Ahead of the marcus evans ACO & Payer Leadership Summit 2023 and the ACO & Payer Leadership Summit 2024, Dr Michael D. Parkinson discusses how ACOs can lower total healthcare costs.

1. Interview with: Michael D. Parkin-
son, MD, MPH, FACPM, Medical
Advisor, Pivio, Past President,
American College of Preventive
Medicine
“Inflammation is the root cause of
chronic diseases, driving 60 percent of
healthcare costs. ACOs and value-based
payment systems must address this
issue with behavior improvement
programs to prevent, treat and reverse
inflammation,” says Dr Michael D.
Parkinson, Medical Advisor, Pivio, Past
President, American College of Preven-
tive Medicine.
Pivio is a service provider at the
marcus evans ACO & Payer Leader-
ship Summit 2023 and the ACO &
Payer Leadership Summit 2024.
What is the root cause of chronic
disease? How can ACOs reduce the
cost of chronic diseases? How does
lifestyle affect health care costs?
Systemic inflammation caused by
unhealthy behaviors and the environ-
ment are the root cause of 90 percent of
chronic diseases and cost. The 2019
Lifestyle Medicine Research Summit
documented the basic science and
clinical evidence showing that changes
in the microbiome, epigenetics and
cellular changes cause inflammation
leading to the common causal pathway
of inflammation. And the evidence
shows it can be reversed through
lifestyle as well.
Typically, five to ten percent of a
population drives 60 percent of costs
(and 20 percent drives 80 percent) the
vast majority of which consists of
cardiovascular disease, diabetes,
obesity, renal, rheumatological, cancer,
depression, and a host of other inflam-
matory-related diseases.
ACOs and value-based payment sys-
tems must implement a comprehensive,
proven behavior improvement program
ideally prescribed and monitored by
providers for maximal impact to
prevent, treat and reverse inflamma-
tion. Prioritizing patients with multiple
inflammatory-caused chronic diseases
who take multiple, usually excessive,
medications (and attendant cost) can
not only be cost-effective but cost-
saving in the near term (six to 12
months).
What behavioral changes do you
consider necessary? How can
people with chronic illnesses
transform their health?
Sustained behavior improvement has
been shown to have three core compo-
nents: basic knowledge, new skills, and
support for both initial and long-term
change. Facilitated coaching either in-
person or virtual, group peer support
and physician prescription or endorse-
ment have all been proven to optimize
behavior change leading to improved
health, lower or eliminated prescription
drug use and lower total healthcare
costs.
How can ACOs help prevent, treat,
and reverse chronic diseases? What
support should they provide to
participants?
The growing number of physicians and
providers embracing lifestyle medicine –
addressing the root cause of chronic
disease through plant-forward eating,
physical activity, stress reduction,
improved sleep, elimination/reduction of
substances of abuse and social connec-
tion – can be championed by ACOs and
value-based payment partnerships.
Each improved behavior synergistically
reduces causal inflammation. Patients
and physicians should be offered
participation in a comprehensive,
integrated, “turnkey” proven program
as the first step in chronic disease
management.
What makes a big difference (which
they might not expect)?
Physician recommendation or
“prescription” with periodic feedback
can increase engagement and success-
ful behavior change ten-fold vs simply
“offering” a behavior change program.
Periodic tracking of inflammation-
related lab tests (hs-CRP, HbA1C, lipids,
etc.) within the course of the program
improves adherence as patients see and
share their progress in real time.
What matters most for people to
stay healthy once they get healthy?
How can ACOs achieve lasting
clinical outcomes?
Patients improving their lifestyle in
multiple domains stay the course
because they feel so much better, have
more energy, and rely less on prescrip-
tion medications (with both health and
cost benefit). And they become advo-
cates to their family and friends for
further change. A “support ecosystem”
for patients to access information,
resources, and reinforcement provides
new skills and adherence.
ACOs and value-based payment allianc-
es making comprehensive, integrated
lifestyle medicine into their core culture
create an optimal “quadruple aim”
strategy which aligns medical practice,
leading physicians, and patient out-
comes with better health and lower
costs.
Each improved
behavior
synergistically
reduces causal
inflammation
Driving Healthcare Costs Down by Addressing
the Root Cause of Chronic Diseases

2. About Pivio
Building on 35 years of published evidence, Pivio is a turnkey, integrated, comprehensive lifestyle improvement program which
prevents, treats, and reverses the majority of chronic diseases caused by inflammation. Consisting of 18 facilitated group sessions
over 3 months addressing plant-forward eating, physical activity, stress reduction, improved sleep, social connection, and reduction
of substances of abuse. Pivio can be administered either with or without provider involvement. Near term cost savings are most
likely when Pivio is prescribed by a physician for patients with multiple chronic diseases and polypharmacy who suffer preventable
and recurrent costly visits, procedures and hospitalizations. A year-long follow-on support ecosystem ensures behavior change
sustainment.
www.piviohealth.com
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