The Unexpected Financial Savior of Primary Care: Lifestyle Medicine
Jason Kerkvliet
7 min read
·
Jul 9, 2024
In 20 years, every primary care group will get a third of their profit from… lifestyle medicine?
I always thought lifestyle medicine was a financial loss-maker. That’s turning out to be wrong. Groups across the country, like Cleveland Clinic and Mass General, have turned it into a profit center, particularly through group medical visits for patients with diabetes, obesity, and heart disease.
The outcomes are good, it drives profit, and patients love them. So how is this possible?
Group Medical Visits for $2,000/hour
The core of these programs are group medical visits, usually with 12–15 patients led by a physician, which can generate $2,000/hour in billings. Patients sign up to a 12-week program (or similar) and join every week for an hour-long session — usually virtually. This adds up to a ton of patient-physician time, more than most patients would normally get in the exam room.
CMS has stated you should bill these as individual E/M visits for each patient, typically a 99213 or 99214 depending on the patient and programming. That’s $75 to $150 per patient. With 15 in an hour, that’s $1,125 to $2,250 — not bad for primary care!
In a 12-week program, you can potentially generate $3,000 in billings per patient. The most successful programs pair these sessions with other resources that keep patients engaged — online content, handouts, and tools for patients. LifestyleRx has a program you can use that includes all of this.
Impact at the Clinic Level
These programs aren’t for everyone, but more patients than you’d think want them. Clinics can usually recruit around 50 patients each year per PCP, generating an extra $45,000 in profit per PCP. That’s a financial game-changer. Give it a few years and we’ll see private equity firms buying clinics, adding lifestyle medicine programs, and boosting profit by 50%.
Why hasn’t this taken off sooner? Most of the successful programs I’ve seen launched after COVID, with virtual care. It’s a big ask for a patient to drive to your clinic for a session 12 weeks in a row. Joining a zoom call is much easier. Plus most clinics just didn’t have physical space to facilitate this kind of thing. A lot of big groups (like Cleveland Clinic) had facilities they could use for groups, and got started before 2020. But their programs were pretty small before COVID, and exploded when they switched to virtual.
Whatever the reason, the movement is well on its way — and not just in the US. One analysis in British Columbia (Canada) showed that the equivalent of 1 in 4 new Type 2 diabetics now enroll in physician group medical visits every year. It’s just a matter of time — if you don’t offer this for your patients yourself, they’ll be finding it somewhere else.
The Outcomes
Alright, so lifestyle medicine makes money and everyone is hopping on the bandwagon. But it doesn’t really shift patient outcomes that much, right?
The answer is it varies a lot. Some programs are underwhelming, but the best programs see pretty incredible results. In the context of diabetes, patients can see A1c drops of more than 1%, and a meaningful chunk of patients even reach diabetic remission. It’s also not all Keto and plant-based diets — whole food diets can actually work for a lot of people and are likely to be more durable. Part of this is just that the current state of diet education for patients is so poor — most patients don’t know what they should be eating. GLP-1s are also helping, and they can be a natural complement for patients making lifestyle changes.
It’s important to remember, lifestyle is the first line of the practice guidelines for diabetes and other chronic conditions — physicians are supposed to counsel patients on lifestyle factors, and most don’t. There is a real outcome gap here between practices that do this well and those that don’t. Look at what groups like ChenMed have done with lifestyle emphasis in every visit.
Practical Advice on How to Do This
So how would a clinic actually go about launching a program like this? It takes work, but I’ve linked to some resources below that can help.
LifestyleRx, where I work, is also an easy way to start — they staff a fractional lifestyle medicine physician to run your program who only gets paid when you get paid, and their team looks after most of the workload for you. You can always start with that and then graduate to your own program in the future.
The right way to get started is to take these initial steps:
1 - Determine what it is worth:
A good first step is to make an honest accounting of the potential financial opportunity in your clinic. There are a couple of variables - we built a calculator to help give a decent approximation:
VARIABLES
>50% patients in most primary care practices have an eligible condition.
ESTIMATE
Annual Profit
$1,078,150/year
Annual Collections
$3,593,832/year
Per Patient
$2,995/patient
Breakdown
See detailed breakdown
2 - Find a practitioner or partner:
Who is going to deliver this care? Any PCP with the right experience can do it, but those with ACLM certification are ideal. Is there someone on your team passionate about this who can develop the programming? Or you can work with a partner who can provide an experienced physician and dietitian for you at no upfront cost.
3 - Find a low-risk way to get started:
As with any new initiative, until you get through your first cycle, it’s wise not to add new staff and overhead costs. Working with a partner who can provide staff with upside-only terms (i.e. they are paid based on collections only) is ideal. This generally means sharing some of the economics with that partner, but you don’t have to put up any capital.
Conclusion
Developing this competency doesn’t happen overnight. But once programs start running, they can become self-reinforcing and robustly profitable.
If you’re interested in learning more about LifestyleRx, you can visit our website, book a meeting with me here, or reach out to us at [email protected].
