Excerpt from a May 2011 YouTube video (FMU featuring Dr. Mark Hyman) in which Dr. Hyman argues that medical reimbursement must change to enable widespread lifestyle medicine. He advocates reimbursing intensive group lifestyle-behavior programs at rates comparable to procedures (argues parity with angioplasty), describes a proposed Senate bill called 'Take Back Your Health' that included a 'double payback' mechanism, and gives a target reimbursement rate example of $100 an hour for integrated teams. He also describes payment tied to biomarker improvements and physician payback if outcomes fail, and suggests plug-in delivery models for primary care using group visits.
Questions this video answers
'Take Back Your Health' (introduced in the Senate).
$100 an hour.
A "double payback" provision requiring the doctor to return payment if the patient had an event (i.e., did not get better).
Only if there was a reduction in biomarkers and improvement in outcomes.
Chapters
One of the things that needs to change is reimbursement. If doctors get paid to do lifestyle medicine, then they will. If we all of a sudden made it as economically viable to do group programs of intensive lifestyle behavior change, which are the only things that have really been proven to work, create sustainable behavior change. If we actually reimburse that, then there'd be institutes of lifestyle medicine showing up in every major institute of health care in this country. Instead of cardiac institutes, there'd be lifestyle institutes and there'd be these programs going on that would be paid for and reimburs. You got paid as much to do that as you got to do an angioplasty, things would change. And I think that that kind of creative restructuring of reimbursement to deliver on outcomes is key. When I was working in Washington with Dean Ornish and Michael Roizen, we created a bill introduced in the Senate called Take Back youk Health. And it had a double payback provision which was still not passed. And the double payback was that with intensive group lifestyle support, with integrated teams of health professionals that were reimbursed at a reasonable rate of $100 an hour, that if patients actually didn't get better and ended up with an event, the doctor had to pay back the amount that they got. The second provision was that they only got paid if there was a reduction in the biomarkers and improvement in outcomes. So one, you only got paid if you succeeded, and two, if you failed, you had to give the money back. So even with the double payback, which was a no risk proposition, it still couldn't pass. And the reason we put those in there is we believe so strongly that this model works better. Imagine if I said to you if you were a cardiologist, well, if your angioplasty fails, you have to get back the money that you got paid doing that. That's essentially what we did. And I think that's the power of lifestyle medicine. But you know, we're still working on it. It's still in process. And I think those kinds of shifts are going to happen. And if we can provide economic models for primary care physicians within their practices to do a different delivery model that includes groups, which I think is a very disruptive delivery model, but can be reimbursed under current reimbursement rules and is actually even something that groups like the American Academy of Family Practice are promoting. If we can provide models for that that are plug ins for primary care doctors to deliver this content, and we package the content and the institute helps with other organizations to collaborate to actually deliver these models and plug them into existing infrastructures. I think we can create changes.
