Featured in Group Practice Journal October 2016 Relearning Obesity Issues - Addressing Problems at the Source

1. 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
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2. 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 Expense
Primary 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 Points
The 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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3. 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 Rates
With 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.
References
1. 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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