The potentially ill-fated Affordable Care Act was implemented, in part, to address this very issue by paying providers based on results rather than on number of procedures performed. Though the act represents a step in the right direction, it is not enough – further work must be done if America is to have a healthcare system that is sustainable, affordable, and equitable for all of its citizens.
One way for us to take the next step towards a healthier and more cost-effective future is by focusing on behavioral waste – costs resulting from lifestyle choices such as bad eating habits, smoking, poor adherence to health plans, substance abuse, and limited stress management. These habits are not only costly (between $303 and $493 billion per year), they’re deadly; heart disease, obesity, diabetes, and certain types of cancer have all been traced back to the choices we make in our everyday lives. Although that may sound discouraging, it ought to be empowering. Everyday habits can be reversed, and with them, so can the costs and diseases they create. That is the aim of lifestyle medicine, the competency that will help determine the future of healthcare in America.
Whereas drugs and surgery tend to focus on treating the symptoms of chronic diseases, lifestyle medicine targets the behaviors that are root causes of them – thus creating a feedback loop of sustainable health-care rather than revolving door sick-care. Led by pioneers such as Dr. Dean Ornish, President and Founder of the nonprofit Preventive Medicine Research Institute, a growing body of evidence demonstrates the clinical and financial effectiveness of lifestyle medicine. Specifically, Dr. Ornish has proven in over 25 peer-reviewed studies that lifestyle medicine:
- Reverses the progression of even severe coronary heart disease, generates more reversal after five years than after one year, and leads to 2.5 times fewer cardiac events.
- Reverses the progression of type 2 diabetes, high cholesterol levels, hypertension, and obesity;
- Slows, stops, or reverses the progression of early-stage prostate cancer;
- Beneficially changes the expression of your genes in over 500 genes in three months;
- Lengthens telomeres, thereby beginning to reverse the cellular aging process.
These unprecedented clinical effects are grounded in similarly transformational financial ones. To illustrate these impacts, let us examine lifestyle medicine’s impact on heart disease in America.
Heart disease is currently the leading cause of death in the United States, and 90% of it is attributable to lifestyle-related activity. Furthermore, it accounts for 17% of all health expenditures in the United States and its costs are expected to triple to $818 billion by 2030. Simply put, there is no aspect of the healthcare industry that needs lifestyle medicine more than heart disease does – and in 2011, Medicare recognized that need. It did so by deciding to reimburse for 72 hours of a new benefit category, Intensive Cardiac Rehabilitation (ICR), which covered – for the first time – lifestyle medicine programs such as Dr. Ornish’s program, Ornish Lifestyle Medicine™. Since that time, other commercial payers have followed Medicare’s lead and decided to cover the program, thus establishing lifestyle medicine as a viable clinical treatment alternative for cardiac disease.
These votes of confidence from Medicare and other commercial payers have not gone unfulfilled by Ornish Lifestyle Medicine – far from it. By the second quarter of 2016, the program had over 1500 participants nationwide, and their results actually exceeded those predicted by clinical trials. Over the course of the nine-week program, the average participant’s weight decreased by 5.9%, cholesterol decreased by 20.5%, triglycerides decreased by 12.1%, blood pressure decreased by 6.15%, and depression score decreased by 53.5%.
Along with these superior clinical outcomes, Ornish Lifestyle Medicine has reduced long-term costs for providers – thus making the program extremely valuable as the industry seeks to reduce behavioral waste and transition to a fee-for-value payment model. A study conducted at a large commercial health plan, for example, determined that offering Ornish Lifestyle Medicine resulted in an average savings-per-participant of $17,687 over a three-year period (based on the value of the dollar in 2000). Providers and patients also benefit from the program’s attendance rate, 93.5%, which clearly outstrips that of other, more-traditional methods for combatting heart disease. For providers, this rate means more reimbursable hours, and therefore, more revenue; for patients, this rate means life-changing clinical outcomes, reduced readmissions, and lower long-term costs.
In short, this program has created a new paradigm for how we treat heart disease in America; it brings about a synergy between the interests of providers and consumers in an often zero-sum healthcare industry, and it does so by targeting the very same behavior patterns that generate the majority of our country’s behavioral waste: nutrition, stress, exercise, group support, and smoking. This approach extends beyond heart disease as well; as Dr. Ornish’s research demonstrates, lifestyle changes bring about similar results for patients with prostate cancer, obesity, diabetes, and other chronic diseases as they do for patients with heart disease.
The use of lifestyle medicine to treat heart disease starkly contrasts the methodology of the rest of our healthcare system. A cartoon that Dr. Ornish likes to show during his presentations illustrates this very point; in the cartoon, a janitor is trying to mop up water on the floor of a bathroom, but the faucet is still running and the sink is still overflowing while he does so. “Wouldn’t it make more sense,” Dr. Ornish asks, “if we just turned off the faucet?” That’s the difference between our current healthcare system and lifestyle medicine; lifestyle medicine turns off the faucet - it corrects the behaviors that cause chronic diseases and behavioral waste - whereas our current healthcare system simply keeps trying to mop up the floor.
We must, therefore, follow the heart disease industry’s lead and expand the use of lifestyle medicine. Doing so would directly limit chronic disease and behavioral waste in America, and bring us one step closer to a healthcare system that makes sense for patients, providers, and the country alike.