Lifestyle Medicine in Health Systems
A case series on facilitators and barriers to implementation

Despite a growing body of evidence supporting the effectiveness of lifestyle medicine (LM) in preventing and treating chronic illnesses, its integration into mainstream medical practice remains limited. This can be attributed to various challenges, including insufficient clinician training, staffing concerns, and a misalignment of LM services with fee-for-service reimbursement models.

However, a comprehensive understanding of the factors that facilitate or hinder LM implementation and long-term success is still lacking. It is imperative to explore the experiences of different LM programs to glean valuable insights from both successful and unsuccessful cases.

This study seeks to identify critical barriers and facilitators to the initiation, growth, and scalability of LM within large health system settings.

We are conducting a multiple case study analysis of eight US health systems. Health systems self-nominated and most are members of the ACLM Health Systems Council. Out of 15 self-nominating health systems, we selected eight that represent diverse characteristics such as geographic location, type, size, expertise, funding, patient demographics, and LM service offerings.

For each selected case, we conducted in-depth interviews, reviewed relevant documents, conducted site visits, and held debriefings with the study team. These activities allowed us to construct comprehensive case narrative reports for each health system. Subsequently, we performed cross-case analyses to develop a nuanced understanding of predetermined and emergent topics, including billing practices, care delivery models, clinician training, leadership support and buy-in, intervention content, workplace culture, and burnout.

Our findings will be shared with participating health systems in deidentified case reports and disseminated through academic publications.