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With change comes opportunity.  The best minds in the business of healthcare gathered at the first-ever Lifestyle Medicine Practice Management Workshop to guide Lifestyle Medicine providers in positioning themselves and their practices for success.  We asked several of these thought leaders to share their perspective on what they see as critical changes underway in healthcare and how practitioners of Lifestyle Medicine can make the most of these opportunities.

Sandra Lawson, MBA, Executive Director of the Institute of Lifestyle Medicine provides perspective on the changes occurring through healthcare reform, and through increased transparency for all providers - the ability of payers and consumers to understand the value they're receiving, quality that will be measured in numbers.  

"Capitation failed because it was perceived as rationing care.  There was no mechanism to quantify quality, no identification of measures of quality.  Under new reimbursement models, such as ACO's, this will change.  There will be value and quality metrics and providers will be paid based upon quality.  This changes the game as far as how providers are paid."   She describes the Patient Centered Medical Home as a model of care that will measure and require patient engagement as a key component.  "This was not measured before and was not considered a metric for how providers perform.  Patient engagement is critical within Lifestyle Medicine - a key competency and an area where Lifestyle Medicine providers may outperform other providers."  She also points to the Medicare Annual Wellness Visit as a recent change and potential revenue stream, with 46 million patients now able to schedule a visit strictly to discuss prevention and wellness.  "These are new modes of reimbursement.  To be successful, providers must be competent in wellness and prevention and must be able to engage patients."  

She goes on to describe how transparency measures such as those currently imposed upon healthcare institutions will affect physicians.  "As of yet physicians have not been affected; however, Medicare's voluntary Physician Quality Reporting System (PQRS), which offers physician's bonuses for reporting quality measures, will become mandatory with bonuses tied to outcome and will be published on Medicare's Physician Compare website.  Physicians must choose measures relevant to their specialty and to their patient population and with that, consumers and payers will be able to assess the value received."  She describes how insurers will tie measures to reimbursement, offering the example of the Medicare Advantage star rating that now gives insurers bonuses. Members of plans are asked questions such as whether their physician spoke with them about exercise.  "This is very relevant to Lifestyle Medicine competencies.  We are going to see these measures built into physician ratings and reimbursement.  This puts Lifestyle Medicine, especially within the primary care context, in a good position to negotiate favorable contracts with insurers for the Medicare Advantage Plan.  Keeping people healthy instead of focusing on treating illness will drive how physicians contract with insurers.   

Lifestyle Medicine physicians are uniquely positioned to achieve good health outcomes. But keep in mind that we've not truly measured Lifestyle Medicine efficacy as of yet. Through transparency, we'll be able to study and measure the efficacy of Lifestyle Medicine." 

Sandra Lawson sees opportunities in both primary care and specialty practices.  "Lifestyle Medicine offered within the primary care context will be able to perform well within the ACO and PCMH systems.  And there will be opportunities as well for specialists to contract with ACO's, especially those specialists who can take on high-risk patients and achieve behavior change."  She envisions opportunities for marketing based on successful outcomes.  "As we see numbers - quality measures on true outcomes - we'll then see marketing opportunities for physician practices to highlight strong ratings in the way that hospitals now use Hospital Compare ratings.   

With coming changes, the ability to track outcomes will become paramount for success.   "Physicians must prepare themselves to collect information electronically. Information technology will be critical to performance.  When sorting out how they will deliver care, physicians must also be prepared to collect and report clinical data.  Data management will drive performance."   

Edward Noffsinger, PhD, pioneer of group medical visits and originator of the Drop-in Group Medical Appointment (DIGMA) and the Physicals Shared Medical Appointment (PSMA) models offers his views on key changes that will impact healthcare.  "First, we now have an aging population with baby boomers emerging from the pipeline in increasing numbers as the sickest, most multi-morbid, sedentary, obese generation in our nation's history. Second, we have the most sedentary, obese, and unhealthy pediatric population reaching adulthood - one in which type 2 diabetes is rapidly on the increase. Third, we have fewer medical students choosing primary care while seasoned and experienced internal medicine/family practice/geriatricians are moving into retirement and are not being adequately replaced. And fourth, under the Affordable Healthcare Act, we'll have an additional twenty to forty million previously uninsured patients with coverage, all of which raise the question of who is going to take care of these patients?  We're also seeing a shift in the last century from acute to chronic care with the vast majority of our nation's healthcare dollars going into the care of chronic conditions, almost all of which have a significant lifestyle component."  

Dr. Noffsinger sees Lifestyle Medicine as particularly well-suited to address the root causes of chronic disease and sees Lifestyle Medicine practitioners as ideally-suited to deliver healthcare in group settings, maintaining that the root causes of chronic disease can often be best addressed in group medical visits.   

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