FG: We’re now seeing this move towards a patientcentered medical home, where each individual has their own “medical center.” It tends to be a little bit broader, as there are several health care specialists versus just one physician in this one locale. It’s essentially a clinic set up more around a team approach, where you might see a nutritionist, a dietician, an exercise physiologist, a social worker, and nurses to help better manage patients with diabetes, or pre-diabetics or other conditions. And you may see other types of therapists in there as well. So they’re looking at the client/patient more holistically, versus a “they’re in here for this illness or that medical condition” type of mindset. We’re beginning to see some companies try to focus on more of those preventive approaches.
with a doctor and then receive referrals to other service providers to help them, if necessary. Again, it may be a nutritionist, exercise physiologist, social worker, or whatever is appropriate for that patient’s needs.
EA: So one would go to one of these patient-centered medical homes versus seeing their “regular” primary care doctor?
FG: I think we could do a better job about nutritional education in general, and clearly provide better access to food that’s good and healthy for you. Some of this we’ve known, such as eating more fresh fruits and vegetables in our diets every day, drinking adequate quantities of water, those kinds of things. It’s also a matter of making individuals aware, and then providing them with opportunities to get those healthier foods more readily, versus the so-called fast foods that are pre-processed and that we may know, or not even know, whether they’re harmful or not. One thing we do know is that if you stick to the basics, and eat that way regularly, you tend to do better.
FG: Yes, and the idea, too, would be to change the [insurance] reimbursement structure so it’s not necessarily that they would get reimbursed for each service as it’s structured now, where the more services or procedures a doctor does, they more they get paid. But maybe they have a population of patients, and therefore part of their reimbursement is based on the overall health on that population. For instance, if their clients received appropriate screenings, how many patients had better results and those types of parameters? Now it becomes more of an outcomebased payment versus a service delivery payment. Those are the kinds of models you’re beginning to see more often. That is, patients going to medical homes and the new groups of accountable care organizations that are broader structures than hospitals, physicians and services, which are now looking more holistically at the population of individuals they serve. Their focus being, “How do we maximize the health of this population versus just treating their diseases?” Then instigate particular payment structures to reward those accountable care organizations or providers for delivering higher quality of preventive care. Instead of getting paid every time you get a patient visit, you may get a flat rate for a given population, and if you keep that population healthier overall, you may get bonuses, or things like that. Those are some of the things that are being explored right now, like these different types of health care delivery models. I don’t think policy makers have gone far enough to recognize how important it is to work with individuals to keep them healthy and employing those services to facilitate doing that. But they’re getting there. You can see Medicare now has “The Annual Wellness Visit” to establish a personalized health care plan. Essentially it includes a health risk appraisal, some lab work, maybe a few other tests. The provider gives the individual their report, explains what their risks are, and what they need to do to get healthier and/or keep themselves healthy. They meet
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EA: Another challenge we face, as a consumer-based marketplace, is that we’re bombarded by companies and products whose nutritional value or overall impact on one’s health can be decidedly negative. I’m talking about canned and processed foods with too much refined sodium and sugar and laden with trans fats, and, of course, all the junk and unhealthy fast-food products such as “supersized” double cheeseburgers, with an extra large order of fries, and a mega-sized, sugar-laden carbonated beverage and so on.
EA: However, there are so many readily available—and heavily marketed—products that are chocked full of ingredients that aren’t healthful, such as high fructose corn syrup, refined grains, monosodium glutamate, aspartame, hydrogenated oils … FG: Right. I think what we also need to do, at the end of the day, is to have studies to show whether an ingredient is harmful or not. And when the studies do show that particular ingredients are harmful, we should ensure those are not included in our foods, or their levels are lowered or whatever. But you’re certainly correct. I remember a health coach once telling me, “When you read the food labels, if there’s anything on there that you don’t understand, or don’t know what it is, or the name is a super long-sounding chemical ingredient, or you can’t even pronounce it, then you probably want to stay away from that product.” [Laughs.] U.S. Preventive Medicine is accredited in Wellness and Health promotion by The National Committee for Quality Assurance (NCQA) as well as disease management by URAC. For more information visit: www. uspreventivemedicine.com, www.thepreventionplan. com, and/or http://macawapp.com.