Lifestyle Medicine Lights the Path to Value

Reflections from the 2019 American College of Lifestyle Medicine Conference

“Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come.” ~ Anne Lamott

We all know the statistics and harsh realities of our current healthcare crisis. We know about unsustainable cost increases, suboptimal patient outcomes, and providers suffering burnout in alarming numbers. We know that chronic conditions are the leading cause of death and disability in the US, that they account for 80% or more of healthcare spending, and that 85% of chronic conditions are caused by unhealthy lifestyle behaviors. These are sobering realities that one might be inclined to greet with resignation or even hopelessness. But what if I told you that these realities are instead an opportunity for new approaches to health and healthcare that can help light a path forward? Fresh from the American College of Lifestyle Medicine annual conference in Orlando last week, that’s exactly where I find myself as a physician and one who aspires to transform healthcare.

The hope comes from straightforward approaches that are right before our eyes. Lifestyle Medicine is the use of a whole food, plant-predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease. The American College of Lifestyle Medicine (ACLM) is the medical professional society for physicians, nurses, allied health professionals, health care executives, medical students, medical residents, and others on the health care team devoted to treating, reversing and preventing chronic disease through lifestyle behaviors as a first-treatment option.

I’ve been a career-long proponent and practitioner of lifestyle medicine even before I knew it by name, as may well be the case for many clinicians. I’ve been an ACLM member for several years (as we built a new primary care model centered around Lifestyle Medicine), but this was my first time attending the annual conference. This year marks the organization’s 15th birthday. I was inspired by the energy, passion, and commitment of the event and of the people in attendance. I enjoyed catching up with friends old and new in the lifestyle medicine community and hearing about progress and paths forward. Here are some themes and takeaways from this year’s meeting:

A Moment for Lifestyle Medicine

• This is a purpose and mission-driven group of professionals, who enjoy and leverage the power of community and global collaboration to further their worthy goals.
• There is strong interest and great progress in training and educating the next generation of clinicians in Lifestyle Medicine — more reason for hope as a generational shift in focus emerges.
• Lifestyle Medicine Board certification began in 2017, and 550 professionals sat for this year’s certification exam.
• Many leaders and attendees share the belief that this is a moment for Lifestyle Medicine, as the ability to deliver whole health can provide a way out of our current challenges, and be a key vehicle on the road to value.

Putting Lifestyle Medicine into Practice

• Delivering Lifestyle Medicine in practices and health systems is a team sport — as are most emerging care models that hope to deliver personalized, collaborative, value-based care beyond the walls of the clinic.
• Culture change among care teams is a critical component to successfully designed models of Lifestyle Medicine. I heard numerous accounts of achieving this by first exposing providers and teams to the Lifestyle Medicine intervention, which has the trebled benefit of building awareness, identifying champions, and fostering a healthier workforce less susceptible to burnout.
• Committed senior leadership is essential for successful program development within health systems. This is not work done on the fringes of a healthcare system but is a core strategic commitment to the health of an organization and the communities it serves.
• Cardiometabolic risk is a heavy focus for Lifestyle Medicine, given its lifestyle root causes, and impact on downstream conditions and events such as diabetes, heart disease, and stroke. Organizational positioning of Lifestyle Medicine as a core cultural competence as well as within cardiology, endocrinology, primary care, and bariatric centers is a key strategy to reduce morbidity, mortality, and cost related to these conditions.

Challenges and Opportunities

• Reimbursement for well-designed and effective Lifestyle Medicine remains a challenge. Reimbursement for shared medical appointments, obesity management, medical nutrition therapy, chronic condition management, and remote patient monitoring are all existing and potential paths to create sustainable models of lifestyle medicine care. There is some promise in new CMS Primary Cares models as those emerge as well. ACLM has created a reimbursement roadmap to guide its members.
• There is a strong and growing employer interest in Lifestyle Medicine approaches to disease treatment and reversal.
• The Lifestyle Medicine Provider Network officially launched last month with a mission “to build a galvanized provider network comprised of Lifestyle Medicine trained healthcare providers and physician-led clinical practice teams uniquely equipped to address chronic disease pain points in the marketplace specific to self-funded employers and insurers.”
• Community-based organizations are essential components of the Lifestyle Medicine delivery ecosystem and can be powerful partners for patients and traditional healthcare provider organizations.
• We have a great opportunity to support, enhance, spread, and scale Lifestyle Medicine programs with thoughtfully designed technology — to facilitate engagement, education, behavior change, relationships, and data-informed insights. Lifestyle Medicine is ideally suited to a future powered by digitally-enabled, continuous, collaborative, personalized care.

These are uncertain but exciting times in healthcare. Lifestyle Medicine provides hope that we can and will find our way — to combat the challenge of chronic disease, promote the health of patients and communities, flatten the cost curve of healthcare spending, and protect clinicians and caregivers from the epidemic of burnout.

I left Orlando feeling grateful to have been among the 1500 people attending this year’s ACLM conference, and inspired to continue collaborating to build the new healthcare. If you were there, I’d love to hear your perspectives. If you weren’t, I hope to see you there next year.