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Culture Shift

By Dr. Chris Lillis
. 2 Comment(s)

The two year anniversary of the day the Affordable Care Act was signed into law is fast approaching.  There is so much to celebrate!  Almost 3 million young adults have health insurance that they could not access prior to the ACA, my Medicare patients have seen their out-of-pocket expenses for pharmaceuticals drop, and there has been an unparalleled transparency brought to the private-for-profit health insurance agency.  In 2014, millions more Americans will have access to life saving medical care. 

But none of these wonderful achievements has the potential to be a game changer.  Health care costs have been skyrocketing for the better part of the last 30 years.  Obesity rates are climbing.  There has been a proliferation of unneeded care and defensive medicine. 

What could be a game changer, you ask?  In my humble opinion, we need to shift the entire approach of the health care industry – doctors, hospitals, insurers, big pharma – from a spot-the-disease-and-treat approach to one of encouraging, fostering and maintaining wellness.  It is with great pride that I will highlight some of the reforms in the ACA that start to move us in that direction.

The ACA has mandated of private health insurance plans that preventive care – mammograms, colorectal cancer screening, cholesterol tests – are to be provided free of out-of-pocket copays or deductibles. The same is true of Medicare – for the first time in the history of the program, seniors can get wellness visits without copays.  However, my colleagues in Doctors for America will be quick to point out that this type of “prevention” is mostly meant to detect disease early, so that treatment can be easier and more effective.

The ACA also created the National Prevention, Health Promotion and Public Health Council .  As our esteemed DFA President, Vivek Murthy, will tell you, this White House Council aims to coordinate the efforts of multiple Executive Branch Cabinet posts to better shape our preventive strategy.  The Surgeon General thinks we need more walking paths? – the Council can coordinate with the Department of Interior and the Department of Transportation to better allocate national resources to encourage walking and bike paths to become part of the infrastructure strategy.   

The ACA has enacted a requirement for chain restaurants to publish nutrition information for the products they sell, so consumers can make more informed decisions about what they choose to eat.  We are what we eat, and wellness truly begins with our diet.  By encouraging healthier foods in our schools through the National Prevention Council, and allowing consumers to see nutrition information for the products they buy is critical to changing our system from a disease-management approach to a wellness strategy. 

One of the provisions I am most excited about, and one I wrote about in a column for my local newspaper last week, is the program to make grants from 2011-2016 to help small businesses start up wellness programs in their workplaces.  Private insurers, through human resource offices, can offer incentives to be healthy.  Enroll in a stop smoking program, or an exercise program, attend dietary counseling classes and your employer can reduce your health insurance premiums in conjunction with their insurer resulting in greater take-home pay. 

This is a true game changer.  Medical Students need to learn early on that learning about pathology and pharmacology is important, but we need to strengthen wellness curricula in medical schools to include much more robust nutrition education programs.  We can encourage health in our patients, and not just wait for disease.  Physicians need to see their role as an advisor to extend beyond disease management, and engage heavily in diet and exercise advice.  Already, the ACA is taking many avenues to realign incentives for doctors to choose this culture shift, but we have the power to accelerate the process.

I encourage you to attend our National Leadership Conference next month to get inspired to be a part of our national health care solutions, instead of remaining a part of the disease management culture.

I’ll be there.  Will you?

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  1. Leslie Batten

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    This was one of the great aspects of naturopathic medical school. We had five terms of medical nutrition, two terms of medical biochemistry, among the basic medical school course (all of the -ologies) but each -ology stressed foods our patients should be eating along with reminding us of biochemical pathways, supplementation that could help (and always short-term until homeostasis returned), and pharmaceuticals that should be considered. But diet and exercise are key. Once our patients see the difference in how they feel, and that they can start weaning off their long list of meds, they are incredibly happy and stunned that something so simple was all that was needed. Indeed.
  2. Rebecca Jones

    Permalink
    Couldn't agree more. We need to start branching out from our limited world within our office walls and recognize that "health" has more to do with policy and infrastructure than it does with pills and procedures. In Vermont, our goal is a public transportation system designed around walking and biking.

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