Bringing health care and nutrition closer together

Losing weight consistently makes the Top 3 for New Year’s resolutions. Closely related to this are pledges by Americans to exercise and eat healthier. According to a review of the most popular Google “how-to” searches made during the first week before and after New Year’s 2015, learning to cook healthier fare made the top 10, including kale chips (#2), lentils (#5), cabbage (#6), collard greens (#8) and broccoli (#9). Luckily for resolution makers, there are 3 developments in healthcare that will help them follow Hippocrates counsel to “Let medicine be thy food and let food be thy medicine.”

  1. Clinics located in supermarkets
  2. Primary care focus on exercise and nutrition
  3. Expanded coverage for exercise and nutrition counseling

These developments should not only contribute to New Year’s resolution success stories, but they are also consistent with the objectives of the Triple Aim (better outcomes, lower cost and increased patient satisfaction).

Clinics located in supermarkets

Retail clinics have proliferated and their visibility in the U.S. healthcare system is increasing. These clinics emerged over 15 years ago to offer routine, non-emergency care in non-traditional locations, such as supermarkets and pharmacies. They were designed to offer greater convenience and lower cost to the patient and reduce the number of unnecessary visits to urgent care and emergency departments.

Health systems, hospitals, physician practices, as well as payers, have begun to see the advantage of engaging the patient on their terms, which includes the use of telemedicine and retail clinics. There are now more than 100 partnerships between health systems and retail clinics according to an April 2015 study from the Robert Wood Johnson Foundation.

Through these partnerships, patients can take advantage of the convenience and lower cost that retail clinics offer, while still keeping their physicians apprised of the care they receive and have it included in their electronic medical record. Increasingly, the care offered at these locations is expanding beyond immunizations and the treatment of minor acute issues, and now includes management of chronic conditions, such as diabetes.

While the 10.5 million primary care encounters occurring at 1,800 retail clinics nationwide represent only 2% of all primary care visits, this has increased rapidly over the past few years and shows no signs of slowing.

Primary care focus on diet and exercise

The partnership between primary care providers and retail clinics is particularly important to those with chronic conditions. The increasing prevalence and severity of such conditions, such as diabetes and heart disease, are associated with poor diet and lack of exercise. Now patients not only have greater access to their doctor to monitor lab results and medications, but this access is now more likely to occur in a place that affords them the greatest opportunity to make positive lifestyle changes – the supermarket.

A routine primary care visit for a person with diabetes, congestive heart failure or heart disease, is a golden opportunity for the physician to discuss lifestyle behavior, such as diet and exercise. The Shop With Your Doc program currently being offered by St. Joseph Hoag Health in Orange County, California and the nutrition and cooking classes offered to medical students at the Tulane University School of Medicine in New Orleans are just two examples of how the healthcare system can promote positive health behaviors in their patients.

Expanded coverage for diet and exercise counseling

While it is important for physicians to understand how to communicate with patients and achieve positive behavior change with diet and exercise, this probably isn’t the most cost effective method for relaying this information to patients. Luckily, there is a large cadre of nutritionists, dieticians and clinical diabetes educators available to provide this service at a much lower cost.

The U.S. Preventive Services Task Force (USPSTF) may have just given nutrition and exercise counseling the boost it needs. Its December 2015 update of its 2008 recommendation is that asymptomatic overweight or obese adults ages 40-70 should be screened for abnormal blood glucose levels. High blood glucose results should then be followed by lifestyle interventions, which includes diet and exercise counseling.

Under the Affordable Care Act, insurers must cover those services that receive a grade A or B from the USPSTF, whether offered at the primary care practice office or offsite at a hospital or within the community. Since a November 2015 CDC report estimates that 40 percent of 40-59 year old adults and 37 percent of adults aged 60 and over are obese, the impact of this recommendation could be substantial.

Next Steps

The link between nutrition and disease has been well established for years. The increasing rates of obesity, diabetes and other chronic health conditions has created a burden on the healthcare system that medicine alone cannot effectively address. Engaging patients at key locations (e.g., supermarkets, fitness centers, their own residences) and offering services (diet and exercise counseling) that will have the greatest impact on their condition is a trend that must continue to help achieve the goals of the Triple Aim.

Steve Delaronde is director of consulting for populations and payment solutions at 3M Health Information Systems.


Do you want to achieve better care and outcomes at a lower cost?  Try putting population health management into action.

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