ACLM Sparked My Life

By Dave Donohue, MD, FACP

 

In April 21, 2018 I sent an email that has changed my life.  I emailed ACLM’s Executive Director Susan Benigas with a simple idea:  What if we formed a lifestyle medicine Accountable Care Organization (ACO).  I already knew from observing Susan that she is an energetic force of nature who makes things happen.  But I was not prepared for the flurry of energy that would be released by that email.


Fast-forward 16 weeks and we have formed a lifestyle medicine ACO!  Are you kidding me? Let’s step back.


I am Dr. Dave Donohue from Delaware, a primary care internist and board certified lifestyle medicine physician.  


I attended my first American College of Lifestyle Medicine (ACLM) conference in October 2016.  

I became inspired by this conference, and the following month I began my first Cure Diabetes program.  I have offered this program to 11 groups and over 150 participants from my practice. As is customary with lifestyle-focused disease reversal programs, we have had amazing success in reversing type 2 diabetes.


I attended with my wife and partner Dr. Deborah Zarek.  She immediately went more plant-based and began transforming our practice into a plant-based office.  Thanks to ACLM’s job listings, we now have 4 plant-based docs and 3 PA/NPs, all practicing lifestyle-focused medicine.  


At the conference, I met an amazing plant-based dietitian, Karen L. Smith, RD CDE.  Within a year, we hired her and it has been wonderful to have an energetic dietitian to help drive us forward.  Karen turned my disease reversal program from a personal project into a collaboration. Karen began running Food for Life classes in Delaware.


After the Lifestyle Medicine 2017 conference in Tucson, which I attended with our partner Dr. Jayshree Tailor, we stepped on the accelerator.  We began a monthly group disease reversal program “Be Well” that draws 30 participants each month.


Meanwhile, our practice has been a member of 2 regional Accountable Care Organizations (ACOs) since 2014.  In 2015 we joined the Aledade Delaware ACO. We have found our ACO to be a super valuable experience. Whereas before there was little or no interaction with our peer primary care practices, we now have a solid practice association.  


We share best practices and this has been transformational.  For example, our practice, with Aledade’s help, has become a Chronic Care Management (CCM) machine, receiving thousands of dollars per week with phone based counseling of our Medicare patients.  We deliver much evidence-based lifestyle medicine through those phone calls.


What has been missing in our ACO experience is lifestyle medicine and disease reversal.  Trying to reduce healthcare cost without addressing lifestyle is like trying to win a heavyweight boxing title by working harder and harder on your tap dancing skills.  It doesn’t work - believe me I’ve tried.


Nationally, the ACO experiment (a provision of the ACA/Obamacare), has had lackluster results.  The lifestyle savvy cynic would say “No surprise, nobody is focusing on lifestyle medicine, and mammograms don’t save cost.”


So imagine the possibilities if we could bring disease reversing wisdom to the ACO.  


Wayne Dysinger has been key to getting where we are today.  He has been involved with pioneering a lifestyle medicine practice in southern California, and he has had for years a clear vision on the possibilities of an association of lifestyle medicine practices.  


Susan, Wayne, and I had frequent discussions and subprojects since April.  In conjunction with the ACLM Board of Directors, we did a due diligence process to vet the many ACO partner organizations out there to see if there was one we could work with.  We identified a list of 7 such companies, and met with them. In the end, it was Aledade who was uniquely positioned to work with a national group of independent offices. Aledade expressed an enthusiasm to include ACLM in the governance of this new ACO, and ACLM was offered a 10% share of any funds we receive from Medicare.


How does an Aledade ACO work?  

  • Your practice pays $1 per Medicare beneficiary per month

  • Someone from your practice attends our monthly board meeting and a clinical call.

  • Staff from your practice work with a practice transformation specialist on a weekly basis, to receive training and coaching on driving best practices.

  • When we achieve shared savings, Medicare splits the savings with our ACO 50/50.  Your practice receives a big check in October.

Aledade is a very well run organization, staffed by professional and smart healthcare professionals.  I have found the company to be uncommonly responsive to physician concerns and ideas. In Delaware, Aledade took a lead role in helping us get some primary care friendly legislation passed this summer.  They really went the extra mile.


The Ask

Are you a decision maker in a primary care practice who cares for fee-for-service Medicare patients?  Do you aspire to move your practice in the direction of disease reversal and lifestyle medicine? Then we ask you to join our ACLM ACO movement.


Our hope and expectation is that the ACLM ACO will achieve what no other ACO can: very significant, 10% plus cost savings.  In so doing we will drive impetus for others to take notice and move in this direction. Such funds would fuel the growth of our practices and provide some welcome extra revenue for ACLM.  With training and expertise of ACLM guiding the way,

we expect to grow into a national lifestyle medicine network, and to have a strong collective voice for bottom-up healthcare reform in the US.  


Meanwhile we will form a powerful capability to distribute best practices freely among our member practices.  For example, I would gladly share all slideware and materials for my Cure Diabetes program. Recently I ran a Cure Hypertension group telehealth & CCM session.  Group telehealth is another opportunity to extend our reach, and I would enjoy sharing my slideware and provide training on that as well.


Every year that I attend the ACLM conference, I come back ablaze with new ideas, and my practice gets more and more unrecognizable.  I hope you will join me in October 2018 in Indianapolis at Lifestyle Medicine 2018, so you can join the ride!


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Interested in learning more about the ACLM ACO? Please contact info@lifestylemedicine.org.