President's Desk, August 2013
Liana Lianov, MD, MPH, FACPM

The Value Proposition of Lifestyle Medicine

A few weeks ago, the Lifestyle Medicine Competencies Working Group--a collaboration of ACLM and the American College of Preventive Medicine--had an interesting discussion about framing the value of LM to key stakeholders. Those who have an ongoing passion for LM may forget the need explicitly voice the reasons for our passion. We can gain valuable perspectives by taking the time to view LM and its value from the shoes of different groups. Let's take a peek here.

Clinicians might view LM as a topic they already incorporate into their discussions with patients and include in treatment plans. Focus groups that I conducted at the American Medical Association a few years ago confirmed that clinicians feel they already do what they can. They recommend and counsel on lifestyle changes within the time constraints of their practices despite the challenges of perceived patients' lack of motivation.

So how can we distinguish LM from standard practice? LM offers health behavior change as first line therapy, whenever appropriate--which applies to most chronic conditions; the emphasis is the behavior, not the condition. (Healthy behaviors simultaneously impact several conditions.) LM incorporates processes of communicating with patients that are more effective at driving lifestyle changes. We are moving from finger waving to fully engaging the patient based on readiness, interests, life situation and level of support. LM also insists that the clinician personally practice healthy lifestyles in order to be more effective in working with patients, as this achieves better results.

The value of operative LM practice to clinicians who now find themselves working in a healthcare environment that is shifting its focus to outcomes is huge. Effective lifestyle medicine offers pragmatic solutions to delivering quality care, improves outcomes and reduces preventable conditions, admissions and readmissions. In this, a LM focus should lower clinician stress levels! LM also harnesses the patient centered approach and contributes to patient satisfaction. It is geared to make the primary clinician's job easier by linking patients to community resources and leveraging the power of the healthcare team. Patients value this kind of experience and support.

LM straddles clinical practice and public health by expecting clinicians to refer to community and public health resources. Ideally, patients are guided to use public health interventions in a coordinated plan that addresses patient actions between clinical visits for better results. Providers can also reinforce public health educational messages to improve effectiveness of PH campaigns. LM also offers clinical guidelines to be used in public health promotion. With these kinds of systems, payers can save money or at least slow the increase in spending. Not only can LM be offered at lower cost than other interventions, including medications, but it can also avoid costly conditions and reduce utilization. Accountable care organizations looking to better manage patients could especially benefit from implementing high quality lifestyle medicine which may even aid in avoiding financial penalties.

Let's look at other LM stakeholders. The wellness community might be seen as a competitor to the LM community, but LM practitioners can be key collaborators to wellness programs. Clinicians can encourage or prescribe the use of wellness programs, mobile apps, and other wellness resources as a bridge between office visits to achieve lifestyle improvements. LM can potentiate the work of wellness companies, products and services and vice versa which would eliminate the stigma of competition and implement the idea of a partnership. This year we even saw the first fitness app be added to a prescription formulary!

Academia offers additional potential partners. LM leaders are developing training and curricula that can enhance medical education offered in the form of CME in medical schools or residency programs. Integration into current medical education has great potential; hence, why organizations such as AMA, AAMC, LCGME, and others might see value in partnering with us. In addition academia can offer clinical research settings to further refine our knowledge and evidence base in LM. A mutually useful relationship between medical societies and lifestyle medicine can also be forged. Societies have a role in education, business support and advocating on behalf of their members. LM can offer useful tools and resources for their constituents. During that process awareness and demand for LM will grow.

And last, but not least, employers are looking to keep their insurance costs down and lower absenteeism and presenteeism. That is why a range of employer based programs have sprung up and more are being developed. LM can offer them value, as well. Coordination between physicians and wellness programs is the key to ensuring employees are getting referred to or prescribed activities most effective for improving their particular health status. Also employees are more likely to follow through with the programs that are recommended by their physicians.

This brief peek at potential stakeholder perspectives makes clear that lifestyle medicine indeed offers value to a variety of groups. It is up to the LM community to spread the message about the key advantages of our field across the healthcare and health promotion spectrum. Please stay tuned for how ACLM and ACPM are working to accomplish this goal, including the guidance of a strategic plan. We will be recruiting a variety of providers, ACLM members, patients, and the public to contribute to this mission. Better yet, get a jump start and join us at the ACLM conference this fall in Washington D.C.