Treating Lifestyles . The Structural Gap in Patient Care

As the COVID-19 pandemic continues to recede in the United States, the health care system is shifting more of its attention from the immediate threat of this infectious disease back to the ongoing threat of chronic diseases, which have long been the leading causes of death and disability in the U.S., as well as the leading drivers of the nation’s $3.8 trillion in health care costs.

Six in 10 American adults have a chronic disease, and a significant percentage of these conditions could be prevented with lifestyle change. Studies suggest that up to 90% of type 2 diabetes, 80% of coronary artery disease, 70% of stroke and 70% of colon cancer are potentially preventable through a reduction in five key lifestyle risk factors: unhealthy diet, inadequate physical activity, overweight, smoking and excess alcohol consumption.

Considering the unhealthy habits many of us picked up during the pandemic (decreased exercise, increased snacking, heavier drinking), compounded by stress and loss of sleep, we can expect a further surge in chronic disease — and the associated personal and financial costs.

How are we going to address this growing problem before it overwhelms our health care system, our economy, and our ability to compete and lead the world by the power of our example?

A lack of primary prevention

Much of the problem lies in the expectation that our existing health care infrastructure is going to solve this problem. Physicians don’t have the training or time to create personalized habit-change plans and ensure that patients follow them, nor are they adequately reimbursed for practicing lifestyle medicine.

While medical education is shifting to incorporate more behavior-change best practices into curricula, most physicians — aside from the key role they play in preventive screenings and identifying patients at risk — continue to focus on sick care rather than on keeping healthy people healthy.

The lack of primary prevention and consistent support for incremental habit change for healthy people represents a massive structural hole in our health care system and our society in general. And it’s a hole that physicians cannot and should not be expected to fill on their own.

The one-on-one personal coaching needed to help individuals achieve long-term successful habit change requires greater frequency of contact than is possible with typical health provider relationships, and although behavior change clearly results in long-term cost savings, it does not fit the fee-for-service model that most providers still operate under.

An opportunity for insurers and payers

The savings do, however, represent an opportunity to introduce the needed paradigm shift via insurers and corporate payers, who currently bear a large share of the cost of managing expensive chronic conditions once they have developed.

The front line in this battle should not be when patients are in the hospital dealing with symptoms, but much earlier — before unhealthy habits have had a chance to negatively affect people’s health.

Insurers and payers certainly recognize the value of promoting a healthier workforce, and they frequently offer preventive health programs for their members and employees. However, traditional health improvement and prevention efforts tend to be one-size-fits-all curriculum-oriented programs — modeled on our learning and education system — that rely on participants’ own motivation to find what works for them and stick with it. Unfortunately, it’s human nature to look for quick-fix solutions, particularly when it comes to lifestyle change and losing weight.

Many people give up if they don’t see the results they want right away. Traditional efforts also rely heavily on willpower, which is rarely enough when it comes to the complex issue of weight loss. An effective plan must also take into account a wide range of individual circumstances and characteristics, including the person’s medical history, genetics, social determinants, personality, intrinsic goals, readiness to change, and many other factors.

Habits are by definition cultivated over time, and sustainable behavior change requires one-size-fits-one coaching and support — in the context of a trusting personal relationship — to build confidence in making small incremental changes and keep individuals engaged, motivated and accountable over the long term. Fortunately, support for habit change is a role that lends itself well to a virtual environment, with telehealth coaching sessions complemented by smart remote monitoring tools such as fitness trackers and smart scales, along with the right gaming and curated social health community. This makes participation more convenient and accessible for employees while reducing costs for payers.

A new partner in health

In short, support for habit change is a task best suited to a new and different type of health specialist that insurers and payers can partner with to overcome lifestyle-related chronic disease. Just as there are many physician and allied health subspecialties that address the diverse aspects of diagnosis and treatment of various illnesses and health conditions, we should look to embrace a new (and virtual) front line of healthy habit change providers that can address primary prevention and effective habit change — working with and alongside physicians and the existing “sick care” infrastructure.

It’s time to fill that structural gap. The health of our families, neighbors, and country is at stake