Lifestyle improvement: An untapped resource in population health

Dec. 4, 2015 / By L. Gordon Moore, MD

The recent report describing a decline in new cases of diabetes is good news. An article about it in The New York Times does a nice job describing the lifestyle changes individuals have made to reduce their personal risk. The article is informative on several levels:

1. People manage their own behavior. The paradigm of “patient compliance” is flawed and ultimately not helpful. There is good science around behavior change and we can use that science to inform how we work with people to help them get better outcomes.¹
2. Lifestyle modification has a profound impact not just on a specific condition like diabetes, but also on many conditions: hypertension, depression, elevated cholesterol, and so on. In other words, lifestyle is one of the root causes of many conditions. If we can help people improve their lifestyle the impact is multiplied across most of their conditions.
3. Working with a person can have greater overall impact than a focus on a specific disease. As I’ve written before – a person- (not disease) focused relationship over time is one of the fundamental attributes of health care that leads to better overall population health.²

A question I hear all the time: “What actions can we take that will help us achieve good quality metrics and succeed in this value-based contract?”   Most of the time we think about improving our management of conditions. This is necessary work, but likely to be both difficult, as we address multiple conditions, and insufficient, as we consider the relative impact of lifestyle versus medical management. Both are necessary. Supporting lifestyle modification is likely to have a powerful impact on health outcomes.³ The impact is multiplied across many conditions and the science for brief intervention through primary care is strong.

L. Gordon Moore, MD, is senior medical director for populations and payment solutions at 3M Health Information Systems.

Today’s value-based care models require a different kind of quality measure. Learn the 10 questions payers must must ask when choosing a value measure.  

¹Thomas Bodenheimer et al., “Patient Self-Management of Chronic Disease in Primary Care,” JAMA 288, no. 19 (November 20, 2002): 2469–75.

²Barbara Starfield, Leiyu Shi, and James Macinko, “Contribution of Primary Care to Health Systems and Health,” The Milbank Quarterly 83, no. 3 (September 2005): 457–502, doi:10.1111/j.1468-0009.2005.00409.x.

³Evelyn P Whitlock et al., “Evaluating Primary Care Behavioral Counseling Interventions: An Evidence-Based Approach,” American Journal of Preventive Medicine 22, no. 4 (May 2002): 267–84.