The program that has NYC patients 'knocking down the doors'

At NYC Health + Hospitals, patients with chronic illnesses are going into remission — not with a novel drug or surgery, but with lifestyle changes. 

The New York City-based system piloted its Lifestyle Medicine Program in 2019 at its Bellevue hospital, to such success that the initiative is expanding to six other sites throughout the city. 

Patients are "knocking down the doors to join [the] program," Michelle McMacken, MD, executive director of nutrition and lifestyle medicine for NYC Health + Hospitals, told Becker's. The system's innovative model pairs each patient with a treatment team — physicians, nurse practitioners, dietitians, fitness instructors, health coaches, community health workers and a site program coordinator are all on staff — to discuss, plan and implement lifestyle changes that allow the patient to play an active role in their own treatment. 

Over the course of a six- to nine-month "active phase," patients have multiple one-on-one visits, enroll in fitness and group classes, and receive extensive education and support surrounding lifestyle change. Afterward, the program offers indefinite support, including monthly support groups that allow patients to stay connected with the health system and one another. Patients living with prediabetes, Type 2 diabetes, high blood pressure, health concerns related to excess body weight (specifically obesity) and arteriosclerotic cardiovascular disease can all benefit from the program's offerings, Dr. McMacken said. 

During the pilot phase, the health system observed improved patient satisfaction scores. Dr. McMacken attributes this to the sense of empowerment the program fosters, and said patients are thrilled to have a care team trained to listen and learn more about their individual situation. 

"We all know that lifestyle change is not always straightforward for people. They need guidance, they need support," Dr. McMacken said. "Many people also need someone to kind of take a look at the things that are preventing you from making lifestyle changes in the first place. Do you have access to healthy food? Do you have a safe place to exercise? So all of those components we knew were going to be really important as we put together a program that would be accessible to all New Yorkers." 

Clinicians also benefit from lifestyle medicine, according to Dr. McMacken, an internal medicine physician herself. The bonds between a patient and physician strengthen when care is not merely prescriptive, but collaborative. 

"In medical school, it's common for physicians not to get a huge amount of training on nutrition and lifestyle change. But I had the opportunity to attend a national conference on lifestyle medicine back in 2013, and it really changed the way I look at healthcare and my relationship with my patients and what I can offer them," Dr. McMacken said. "It was very eye-opening to recognize that we have so much potential to prevent and even dramatically improve existing chronic diseases with lifestyle changes. And the fact that that was not something that was emphasized in my medical training or in in my practice was really humbling." 

Through the practice of lifestyle medicine, Dr. McMacken said she's seen patients "get healthier in a way that [she] never had before." Dedicated research into the pilot phase at Bellevue found that participants saw significant reductions in hemoglobin A1C (a marker of average blood sugar); improvements in cholesterol and blood pressure; and significant weight loss in those living with excess weight. 

Lifestyle medicine holds a lot of promise in the value-based care space as it helps to reach the quintuple aim, Dr. McMacken said. It can also help lower healthcare costs; if a diabetes diagnosis is prevented or even sent into remission, it lowers the risk of other conditions that can lead to hospitalizations and costly treatments — for example, chronic kidney disease and the need for dialysis. 

As more health systems recognize the value of lifestyle medicine, it is "arguably the fastest-growing specialty out there," Dr. McMacken said. The American College of Lifestyle Medicine's Health Systems Council — which has only existed for two years — has grown to include 100 members. Up to 80% of chronic illnesses can be addressed with lifestyle medicine initiatives, according to the College's website

It all boils down to taking the time: the time to listen, provide support, help remove barriers to care and build trust with every patient. 

"I have patients who are living in extremely challenging circumstances, who other providers might have said, 'You know what, there's no way that someone like this could work on lifestyle change,'" Dr. McMacken said. "I've actually seen that my patients in those situations, many of them do want the support to work on lifestyle change. They also need the support to help address those barriers."  

"I do think this is something that everyone has a right to," Dr. McMacken continued. "And it's not that everyone is going to be able to make the same degree of lifestyle changes, that really varies depending on a lot of different factors. But I think everybody deserves the option to be able to work in a program like this." 

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