ACLM Lifestyle Medicine Newsletter

President’s Column for May Member Newsletter

The COVID pandemic is unfortunate and everyone is suffering under it in one way or another. It is upending health care as we have known it and points to the fact that how our health care system has been focused and financed is wrong.

Until recently the medical industry has not focused enough on treating the root cause of chronic disease, but worked to train, reward and incent physicians only to manage such illnesses.  This is often with little or no thought of how to deploy the most universally effective intervention for chronic common illness—Lifestyle Medicine. Painfully apparent now, that approach has not protected our most vulnerable populations from the havoc a deadly virus can wreak on those with one or more existing chronic diseases.

As our President-Elect Cate Collings has said, the virus is the virus, the disease varies by the host. Further, she says, it is not the chronologic age that matters, it is the physiologic age derived out the cumulative toll of chronic disease. This risk and toll are sadly greatest among the most socioeconomically vulnerable, highlighting chronic disease and health disparities.

Financially, who would have imagined the financial hit that provider organizations are experiencing at a time of such great need for health care?

Despite the challenges, sometimes the biggest challenges open the largest doors. COVID has forced us to rethink health care and with it, unrealized areas of potential innovation.

While not novel concepts, telehealth and remote patient monitoring have gained a new foothold amid the COVID crisis. We believe this will be a silver lining for Lifestyle Medicine, allowing providers the opportunity to see patients more often as is necessary in lifestyle behavior change and to be reimbursed for it. In particular, it aligns well with our ideas for gaining traction with large employers for our Lifestyle Medicine Provider Network.

Innovation and the experience gained under COVID should be examined by all of us dedicated to LM to better understand the impact on access, cost, quality and outcomes. This can serve us well and could have definite implications on future health and payment policies.

For Lifestyle Medicine, this also means making sure our message of hope and healing is heard and appreciated. The time is right: Our root-cause approach to health and health care are vital interventions for minimizing disease severity now and in the future.

Thank you for all you are doing and for your dedication to Lifestyle Medicine. Our work is needed now more than ever.

LM2020 Fall Conference Update: Not knowing what travel and meeting restrictions may be in place when we were originally scheduled to hold our annual conference in November, we have decided to transition to a virtual meeting in October in lieu of an in-person meeting. With the appropriate theme “LM2020 Lifestyle Medicine: Health Restored,” we are hard at work to make this the best virtual meeting. As we work on the plans the everything is shaping up nicely and the level of excitement is mounting!

www.lmconference.org

Lifestyle Medicine and DPC

The natural combo that is getting LM to the primary care level. 
By Amy Mechley, MD

Direct primary care is a new financial model for health care delivery that allows the patient and doctor relationship to thrive. It is based on the premise that primary care is essential and personal to one’s well being across their lifetime. Primary care is just that, primary. It is focused on prevention, primary and secondary screening of predictable medical issues and early diagnosis and treatment of many common chronic diseases.  It can typically be managed without a great cost relative to other medical care in the US.

The fundamental concept of keeping insurance out of primary care works. The cost of care is known and can be budgeted per individual. Insurance is used for the unpredicted. Your car insurance is used for accidents, not oil changes, gasoline and battery replacements. Your homeowner’s insurance is used for tragic occurrences like fires, floods and burglaries, not HVAC cleaning, lawn maintenance and roof inspections. Primary care is the first level of care and maintenance for all US citizens. Tragically what has happened is 40% of a primary care doctors overhead in a fee for service system is dedicated to paying for the interaction with the insurance, which adds zero value to the health and wellbeing of the patient. As we are looking for improved health care delivery, we need to critically look for the value of each dollar spent. Insurance has no value in the primary care office.

Don’t get me wrong, insurance is very important when used appropriately. We do need to plan and pay for coverage for more expensive care like colonoscopies, hospital stays, advanced cancer care, accidents and specialty pharmaceuticals when judiciously used.  And that is exactly what it was designed for.

In a Direct Primary Care (DPC) arrangement, the patient or employer pays a set fee to cover the care for the patient, usually a year at a time. It is a direct relationship, both personally and financially. It is transparent, able to be budgeted and upfront. I work for the patient. Period.  When this happens many other ill constructed policies fall away: Like not being able to treat a patient for an issue  at a well visit (a rash or refill of a diabetes medicine at a pap appointment); like having to see a patient every 10 minutes to make your quota or having to refer to your groups specialist when you prefer another specialist outside your system.  Also I am documenting for communication and organization; not to make a base level of checkboxes for a certain billing requirement. Common sense rises and my energy and focus return to the patient and what is important to them.

As a direct primary care doctor, your schedule and panel number is set by you. You design your day, create a schedule template that supports the care you want to deliver. Lifestyle Medicine takes organized time and focus. DPC supports LM in that you have the time and systems to deliver complete care. It should be a part of every interaction and then also can be delivered more intensely with focused LM visits or LM group visits. Telehealth has been a wonderful addition to using the doctor and patient time wisely to continue to gain on goals and behavior changes.  It is easily integrated in a DPC practice.

Personally, this model has reinvigorated in me the passion for patient care. I feel more than ever I am practicing the best medicine of my 22 year career. I am having the kind of positive impact on patients' lives that I hoped for in medical school. It is truly a model for CARE, both for the patient and for you,  the doctor. If I measured my quality scores in hugs, it would be off the charts!

To learn more about DPC, please join us at a DPC conference (AAFP DPC Summit, HINT Summit) , talk to a DPC doc or find more info at DPCfrontier.org.

March 2020 Edition: Consider ACLM Board Service

By Dexter Shurney, MD, MBA, MPH, FACLM, DipABLM

At its core, the American College of Lifestyle Medicine (ACLM) is the Lifestyle Medicine (LM) provider’s voice and the profession's best advocate during medicine's most turbulent times. As the nation’s only medical professional association for physicians and other professionals dedicated to clinical and worksite practice of Lifestyle Medicine, our collective goal is to improve the lives of physicians and the patients we serve. 

ACLM is at the forefront of championing a new system of health care for our nation. The health care industry as a whole is at an inflection point, and it is evident that the status quo is not working for patients nor for providers. Our past and present ACLM leaders have understood the need to change and have been instrumental in taking active steps toward accomplishing our goal of re-imagining and transforming the current sick- care system to one in which LM becomes the foundation of health and all health care.

As opposed to chronic disease management, our focus is health restoration. We believe evidence-based LM should be the first-treatment option to prevent, treat and reverse chronic disease.

You, as ACLM members, are the change agents who are committed to a Lifestyle Medicine-first approach to real health care, and we thank you for being part of our 4,000-plus member “tribe” of health pioneers. As our executive director, Susan Benigas, often says, we are an organization that is a magnet for purpose, passion-driven medical professionals dedicated to ushering in a transformed and sustainable system of health care delivery.

Many of you are actively participating in member interest groups (MIGs), committees and task forces, networking among peers both within ACLM and external to ACLM, and promoting and raising awareness of LM within your realms of influence.

Are you ready to take the next step?  Serving on ACLM’s Board of Directors is an opportunity to serve—at the highest level—what is now regarded as our nation’s fastest growing medical professional association. 

If you desire to advocate on behalf of physicians and patients, have a passion for LM and seek to share knowledge across disciplines, improve reimbursement and develop policies to expand its use—reshaping the future of medicine—then you have a role to play in defining how we get there. If the timing isn’t right for you, personally, you may know of a fellow ACLM member whom you believe would be an exceptional ACLM leader.

Please be giving this some thought, as our call for nominations for our summer 2020 Board of Directors election will go live on May 15. 

I have thoroughly enjoyed serving as ACLM’s president-elect, now president, and, upon the conclusion of our Lifestyle Medicine 2020 conference, as immediate past-president.  This six- year service on our board has been inspiring, invigorating and is FAR from over.  I know that the best is yet to come, as, in the past five years alone, ACLM’s membership has seen explosive growth: over 600% during this time span.  During this same five years, our staff has increased from two part-time positions to what is now a team 20+ strong.  And, with robust educational offerings, certification through the American Board of LM and through ACLM, and so much more, the building blocks are now in place for ACLM’s impact to grow exponentially.

From what I have witnessed of our pipeline of future leaders, I am more than optimistic that they will not only continue to carry the banner towards achieving our goals but will surely accelerate our getting there. 

Our summer election will feature the offices of president, young director and four at-large board positions.  While ACLM’s Executive Committee meets virtually for an hour each month, ACLM’s full Board of Directors meets quarterly for a two hour meeting, with three of these being virtual, and the one face-to-face meeting taking place during the annual conference.  Lifestyle Medicine 2020 will be held in Carlsbad, CA, at the Omni La Costa Resort and Spa, November 1-4, with ACLM’s BOD meeting slated for 8:30 a.m. PT on Sunday morning, November 1.  Additionally, the full board is asked to participate in one additional live meeting each year: either tied to our Corporate Roundtable or to a bi-annual strategic planning meeting.  Active board leadership on at least one or more ACLM committees, task forces or MIGs is asked, as part of board service.

Our call for nominations goes live May 15, 2020 and closes June 15. Watch for future communications in this regard. The election takes place in August (the ballot will be sent by ElectionRunner).

Here’s to transforming health and redefining health care throughout the U.S. and around the world by addressing root causes of disease. Lifestyle Medicine is what equips and empowers us to achieve the Quadruple AIM.