A new path to value-based care of chronic diseases

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Rochester Regional Health is helping steer a paradigm shift in patient treatment. The health care system is a founding member of a new group that supports the implementation of lifestyle medicine.

Formed by the American College of Lifestyle Medicine, the Health Systems Council is designed to support a collaborative community of health systems leading the transition to value-based care through the integration of lifestyle medicine. Organizations within the council include names such as Kaiser Permanente Southern California, Massachusetts General Hospital and Emory Healthcare.

Kerry Graff

“Right now, the entire medical system is set up around this idea that we’re treating diseases once they already exist,” says Kerry Graff M.D., who practices at RRH Family and Lifestyle Medicine in Canandaigua. “It was set up more than 100 years ago to treat the diseases that were seen then, which were mostly infections and trauma.”

While it made sense at the time, it doesn’t anymore.

“We’re still trying to take the same acute-care management mentality into treating all of the chronic lifestyle diseases that we’re seeing right now,” Graff says. “So, we really need to change our medical system to treat what is going on currently, what changes to make and how to make that fit.”

The ACLM defines lifestyle medicine as the use of evidence-based lifestyle therapeutic intervention as a primary modality, delivered by clinicians trained and certified in this specialty, to prevent, treat, and often reverse chronic disease. Lifestyle interventions can include a whole-food, plant-predominant eating pattern, regular exercise, restorative sleep, positive social connections and stress management.

Each system within the council is trying different approaches to introducing lifestyle medicine. 

RRH’s practice offers lifestyle medicine consultations, lifestyle coaching, a class to ease the transition to a whole-food and plant-based diet, among other services. It is not an alternative, homeopathic or integrative practice. 

“We’re not really sure what’s going to work,” Graff says. “Part of the process is that we need to reeducate our physicians because we were all taught how to treat diseases once they already occur. We are not taught how to prevent them.”

Chronic diseases include hypertension, heart disease, type 2 diabetes, obesity and several types of cancer. These diseases, experts maintain, are common, costly and preventable. Changing lifestyle behaviors can go a long way toward reducing mortality and, in some cases, avoiding the onset of these conditions. 

“We need to first learn that we’re capable of making those changes, that we can do that,” Graff says. “And then we’ve got to learn how we can help patients make those changes. How do we need to change what we offer within our health care systems to meet that need?”

Typically, medical professionals diagnose a disease, and design treatment plans—either medicine or surgery—to help manage the affliction. While individual physicians have promoted lifestyle behavioral changes, large-scale implementation of such approaches is a new step. The council hopes to offer a platform for health care organizations to exchange information and ideas, identify solutions, and speed up the integration and implementation of lifestyle medicine therapeutic modalities within health systems and communities. 

“This is pioneering work with systems who have identified that providing care through a lifestyle medicine lens and through lifestyle medicine programs is an avenue to successfully make a transition to value-based care,” says ACLM president Cate Collings M.D. “These organizations are leading edge in this recognition, and ACLM and patients are equally fortunate to move forward together in this direction.”

Implementing lifestyle medicine could have an impact on the cost of care as well. According to the Centers for Disease Control and Prevention, 90 percent of the nation’s $3.8 trillion annual health care expenditures are for patients with chronic and mental health conditions. For example, heart disease and stroke cost the health care systems $214 billion each year. 

In a 2018 article for the American Journal of Medicine, cardiologist James Rippe urges the medical community to act.

“Employing the principles of lifestyle medicine in the daily practice of medicine represents a substantial opportunity to enhance the value equation in medicine by improving outcomes for our patients and simultaneously controlling costs,” Rippe writes. “The time has come to truly practice lifestyle medicine and encourage positive lifestyle decisions for our patients and adopt them in our own lives. Our patients and our country should demand nothing less.”

ACLM’s Health Systems Council is one step in that direction.

Smriti Jacob is Rochester Beacon managing editor.

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