Lifestyle medicine is gaining steam in mainstream medicine, and value-based care has already given us a boost.

But unlinking patient reimbursement from specific prescriptions and procedures won’t be enough to unleash the life-changing power of lifestyle medicine.   

If we’re truly committed to improving the health of our nation, we must use the patient outcome as the ultimate yardstick and stop penalizing physicians who pursue the most valuable kind of care for chronic conditions — disease remission. 

Within existing value-based care models, such as ACO REACH and MSSP, the six pillars of lifestyle medicine become far more valuable to a physician than under fee-for-service. Previously, it barely has been worth the effort to bill for some of our efforts.  

We literally write prescriptions that address nutrition, physical activity, stress, risky substances, sleep and social connection. Good luck finding some of those CPT codes. 

Under these new fully-capitated, value-based reimbursement models, physicians are effectively paid a set amount per patient each year. Then it’s up to us to provide the most cost-effective care.  

It would make sense, even for previously disinterested physicians, to turn to high-impact, low-cost interventions. According to the World Health Organization, 80% of heart disease, stroke and type 2 diabetes could be reversed if we focus on lifestyle factors. Roughly 40% of all cancers could be avoided, mostly by behavior change.  

But it’s clear the U.S. healthcare system still isn’t a true believer in lifestyle medicine.  

Hurt by Quality 

Our quality measures, which increasingly determine how much we get paid, effectively discourage us from pursuing disease remission through lifestyle change. 

The way we’re judged on treating high cholesterol exposes the persistent priorities of our system.  

• A colleague who is board certified in lifestyle medicine had a Medicare Advantage patient diagnosed with hyperlipidemia.  

• Total cholesterol was high but borderline.  

• Instead of prescribing the routine statin regimen, this physician opted for the more tedious work of prescribing lifestyle modifications and helping the patient stick with them. 

Three weeks later, total cholesterol had dropped out of hyperlipidemia ranges. The patient was thrilled. The physician had provided the most valuable care and deserved more than a grateful patient.   

But the CMS 5-Star Rating System didn’t see the good that had been done. The episode resulted in a C rating, rather than the A this physician deserved, because our quality measures are based mostly on managing diseases the way we have for so long — with medication.  

I’ve shared this anecdote several times, including with policymakers in Washington, D.C., in the hopes that they will finally hear what lifestyle medicine evangelists have been saying for years. Our system remains focused on managing the chronic diseases that afflict 2 out of every 3 Medicare patients and not truly providing a path to better health. 

Outcomes Are Everything 

It may seem easier to measure success by focusing on the process of prescribing a pill for every ill. But it should be no more difficult to measure patient outcomes. The proof is right there in front of us — in cholesterol lab work, blood sugar readings and spirometer results.  

I’m not shouting into the wind here. CMS is developing “a universal foundation” for all quality measures to streamline 2,500+ data points physicians have been measured on in recent years.

We would be wise to keep our collective eyes trained on how physicians address nutrition, physical activity, restorative sleep, social connections, stress management and avoidance of harmful substances. 

When we fully embrace lifestyle interventions, we will truly unleash a new era for value-based care. 

Padmaja Patel, MD, is a medical director for Wellvana and the president-elect of the American College of Lifestyle Medicine.