How to use shared medical appointments in under-resourced communities 

Two lifestyle medicine-certified clinicians who have successfully launched shared medical appointments share their experiences and advice for other clinicians interested in starting the innovative delivery model in their communities. 

By Alex Branch | ACLM Director of Communications 

September 4, 2025

As the chronic disease epidemic continues to grow—particularly in underserved and rural communities—lifestyle medicine clinicians face a pressing challenge of how to effectively deliver care that requires more time and education than the typical 15-minute exam allows.   

Shared medical appointments (SMAs) are not new, but have emerged as an innovative delivery model that allows lifestyle medicine clinicians to scale their impact by synergizing clinical care, education and peer support in a group setting. But clinicians who are exploring the possibility of starting SMAs may feel daunted by logistical, payment and cultural factors.   

To support clinicians interested in lifestyle medicine, ACLM offers a number of resources, including a Shared Medical Appointment Calculator and a Reimbursement Roadmap, as well as educational opportunities in which members learn from clinicians who have started SMAs in the communities they serve.  

ACLM spoke with two lifestyle medicine clinicians who have put SMAs into practice: Kathleen Findley, MD, MPH, DipABLM, medical director of the Lifestyle Medicine Program at Western Wisconsin Health, and Will Koopal, PA-C, DipACLM, of Albany Area Primary Health Care, a Federally Qualified Health Center in southern Georgia. In a Q&A interview, they share how they established SMAs in their communities and the key lessons they’ve learned along the way. 

Kathleen Findlay, MD, MPH, MHCDS, DipABLM

Tell us about the area you serve? 

We’re about 45 minutes outside the Twin Cities of Minneapolis and St. Paul in a unique area where we have access to some city amenities but are also a rural community. Many of our patients are unable to access the city for healthcare. Residents in our service area experience significant financial, housing and food insecurity. I joined a team with a dynamite dietitian and health and wellness coach, and we realized that the work we were doing was actually lifestyle medicine. I got my certification in lifestyle medicine from the American Board of Lifestyle Medicine in 2021.  

What led you start shared medical appointments? 

In trying to grow and scale a lifestyle medicine program, we discovered shared medical appointments. This was not an easy fit within a rural health clinic. Initially, we were told “No, you can’t do group visits because regulations don’t allow it.” But working with our coding team, we found that we could do shared medical appointments. You just can’t call them group visits. That’s important because colleagues across the country often say they aren’t allowed to do group visits. Sometimes it’s semantics, but by using the specific verbiage around shared medical appointments from the American Medical Association, you can get them validated through your legal department. 

How are your shared medical appointments structured?  

Often shared medical appointments are organized around patients with a certain diagnosis, such as hypertension. But we call our program “diagnosis agnostic” and bring in patients with different conditions—Dan has type 2 diabetes, John has hypertension, etc. Patients get to be their whole person, not a diagnosis, and we work in a holistic way. The variety in patient diagnoses actually contributes to the shared compassion and wisdom shared among participants. Initially, our intervention began as a three-week program, then grew to four weeks and now we are 12 weeks. We added an orientation session to level set on things like nutrition and goal setting. That has been helpful to our retention rate–47% of participants complete at least nine of the 12 classes. We also offer secondary SMAs, including a culinary series of SMAs and a monthly maintenance SMA for program graduates.  

How many patients attend the appointments?  

Our big conference room was within the critical access hospital, and rural health clinic requirements don’t allow us to bill there. So, we our space is limited to a small conference room. We schedule 10 patients but usually six to eight attend. After regular team assessments, we are in agreement that that eight people is a good number for these hour-long classes.  

How do you sell the idea to patients?  

Showing them patient outcomes from the course is a powerful tool. Pulling the data out of the EHR was challenging, but a few years ago ACLM President Dr. Padmaja Patel suggested just having our medical assistant input values into a deidentified Excel file we created for our program intervention. We track both qualitative and quantitative measurements, including standard clinical biometric values, such as BMI, blood pressure, and waist circumference. In addition, with a tool my partner created, called the simple health lifestyle assessment, we track and graph changes in lifestyle self-efficacy across the lifestyle medicine pillars.   

Could you share a success story?  

The story I share is about Dan. He came to us with multiple co-morbidities, A1c over 12, repeated hospitalizations, and severe depression. He has made slow and steady progress. His A1C is down in the 7s and he’s had no hospitalizations in two years. He rides his e-bike several times a day and comes to exercise classes at our facility four days a week. He even volunteers as a mentor for our program. He is a big voice in the community for our program.   

What do you tell other clinicians exploring shared medical appointments?  

Start with a strong value proposition and identify leaders in your organization to support you. You will run into hurdles with different departments and you need allies who will step up and say “This is worth doing.” One of our early missteps was pushing forward before we got buy-in from all the different departments. Decide early what stakeholders you need on board. And take advantage of all the resources ACLM offers to support you.  

William Koopal, PA-C, DipACLM

What led you to explore the concept of shared medical appointments? 

After PA school in Arizona, I returned to Albany and started working for a FQHC caring for a population that is about 70% to 80% African American, with high rates of chronic disease, low health literacy, and few nutritious food options. About three years ago, I asked myself “What are we doing?” My only tool was giving these people medications. When I was growing up, I had obesity and struggled with addiction for a time. I thought back to my sobriety journey, and the sense of community and support you experience in groups like Alcoholics Anonymous. To be honest, I hadn’t even heard of shared medical appointments at the time. 

How did you get started? 

Well, our CEO really liked what we wanted to do and gave us full rein. Our health system has thousands of patients, so I basically started looking for people with uncontrolled diabetes. They weren’t hard to find. I see patients every day with an A1c of 14, history of stroke, chronic kidney disease, amputations — patients just decimated by disease. And we started calling them, explained what we were doing and asked if they were interested. We found a call center at our health system, which is basically a big open lobby, to hold the classes. 

How are the shared appointments structured? 

We have shared appointments once a month, from 10 a.m. to noon, usually with about 10 but up to 15 patients.  Originally each class would cover a pillar of lifestyle medicine (optimal nutrition, physical activity, restorative sleep, stress management, connectedness and avoidance of risky substances) but now we have applied for a grant from the Ardmore Institute of Health and are transitioning to the Full Plate Living curriculum. I think it will make the classes much more organized and focused. Also, we have local farmers deliver fresh produce to our classes and that helps stimulate conversation. A lot of our people with diabetes do not know there is a correlation between their disease and their diet.  

How have you handled billing?  

(Laughs) Yes, that was a bit of a logistical nightmare at first. Our administration asked “Well, are you going to bring in money for this?” I hadn’t actually thought about that yet. But we figured it out. For every person who attends, we bill a CPT code of 99213, which is a follow-up visit.  That helps pay the farmer, the nurse, and part of my salary.  

What kind of outcomes have you seen? 

I went to PA school at A.T. Still University in Arizona and now host their PA students on rotations. The students help me gather data—they take health measurements at the beginning of a class, at the midpoint and at the end–to track progress. We submitted a poster to the National Association for Community Health Centers (NACHC) conference last year and got second place. Our program led to an average weight loss of almost 30 pounds, increased confidence in diabetes management and increased fruit and vegetable intake. We also have a few rock star participants who have really bought in and lowered their A1c.  

Any advice for a clinician interested in exploring shared medical appointments?  

Be patient and persistent. I honestly was ready to throw in the towel at one point because I wasn’t getting much traction. But then I was fortunate to receive a scholarship through ACLM’s National Training Initiative (scholarships that cover training and certification for a primary care provider in lifestyle medicine at FQHCs and Community Health Centers) and that gave me the spark I needed. I would advise anyone who is working at a FQHC to do their research on SMAs, join ACLM to collaborate with like-minded clinicians and approach their leadership with a clear and concise plan of how to integrate an SMA.  

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