38 GROUP PRACTICE JOURNAL x AMGA.ORG OCTOBER 2016

As the healthcare industry looks to the future, we all must become much more comfortable taking on risk. Not only are commercial payers now incentiviz-ing shared risk, new government programs announced as part of the Medicare Access and CHIP Reauthoriza-tion Act of 2015 (MACRA) are imminent and forcing us all to strategize our transitions from fee-for-service to new government-mandated value-based reimburse-ment methods.

Prevea Health’s weight loss program

targets obesity at its very core: insulin

overproduction.

Preparing for the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) can be daunting, especially when individual patient behaviors determine so much of patient well-ness. Many of these behaviors have significant adverse outcomes, such as morbid obesity. Taking on obesity is a topic that’s frequently difficult for physicians to broach with patients.

Research, including a study recently published by the University of Georgia,1 indicates that patients have greater success in weight loss when they receive appropriate education and encouragement from their physician. Yet, physicians note lack of time and a level of discomfort with their own weight as reasons why they don’t actively discuss necessary weight loss with patients. In fact, the Centers for Disease Control and Prevention (CDC) estimates that physicians discuss diet and nutrition during only one third of obesity-related appointments.2

This is an issue that we as physicians must get over. For many of us, surmounting this hurdle may require re-educating ourselves on the intricacies of obesity and weight loss. We were trained around somewhat archaic norms of diet which were based on a colorful food pyramid and one-size-fits-all calorie counts created by the U.S. Department of Agriculture (USDA).3

Neither is applicable in extreme weight loss situations, and neither makes sense in the clinical setting. Clinicians are often left at a loss and turn to pharmacopeias to treat symptoms, which does not address the source of the problem and is not in the patient’s best interest. We also face stiff competition on changing behaviors from our own government, which

MACRA PrimerRaise awareness in your organization about the urgency of addressing MACRA and the specifics of the legislation and regulations.

Workshops and RetreatsThrough these in-depth engagements led by your peers, we help you address key issues and challenges as you build the capability to succeed in taking on risk.

ConsultingWe will work with you to assess opportunities for improved operational efficiency, care model transition, and alignment of provider compensation models to succeed under MACRA.

Assessment ProgramWherever you are on the continuum of moving from fee-for-service to value-based care, our Assessment Program provides essential direction and strategic guidance for succeeding in risk-based payment models.

Visit amga.org/macra today!

MACRA: Your Partner for Success

Whatever your MACRA or risk goals are, AMGA is committed to empowering you with

the solutions and strategies to advance your organization.

AMGA is your partner for success under MACRA

and other risk-based models. Our MACRA and Risk

Initiative provides the insights and resources to

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40 GROUP PRACTICE JOURNAL x AMGA.ORG OCTOBER 2016

is significantly influenced by the food and restaurant industry, an industry that is also a significant portion of our Gross Domestic Product (GDP).4

Biggest ExpensePrimary care providers (PCPs) know better than

anyone the sequelae of failing to address obesity—from type 2 diabetes and hypertension to hypercholester-olemia and joint disease—they see it affect so many parts of the body. PCPs know that obesity and its downstream affects are probably the biggest expense in health care. They understand the immensity of this issue, and as they’re required to take on an increased level of risk, it’s fairly clear that they need to directly combat the obesity epidemic or we will all fail in the changing healthcare environment.

Preparation for our future and our desire to best serve the medical needs of our patients caused Prevea Health in Green Bay, Wisconsin5, to seek expertise outside our medical group. We were seeking a solution that was scientific and evidence-based—something outside the normal diets that we learned about in medical school. We also determined early on that we needed one of our physician partners to take the lead in this arena—and we found that physician champion in Kristen Lindgren, M.D.

Dr. Lindgren already had a successful family medicine practice at Prevea Health, but after becom-ing fellowship-trained in functional medicine, she expressed her desire to expand her practice in a way that would holistically address the root cause of her patients’ illnesses.

With her heightened understanding of diet com-plexities, Dr. Lindgren turned our conversations toward the literature on and benefits of ketogenic diets—such as that offered by the medically developed weight loss pro-tocol, Ideal Protein.6 We found that Ideal Protein would be a great partner in developing Prevea Health’s “Ideal Weigh” medically supervised weight loss program.

The Ideal Protein Weight Loss Protocol targets obesity at its very core: insulin overproduction. Insulin is secreted whenever we eat carbohydrates, good or bad. As the standard American diet has become dispro-portionately high in carbohydrates of all kinds, so have our circulating levels of insulin. Insulin is secreted by the pancreas in an effort to manage sky-rocketing levels of blood sugar, but its actions don’t stop there.

Chronic insulin overproduction is also called “metabolic syndrome,” and it is responsible for elevations in blood pressure, blood sugar, and lipid abnormalities and is directly linked to abdominal obesity. Effectively treating obesity means targeting

metabolic syndrome by normalizing insulin levels. When we treat the root of the problem, we not only see weight loss but improvements in metabolic and health parameters across the board.

“Working with patients on the Ideal Weigh pro-gram has been incredibly rewarding,” Dr. Lindgren reports. “I went into medicine to promote wellness and help patients get healthy—not to just prescribe pharmaceuticals, which is what I felt like I was doing in conventional family practice. Functional medicine has allowed me to get back to the basics of optimizing lifestyle, exercise, hormone systems, and nutrition as tools to improve my patients’ overall well-being. Ideal Weigh is a small piece of my intervention, but one that has had tremendous and wide-reaching results for the many patients I see struggling with obesity.”

Starting PointsThe program begins with educational seminars

and online videos designed to help potential patients learn more about Ideal Weigh and whether or not the program is the right fit for their personal goals. Patients interested in pursuing Ideal Weigh then have a one-on-one consultation with Dr. Lindgren to establish their baseline measurements—with the completion of an ini-tial set of labs and a measurement of body mass index (BMI) and skeletal muscle mass.

Weekly follow-up visits with a health coach then provide ongoing support and encouragement, with the patient’s weight tracked weekly and measurements taken monthly. The weekly visits also provide an oppor-tunity to discuss meal planning and serve as a retail opportunity for patients to purchase the Ideal Protein products that form the basis of their diets each week.

The infrastructure needed to make our program successful relies on having a dedicated physician working with patients to set their goals and supervise all aspects of the program, including each of the weekly meetings between the patient and his or her health coach. Instead of requiring all our PCPs to fully understand the intricacies of Ideal Weigh, having one dedicated provider allows us to have an expert in weight loss who co-manages care and actively partners with each patient’s PCP in medication reduction and elimination as the weight comes off.

Promotion of the program has been successful, which indicates a strong desire in our community to lose weight and improve wellness. We initially launched Ideal Weigh through an internal pilot with our own employees and also with a pilot group of 30 individuals who work with our hospital partners.

In the hospital pilot, 26 of the 30 participants

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completed the four-phase Ideal Weigh program through to its final maintenance phase. Of the 26, four were removed from at least one blood pressure medi-cation, and two were able to reduce their dosages. A total of 798 pounds was lost, and BMI decreased an average of 5.1%.

The success of our internal pilots led to one of our most successful promotions—word-of-mouth advertis-ing. We also promote the program through internal Prevea communications and a small amount of external advertising which invites potential patients to attend our monthly educational seminars.

The overall community response has been grati-fying. To date, 298 people have participated in the program, and 43 have reached the final maintenance phase. We are currently recruiting two additional health coaches to facilitate an enlarged patient panel, and we’re investigating adding video visits to the program where Dr. Lindgren will offer virtual consultations with patients over a wide geographic area.

Success RatesWith implementation of the Ideal Weigh compre-

hensive maintenance program, we will continue our commitment to our patients by offering maintenance workshops and ongoing touchpoints. It’s a fact of life that some people stumble, and some weight will be regained, but by offering ongoing support, we will help patients achieve a high success rate for sustainable weight loss.

As we continue to refine our program, the overall revenue potential becomes evident. Ideal Weigh is in contrast to the business model of traditional health care in that time spent with the physician is a secondary area of revenue. Each patient is charged a minimal fee for their initial consultation with Dr. Lindgren, which kicks off their Ideal Weigh journey. Following that consultation, revenue is generated through Ideal Protein products, which are available for purchase during the weekly meetings with the individual health coach.

While both revenue streams help the program to succeed, the ultimate success is seen in sustainable weight loss resulting in a high state of wellness for our patients. We are doing what’s right for our patients—who are becoming healthy and happy—and almost as a side effect for doing what’s right, we’re positioning our medical group to assume risk for success in the health-care industry of tomorrow.

References1. J. Berning. 2015. The Role of Physicians in Promoting Weight

Loss. Economics & Human Biology, April 2015, 17: 104-115.2. A. Talwalkar and F. McCarty. 2012. Characteristics of Physi-

cian Office Visits for Obesity by Adults Aged 20 and Over:

United States, 2012. Centers for Disease Control and Preven-tion. NCHS Data Brief No. 237, March 2016.

3. U.S. Department of Agriculture Center for Nutrition Policy and Promotion. 2016. Food Guide Pyramid. Accessed August 26, 2016 at www.cnpp.usda.gov/FGP.

4. U.S. Department of Agriculture Economic Research Service. 2016. Ag and Food Sectors and the Economy. Accessed August 26, 2016 at www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/ag-and-food-sectors-and-the-economy.aspx. National Restaurant Association. 2016. Industry Impact: Economic Engine. Accessed August 26, 2016 at www.restaurant.org/Industry-Impact/Employing-America/Economic-Engine.

5. Prevea Health’s mission is to care for people with passion, pride, and respect. Founded in 1996, Prevea Health has more than 40 locations throughout Northeast Wisconsin and West-ern Wisconsin’s Chippewa Valley region. For more informa-tion, visit prevea.com.

6. The Ideal Protein Weight Loss Protocol is medically designed and developed and consistent with evidence-based guidelines for weight loss management and maintenance. The protocol tackles the root cause of weight gain—the body’s overproduction of insulin—by limiting consumption of sugars in the form of fats and carbohydrates while maintaining protein intake to preserve muscle mass. For more information, visit IdealProtein.com.

Ashok Rai, M.D., is president and chief executive officer of Prevea Health in Green Bay, Wisconsin. He joined the AMGA Board of Directors in 2012, where he currently serves as the Board Treasurer. Dr. Rai also sits on the Ideal Protein Medical Advisory Board.

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The National Patient Safety Foundation offers programs that support the health care community, patients and families, and key stakeholders in the ongoing work to advance patient safety and health care workforce safety. Find out more about our programs and resources at npsf.org.

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at the National Patient Safety Foundation

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