Use of lifestyle medicine interventions show economic benefits

Lifestyle medicine interventions are driving cost savings for employers by improving employee health and reducing chronic disease care expenses. This blog highlights evidence showing that investing in lifestyle medicine not only enhances health outcomes but also delivers significant financial returns on investment for businesses.

By Mary Anne Kiel, MD, FAAP, FACLM, DipABLM, CPE
Pediatrician & Lifestyle Medicine Physician
US Air Force Colonel (Ret)
August 19, 2024

Background

The current state of U.S. healthcare costs and the ever-growing need for chronic disease care require a strategic pivot toward high-value care delivery. The rapidly growing field of lifestyle medicine (LM) offers the evidence-based opportunity to support high-value care that meets the Quintuple Aim: lower-cost care; patient-focused therapeutic interventions focused on what is important to the patient (thus, improved patient satisfaction); significantly improved health outcomes; improved healthcare staff well-being; and the advancement of health equity. The rapidly growing field’s potential to create cost savings should be of interest to employers.

Solution

The American College of Lifestyle Medicine defines LM as “a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions including, but not limited to, cardiovascular diseases, type 2 diabetes, and obesity. Lifestyle medicine-certified clinicians are trained to apply evidence-based, whole-person, prescriptive lifestyle change to treat and, when used intensively, often reverse such conditions. Applying the six pillars of Lifestyle Medicine—a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections—also provides effective prevention for these conditions.”1

A variety of healthcare delivery models have shown success in operationalizing LM in primary care, using approaches including shared medical appointments, in-person versus virtual engagements, and synchronized versus asynchronous evaluations (patient interactions occurring in a face-to-face or virtual appointment versus care delivered via email or capturing health data that is transmitted/uploaded and viewed/addressed later by a clinician who then responds with assessment and treatment, or medical record review).2 

Examples of economic benefits

• A 2020 publication reported significant clinical effectiveness and long-term healthcare cost savings after analyzing data from the DiRECT Trial, a two-year intensive lifestyle intervention program in the United Kingdom that produced diabetes net remission at two years in 32.3% of the participants who were randomized into the lifestyle weight management program compared to only 3.4% of those in the control group. The intervention group had significantly less use of oral glucose-lowering and anti-hypertensive medications, as well as fewer healthcare contacts for diabetes. Lifetime costs were estimated and modeled per quality-adjusted life-year (QALY) including projected relapse rates, with the intervention modeled to achieve a QALY gain and mean total lifetime cost savings per participant of £1337, significantly outperforming the standard of care and becoming cost-saving within six years.³
• Total procedure costs for coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) for patients with known coronary artery disease who were enrolled in the Ornish Intensive Cardiac Rehabilitation (ICR) program required only one-third of the cardiac procedures (a cost savings of almost $30,000 per patient over a three-year period), compared to those in a control group, resulting in almost 80% of people being able to safely avoid surgical interventions. Overall patient adherence with wellness program interventions after one year was 88%.⁴
• Comprehensive lifestyle changes occurring over a three-year period using the Ornish ICR program resulted in an estimated cost savings of $17,687 per patient based on their expected rate of required cardiac procedures. Additionally, analysis of claims data showed significant reductions in both emergency department (ED) visits (19.3% reduction in ED visits for chest pain and 55.4% reduction in ED visits for all causes) and hospital admissions (89.4% reduction in hospital admissions for chest pain/angina and 84.1% reduction in hospital admissions for all causes) for patients who participated in the Ornish ICR program.⁵
• Self-insured health plan members with hypertension, hyperlipidemia, diabetes, or a combination of these conditions met with a pharmacist regularly over the course of five years to implement LM interventions and to optimize medication therapy. The combined healthcare and productivity ROI for the program at five years was $9.64 for every $1 invested, attributable to significant improvements in patient biometrics and less need for pharmaceuticals, procedures, and specialty referrals.⁶
• Pivio, previously known as the Complete Health Improvement Program (CHIP), is a “lifestyle enrichment program designed to reduce disease risk factors through the adoption of better health habits and appropriate lifestyle modifications.” It serves as a reproducible model for LM. A case report from Vanderbilt University describes an intervention which offered CHIP free of charge to employees utilizing the employee health plan with a “clinical diagnosis of type 2 diabetes (T2D) while having at least two consecutive years of coverage under the plan.” Reductions occurred in medications and medical claims, improvements in biomarkers, as well as survey responses related to life evaluation, physical health, emotional health, healthy behaviors, work environment, basic access, and a well-being index. Approximately 23.8% of study participants eliminated one or more of their medications. Reduction in healthcare cost to the system equated to a net savings of $67,582, showing the feasibility of LM education to a member population.⁷
• A five-year observational study by the University of Pittsburgh Medical Center initiating a comprehensive wellness, prevention, and chronic disease management program for 13,627 participants that tied achievement of health and wellness requirements to receipt of an annual credit on participants’ health insurance deductible showed significant improvements in health-risk status and increases in use of preventive and chronic disease management services in the intervention group. Although total healthcare costs increased, reductions in costs were significant for those who moved from the higher-risk levels to the lowest-risk levels.⁸
• An initiative spearheaded by Carmel Clay School in partnership with Ascension St. Vincent Health, Carmel, Indiana, offered wellness center services at no cost to employees. Over a four-year period, they showed engagement of 49% of the 2,077 total employees, chronic disease risk reduction in multiple health risk categories, and reduction in medications for diabetics. Additionally, they showed an average cost decrease of 36% for individuals who were engaged in the onsite clinic and a savings of $5 million dollars in 2017, even after accounting for the cost of the clinic to thoseutilizing the services (non-peer reviewed publication).⁹
• A 12-week wellness initiative utilizing a nutrient dense, plant-rich dietary protocol involving 77 employees resulted in a 41% reduction in monthly healthcare costs and a financial savings of more than $232,000 over a 16-month period, in addition to significant improvements in employee biometrics, depressive symptoms and quality of life measures (non-peer reviewed publication).¹⁰
• A 2019 article highlighted the medical and financial benefits to be incurred by self-funded employers who embrace a LM-focused business model, specifically by using plan designs which leverage requirements for education and behavior change therapies for patients with lifestyle-associated chronic diseases. It reported significant positive outcomes and performance guarantees which are uncommon in conventional designs.¹¹

Conclusion

It is recognized that some of the above illustrations are limited by small sample size, lack of long-term outcomes data and design type, however, their results show impressive ROI trends. While more studies will provide additional ROI clarity, these examples serve as a solid threshold for continued advocacy of LM integration, especially for value-based organizations and self-insured employers who stand to benefit significantly from improved employee health, risk reduction and cost savings.

1. American College of Lifestyle Medicine. Overview. lifestylemedicine.org. March 8, 2024. Accessed August 8, 2024, https://lifestylemedicine.org/overview/
2. Pauly K. Delivering High-Value, Whole-Person Care in Current Payment Models. American College of Lifestyle Medicine. lifestylemedicine.org. January 6, 2024. Accessed August 8, 2024, 2024. https://lifestylemedicine.org/articles/lifestyle-medicine-payment-models/#:~:text=Opportunities%20for%20Lifestyle%20Medicine&text=These%20models%20allow%20interdisciplinary%20care,as%20intensively%20or%20non%2Dintensively.
3. Xin Y, Davies A, Briggs A, et al. Type 2 diabetes remission: 2 year within-trial and lifetime-horizon cost-effectiveness of the Diabetes Remission Clinical Trial (DiRECT)/Counterweight-Plus weight management programme. Diabetologia. 2020;63(10):2112-2122. http://doi.org/10.1007/s00125-020-05224-2
4. Ornish D. Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project. Am J Cardiol. 1998;82(10b):72t-76t. http://doi.org/10.1016/s0002-9149(98)00744-9
5. Highmark Cost Analysis. Dean Ornish Program for Reversing Heart Disease Cost Effectiveness Summary. www.ornish.com. Updated June 12, 2000. Accessed August 8, 2024 https://www.ornish.com/wp-content/uploads/Highmark-cost-analysis-2.pdf
6. White ND, Lenz TL, Skrabal MZ, Skradski JJ, Lipari L. Long-Term Outcomes of a Cardiovascular and Diabetes Risk-Reduction Program Initiated by a Self-Insured Employer. Am Health Drug Benefits. 2018;11(4):177-183.
7. Pivio Lifestyle Medicine Institute. Piviohealth.com. Accessed August 8, 2024, https://piviohealth.com/
8. Parkinson MD, Peele PB, Keyser DJ, Liu Y, Doyle S. UPMC MyHealth: managing the health and costs of U.S. healthcare workers. Am J Prev Med. 2014;47(4):403-410. http://doi.org/10.1016/j.amepre.2014.03.013
9. Vital Inccite Population Health Solutions. Employee Wellness Center Delivers Exceptional Outcomes for School System. Employersolutions.ascension.org. Accessed August 8, 2024, https://employersolutions.ascension.org/-/media/project/ascension/employersolutions/pdfs/carmel_clay_schools_case_study-final.pdf
10. Sutliffe J, Scheid J, Gorman M, et al. Worksite Nutrition: Is a Nutrient-Dense Diet the Answer for a Healthier Workforce? Am J Lifestyle Med. 2018;12(5):419-424. http://doi.org/10.1177/1559827618766485
11. Gulati M, Delaney M. The Lifestyle Medicine Physician’s Case to Self-Insured Employers: A Business Model for Physicians, a Bargain for Companies. Am J Lifestyle Med. 2019;13(5):462-469. http://doi.org/10.1177/1559827619843882