going into the care of chronic conditions, almost all of which have a significant lifestyle component.”
Dr. Noffsinger sees Lifestyle Medicine as particularly well-suited to address the root causes of chronic disease and sees Lifestyle Medicine practitioners as ideally-suited to deliver healthcare in group settings, maintaining that the root causes of chronic disease can often be best addressed in group medical visits. He points to potential benefits of a group approach, including:
- Prompt access
- More face-time with one’s provider
- Greater patient education
- Reduced repetition, with issues often being discussed once, in greater depth with the entire group as a whole – rather than the same thing said over and over in individual patient visits
- More relaxed pace of care, because the entire team is helping the physician in every possible way, such as the documenter creating chart notes, which frees the provider from this task
- A multidisciplinary care delivery team
- The help and support of other patients
- Answers to questions patients might have not known to ask (but others do)
- Max-packed visits that address future as well as current health needs
- Greater depth of guidance and support with lifestyle issues such as nutrition, activity, weight loss, stress management and other lifestyle areas that impact health and well-being.
“Lifestyle Medicine practitioners are confronted with the challenges of addressing needs and issues that require a lot of time and patient education but have a relatively low reimbursement rate. These challenges can in large part be overcome by the increased efficiency, productivity, and economies of scale that properly-run group visits can offer. He offers examples of these efficiencies: “Physician downtime due to cancellations and no-shows can be overcome by the group visit simply by overbooking group visits accordingly, as is done in the airline industry. Also, the Drop-in Group Medical Appointment (DIGMA) and Physicals Shared Medical Appointment (PSMA) models typically enable healthcare providers to see two or three times as many patients in the same amount of time as they normally could with individual office visits, with both higher levels of patient satisfaction and higher levels of physician satisfaction.”
For more information on Dr. Noffsinger’s book, Running Group Visits in Your Practice, see http://www.springer.com/medicine/book/978-0-387-33683-1
Marc Braman, MD, MPH, Executive Director and Past President of the American College of Lifestyle Medicine describes healthcare as experiencing a “forced re-evaluation,” with new opportunities arising within healthcare reform as well as beyond and outside of the government-driven processes taking place.
“There is opportunity within the present change; however, the current focus is on reshuffling dollars while providing the same kind of “consequence care.” The real quantum leaps will come from people and systems that create a different kind of care - care that treats the cause and not just the symptoms.” He describes the common perception that lifestyle relates chiefly to prevention. “Lifestyle needs to become the foundation of treatment. It must become the primary therapeutic tool for the treatment of disease. This is the gap – prevention vs. treatment. Lifestyle Medicine encompasses prevention, and primary prevention is the ideal approach. But Lifestyle Medicine needs to be the primary treatment for lifestyle-related disease. The challenge will be in transitioning from a ‘lifestyle is the neglected step-child, community service freebie, held in a basement room of the hospital every 3rd Tuesday’ to lifestyle-based treatment valued as the best approach and implemented as a therapeutic tool; where Lifestyle Medicine is valued for what it is, and, in effect, has the ‘corner office’ in the medical system.”
He asserts current treatments are not always backed by evidence of health benefit, referring to the cardiac stent as an example of a financially lucrative treatment that has not been shown to improve outcome. “An intensive lifestyle intervention program has a radically better outcome for a radically better price than a cardiac stent; but this is where the rub will come. These procedures have been the big money-makers. Leaders of healthcare business communities and professional organizations are talking about radical changes, but they’re still not talking about treating the cause as an obvious solution. Real opportunities for success will be turning the model on its head - not doing the same thing more efficiently. When healthcare providers are paid for outcomes, the biggest income generators of the present will become the biggest financial ‘holes in the boat’ in the future system.”
Dr. Braman sees many of the changes and opportunities in healthcare occurring at the system level. “This is our challenge: bridging the gap between lifestyle medicine practitioners just trying to survive in their own practice and engaging decision-makers within systems. Opportunities will come to those who can best manage system issues: from leveraging EMR systems to track and demonstrate outcomes, to communicating this data to insurers and system decision-makers. If you have the data to show better outcomes, you can do things like negotiate with insurers for higher contractual reimbursements, etc. Most doctors are not yet aware of this potential power.”
He describes a new paradigm involving quality measures that focus on treating the cause, instead of the often short-sighted quality measures now in use. “My physician father was given grief by his cardiologist because he couldn’t tolerate the medicines prescribed. The cardiologist is graded and rated for prescribing these medications. But these aren’t real outcomes. This is an example of not treating the cause and not measuring the outcome, and instead measuring pills instead of the health of people.” But, he sees change underway; people and systems beginning to look, think, and do things differently, with power starting to shift as the vested interest ‘silos’ in medicine begin to lose their grip on the status quo.
“I want to give the message of hope and optimism to individual practitioners. They should and can be committed to ‘treat the cause’ healthcare. There will be challenges, but it is possible to make a living today, and the opportunities going forward will be great. Practitioners who commit themselves to becoming an expert in care that impacts outcomes can expect to be successful, clinically and financially. This will depend on how committed they are to quality processes and to practice management – electronic tracking of outcomes, as well as the coding, billing, and scheduling processes that support quality care.
“Lifestyle Medicine is the only rational solution that can and will work for solving the health care problems of modern society.”
In his role as a consultant to the health care industry, Audun Utengen, MBA, and Lead Developer of Fox ePractice offers his view on one of the most powerful shifts in health and human behavior in the last generation: the convergence of web 2.0 and health 2.0.
“The creation of easy to use technologies has enabled us to discover, connect, and share information with people who are of interest to us no matter where they may be located. This is more true for patients than for anyone else, because patients living with a condition are strongly incentivized to go online, research their condition and connect with other patients with a similar condition. We are social beings. Healthcare is social.”
He views this phenomenon as a structural change in society, one that enables patients, including those with lifestyle-related conditions, to empower themselves with information. He describes this change as “an amazing force with great potential to improve healthcare outcomes,” but notes that this force may be viewed by some as a threat.
He points out the reality of online misinformation. “Since eighty percent of patients go online for health information and two-thirds of them start at a search engine, we are at the mercy of Google's search result algorithm to present the best websites.” But, he contends that we cannot expect an algorithm to sort good information from bad, and therefore search engine optimization will be of increasing importance to the field of Lifestyle Medicine. It will be necessary to crowd out misinformation with quality health information. “One of the most important roles of today's healthcare providers is to be a ‘curator’; to guide patients in their online quest to empower themselves. Providers need to have an online presence - simply a very smart business practice for all healthcare providers. Because of the nature of provider rating sites, if you don't create your online presence, someone else will."
“The near future will bring attention and focus on lifestyle change as a way of managing disease and lowering healthcare costs. We know that Lifestyle Medicine is better able to treat some diseases when compared to standard medical treatments. And Lifestyle medicine has many incredible success stories to share. Why not take advantage of the opportunities to communicate this online?”
He maintains that providers who create lifestyle content online will find that people are hungry for this message, and he highlights the importance of word-of-mouth as a key element to practice success. “Seventy percent of the U.S. population is on Facebook and fifty percent are active on Facebook every day. The fastest growing segment of Facebook users are women over fifty-five. These women, the healthcare decision-makers in their families, share a great deal with their network of friends. Through your online presence, you can connect with them. You can make it easy for them to share your Lifestyle Medicine content.”
Viewing Lifestyle Medicine practitioners as ideally poised to take advantage of these opportunities, Utengen maintains that “there are no medical specialties with better news than Lifestyle Medicine. You already have such an advantage in the world of healthcare social media. Facebook users create or share on average ninety pieces of content each month, and they are on average connected to eighty community pages. This connection could be with your practice. People clearly share stories, and people love sharing better ways to live. Make it available to them to share. Be content creators and curators.”
In envisioning the future, he offers that “those who begin creating an online presence today will not only benefit from social media and the attention they will receive as visionaries, but they will build credibility as thought leaders and trusted sources.”
Utengen leads providers in creating a powerful online presence that includes a highly customized medical website with content management for keeping the website dynamic via blogs and site updates. Learn more about Fox ePractice at www.foxepractice.com
Dave Gans, MSHA, FACMPE, Vice President of the Medical Group Management Associationshares his perspective on the key role of Lifestyle Medicine in addressing key issues in healthcare today.
“The most pressing healthcare issue facing this nation today is how to create a healthcare system that is affordable for all Americans. The second most pressing issue relates to the health of Americans. Our system is failing us because the focus has been on distinct medical treatments while ignoring the impact of lifestyle on health. In many instances, lifestyle change will have a greater and more lasting impact than medical interventions now considered to be standards of care.”
He points out that as a nation, we cannot afford our current healthcare system, and we’re not seeing value in terms of improved health outcomes. “There are attempts to change the system, for example through mandatory health insurance, subsidizing those with low incomes in order to meet the first goal of affordable healthcare for all. When the mandate for universal coverage is implemented in 2014, we envision major changes in the delivery of healthcare. Forty million previously uninsured patients will gain better access to care, and this will create demand in the system for more healthcare services.”
He advises providers to think ahead, to proactively envision their future practice. “Physicians need to begin planning now to evolve their practice for this new environment,” pointing out that providers will need to consider options such as adding additional providers, including nurse practitioners and physician assistants; adding new services, such as nutrition counseling; and changing the practice to better meet the needs of patients. He advises that even though the Affordable Care Act will not be fully enacted for two years, any changes need to be planned now. “It takes time to expand facilities and to partner with new providers. The well-prepared practice will be thinking today about positioning for the future.”
“The opportunities will come to those who plan. You can proactively decide where you want to be and take advantage of the new environment, in the changes in demand for services and the demand from patients who want to improve their health through lifestyle.” He points to the growing number of people who “recognize the importance of lifestyle and are willing to seek out physicians who can coach them on their lifestyle while addressing their medical needs.”
Noting that doctors are typically more reactive than proactive in responding to change, he advises, “Change takes time. You can evolve your practice to where it will be ready when the demand for lifestyle services is present. Physicians who practice Lifestyle Medicine will be well-positioned for the future.”
The Medical Group Management Association helps leaders of medical practices be more efficient and more effective in meeting the needs of their patients.
Article by Kathleen Jones, MA
American College of Lifestyle Medicine
ACLM Disclaimer: Our Practice Spotlights are intended to provide examples of Lifestyle Medicine in practice.
We recognize that Lifestyle Medicine practices vary widely, and inclusion in Practice Spotlight is not intended
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