The US spent a record $4.1 trillion on health care in 2020. Costing us $320 billion annually, health inequities are on track to exceed $1 trillion by 2040, an increase that would cost the average person $3,000 a year, up from $1,000 today. Chronic diseases, one of the main drivers of health care costs, affect 6 in 10 American adults.
If we are serious about changing the unsustainable trajectory of US health care spending, it is time to stop controlling disease and start finally addressing the root causes of chronic disease and its associated costs.
The good news is that most of these chronic diseases, from diabetes to heart disease and many others, are related to lifestyle. That means many of them are not only preventable but treatable and even reversible with lifestyle behavior changes.
As the White House prepares for its September 28 Conference on Hunger, Nutrition and Health—the first of its kind In 50 years, it’s time to change not only the way we talk about chronic disease, but also the way we prepare healthcare professionals to help patients make sustainable lifestyle behavior changes, as well such as improving the financial incentives for doctors to do so successfully.
Prevention is not enough
Most health care strategies to reduce the incidence of disease focus on prevention. But, with so many already sick, that’s not enough, not for those currently suffering or as an effective cost-cutting measure. There is growing evidence that common chronic diseases, including diabetes and heart diseaseare treatable and reversible with therapeutic lifestyle medicine interventions in sufficient doses. Lifestyle medicine is an evidence-based specialty that harnesses behavior change in areas such as nutrition and physical activity to treat the underlying cause of chronic noncommunicable diseases, without the exorbitant cost of many other interventions.
Consider diabetes, which affects 37 million Americansthe vast majority of whom have type 2 diabetes. They incur an average of $16,750 a year in medical expenses, about 2.3 times more than those without diabetes, according to the American Diabetes Association. By 2030, the prevalence of type 1 and type 2 diabetes is forecast to increase by 54 percent and cost more than $622 billion annually. One in five teens has prediabetes.
Most treatment plans are prescribed just to control diabetes. Such an approach is better than leaving a disease untreated, but ultimately results in an ever-increasing use of medications and procedures. Instead, the goal should be to achieve a clinical outcome of type 2 diabetes remission.. In fact, an expert consensus statement published by the American College of Lifestyle Medicine found agreement that it is possible to achieve remission with diet alone. Hardly an outlier, this statement was endorsed by the American Association for Clinical Endocrinology, endorsed by the Academy of Nutrition and Dietetics, and co-sponsored by the Society for Endocrinology.
What if our system offered financial incentives for primary care providers to support lifestyle interventions, delivering an annual bonus payment as long as patients maintain a referral? According to a 2018 modeling study, this approach could lead to significant cost savings in the future, potentially reducing costs by thousands of dollars per patient treated each year. Such savings will benefit the overburdened health care system as well as patients, 41 percent of whom report financial hardship from medical bills. Similar potential economic benefits have been identified for other lifestyle medicine interventions targeting conditions such as obesity, high blood pressure, and liver disease.
obstacles to progress
So why isn’t lifestyle medicine more widely practiced?
One obstacle is training.
In 1985, the National Academy of Sciences recommended a minimum of 25 hours of nutrition education, but today only 27 percent of medical schools in the US offer that minimum. A good step forward would be to promote the inclusion of substantive nutrition and diet training in health professional training programs such as medical schools and residency. In November 2021, Representative James McGovern (D-MA) introduced House Resolution 784 calling for exactly that.
Another hurdle is reimbursement.
More than half of physicians who practice lifestyle medicine report receiving no reimbursement for these interventions. Let’s stop punishing doctors who take the time to work with their patients and start rewarding them for prioritizing lifestyle medicine interventions, especially when patients achieve their goals. The dominant fee-for-service model rewards a greater number of procedures and services performed. While some promising value-based payment models have been implemented in the last decade, many of them are based on care coordination, health screenings, medication adherence and disease management.
Lifestyle medicine emphasizes disease remission, but because quality measures and payment incentives that reward restoration of health are often missing from value-based payment models, value actual deliverable is limited. We must move away from emphasizing process measures, towards outcome measures and financially reward those who achieve better results. Accountable care organizations that incorporate lifestyle medicine are more likely to deliver better health outcomes and cost savings.
It is also critical that we remove coding reimbursement barriers that limit where care can be provided. Such barriers currently prevent providers from being paid if they see patients outside the office in places where people gather, such as churches and community centers. Removing such barriers would allow providers to better reach communities historically disproportionately impacted and medically under-resourced.
Health systems can lead the change
Fortunately, the momentum for change is growing. Large health systems are increasingly integrating lifestyle medicine and showing that they value physicians certified to practice it. The Departments of Defense and Veterans Affairs recognize that chronic diseases are a threat to warfighting capacity and national security and are incorporating concepts of lifestyle medicine into the care they provide.
Real sustainable change will take time. But every day that we delay these sensitive and essential changes in the way we deliver health care is another day that our chronic disease crisis has a devastating impact and becomes more overwhelming.
Source: www.healthaffairs.org