Lifestyle Medicine and the Corporate Culture
Executive Director, Cummins, Inc.
Over the last decade, it’s become widely appreciated that the leading causes of death for adults in the United States are largely avoidable and related to lifestyle. Poor diets, lack of physical activity, tobacco use and excessive alcohol consumption have led to the majority of chronic diseases that plague our society . Moreover, there is convincing evidence that Lifestyle Medicine, using lifestyle as a treatment, has tremendous capacity to alleviate and even reverse many of our nation’s most common chronic illnesses. However, despite this understanding little has changed in how most clinicians go about the practice of medicine on a daily basis.
In 2009, a joint Blue Ribbon panel that included the American College of Lifestyle Medicine (ACLM) and the American College of Preventive Medicine (ACPM) looked into the issue of why physicians were not moving toward a more lifestyle-based approach to care given the evidence. One of the Panel’s findings was that a majority of physicians “cited inadequate confidence and lack of knowledge and skill as major barriers to counseling patients about lifestyle interventions.”
To address this situation, the American College of Lifestyle Medicine embarked on a bold initiative to establish standards for the practice of Lifestyle Medicine (LM) and bring the key competencies within the reach of many more physicians and ultimately the patients they serve. Partnering with ACPM at the beginning of this year, ACLM has made major progress in developing the first of its kind LM competencies curriculum for physicians.
Key segments of Payers, insurance companies and large employers, have started to take notice and support what is happening in the LM space. Following the Center for Medicare and Medicaid Services’ (CMS) decision to provide reimbursement for programs like the Dean Ornish “Intensive Lifestyle” Program for Cardiac Rehabilitation, commercial payers such as Anthem have made similar coverage decisions. The Ornish program focuses on reversing heart failure using LM techniques and principles. Through this program, individuals are empowered to reverse their heart disease and other chronic conditions, allowing them to transform their lives for the better in a sustainable fashion.
Corporate Culture Application
With over 48,000 employees world-wide, Cummins is one of the largest employers planning to put the competencies of LM into the hands of primary care providers as soon as possible. Starting next year, a criterion for being a designated High Performance Network primary care provider will be to obtain LM training in one or more of the competencies. In 2016, Cummins will require that all primary care providers working in any of its worksite clinics become “certified in LM” through the ACLM/ACPM initiative. Additionally, Cummins is building an onsite, state of the art, lifestyle clinic, the Cummins LiveWell Center, which will focus on a lifestyle approach to care for the prevention and treatment of illness for all active Cummins employees and their dependents. The Cummins LiveWell Center physicians will be required to be certified in Lifestyle Medicine. The core focus will be on lifestyle and shared decision-making to empower employees to be owners of their health and masters of their health destiny.
Focusing on lifestyle, the root cause for a plethora of diseases, is not only an important aspect of care in the LiveWell Center but also outside its walls since most employees spend a relatively small amount of time each year with a physician. To see real health improvements, an individual needs to understand and possess the skills to make healthy choices on a daily basis. Cummins seeks to empower its employees and their families to make healthier lifestyle decisions by providing the proper tools and programs to accomplish these goals. A prime example of such a program is the Complete Health Improvement Program (CHIP) that is being piloted this year with Cummins employees and the community. We are also offering an online learning program called “Lifestyle Competencies.” These interactive, insightful and informative programs focus on nutrition, physical activity, sleep and stress management. Each program focuses on skills and easy to remember tools that an employee can master to improve their health, relationships and overall well-being. Thus, employees and their families can make healthier lifestyle decisions to live fuller lives at home, work and in their communities.
Cummins believes that LM is the center piece of true health reform and that only through such an approach will it achieve its global health goals for its employees. By implementing a provider network trained in LM, an employee lifestyle clinic and providing employees with the necessary tools, we believe that we can have a profound impact.
A practicing primary care physician should possess the following knowledge, skills, attributes and values.
- Promote healthy behaviors as foundational to medical care, disease prevention, and health promotion.
- Seek to practice healthy behaviors and create school, work and home environments that support healthy behaviors.
- Demonstrate knowledge of the evidence that specific lifestyle changes can have a positive effect on patients’ health outcomes.
- Describe ways that physician engagement with patients and families can have a positive effect on patients’ health behaviors.
- Assess the social, psychological and biological predispositions of patients’ behaviors and the resulting health outcomes.
- Assess patient and family readiness, willingness, and ability to make health behavior changes.
- Perform a history and physical exam specific to lifestyle-related health status, including lifestyle ‘vital signs’ such as tobacco use, alcohol consumption, diet, physical activity, body mass index, stress level, sleep, and emotional well-being, and order and interpret tests to screen, diagnose and monitor lifestyle-related diseases.
Use of office and community support
- Use nationally recognized practice guidelines (such as those for hypertension and smoking cessation) to assist patients in self-managing their health behaviors and lifestyles.
- Establish effective relationships with patients and families to effect and sustain behavioral change using evidence-based counseling methods and tools and follow up.
- Collaborate with patients and their families to develop evidence-based, achievable, specific, written action plans such as lifestyle prescriptions.
- Help patients manage and sustain healthy lifestyle practices, and refer patients to other health care professionals as needed for lifestyle-related conditions.
- Have the ability to practice in an interdisciplinary team of health care providers and support a team approach.
- Develop and apply office systems and practices to support lifestyle medical care including decision support technology.
- Measure processes and outcomes to improve quality of lifestyle interventions in individuals and groups of patients.
- Use appropriate community referral resources that support the implementation of healthy lifestyles.