How to Implement Lifestyle Interventions for High-Risk Patient Care

Imagine a type of intervention that’s indicated for all high-risk patient care. It has no contraindications and doesn't cause any medication-related problems. This type of intervention can result in optimized health, reduced incidence of chronic diseases, and decreased costs for health plans, healthcare providers, and patients.

This powerful treatment is a lifestyle intervention or non-pharmacological therapy focused on improving or implementing healthy behaviors and habits. These interventions include regular exercise, a healthy diet, smoking cessation, and stress management.

Studies have shown that lifestyle interventions can prevent the occurrence or slow the progression of chronic conditions. Yet, a gap still exists between lifestyle intervention guidelines and their implementation in high-risk patient care.

For example, eating a diet rich in fruits and vegetables may help decrease the risk of type 2 diabetes, cardiovascular disease, and cancer. Yet only one in ten adults eat the recommended amounts of fruits and vegetables according to the Centers for Disease Control and Prevention (CDC). Although the benefits of regular exercise are well-known, only one in four American adults meet the physical activity levels in guidelines from the Office of Disease Prevention and Health Promotion (ODPHP).

As straightforward as healthy lifestyle interventions may seem when patients can make these changes in their daily lives, it pays off. Delaying the onset of diabetes by three years can save health plans over $8,000 in medical expenditures per member over that period. A 20% increase in adherence to healthier eating habits likely saves over $20 billion in direct and indirect costs. And even a small reduction, as little as 10%, in smoking rates decreases healthcare spending by $6.3 billion.

Challenges to implementing lifestyle interventions in high-risk patient care

While research points to the cost-effectiveness of lifestyle interventions as well as their positive effect on patient health, it turns out that implementing these simple interventions isn't so simple. Providers and caregivers often lack the appropriate tools to support patients in a scalable way, and health plans and providers may not have the proper data analytics to identify which patients could benefit from lifestyle interventions, creating a domino effect that leaves patients unsupported in making lifestyle changes.

Lack of time for care teams

The annual wellness visit was created as part of the Patient Protection and Affordable Care Act to provide the opportunity for care teams to discuss preventive care–including lifestyle interventions–with their patients. But with the average physician visit lasting 15 minutes or less, having those conversations, referring patients to appropriate health services, and following up with patients’ progress can be challenging.

Care coordination challenges

In addition to the limited time clinicians have to spend helping patients implement lifestyle interventions, care team members are not always aware of the resources offered by patients’ health plans. As a result, patients are left to figure out how to implement lifestyle interventions on their own. While many health plans offer benefits like smoking cessation support or physical therapy so patients can start exercising, patients left to navigate the healthcare system on their own are often unaware of these benefits and, hence, these benefits remain underutilized.

Targeting the right patients and implementing effective interventions

Finally, finding the patients in need of intervention is also a monumental challenge. Care teams must sift through reams of data to find patients, and as a result, the highest-need patients may slip through the cracks. Poor targeting results in reaching out to patients who don’t need lifestyle interventions, and health plans and providers potentially waste precious resources and may lower the overall engagement of their populations as patients learn to ignore calls from their health plan. It also results in missing patients, such as those with uncontrolled diabetes, who need lifestyle and dietary counseling to avoid harmful consequences. Oftentimes, accurate targeting is challenging due to the multifactorial nature of chronic health conditions.

Addressing the lifestyle modification gap with artificial intelligence

Fortunately, health plans and providers can incorporate practical strategies to address the lifestyle modification gap and deliver relevant interventions to patients who need them. With the correct technology tools, care teams can help patients optimize a patient’s medication therapy as well as identify what lifestyle changes to focus on to reach their health goals.

Stratify risk and target the right patients with predictive analytics

By using predictive analytics, health plans can target high-risk patients who are the most in need of lifestyle changes based on their risk factors, their medical history, and their socio-demographic data.

For example, Jane (name changed for privacy), a 66-year-old, had a history of hypertension, and uncontrolled blood sugar (A1C of 8.5). She also had a history of high cholesterol and had run out of refills of her rosuvastatin. Due to COVID-19, Jane had been experiencing high stress and had stopped exercising. Additionally, she’d missed her doctor’s appointments due to transportation access issues. A language barrier prevented her from understanding how to take her medications correctly. Finally, she had a poor diet and regularly drank soda when she experienced low blood sugar.

Arine’s medication intelligence platform identified Jane as a patient at increased risk for disease progression and triggered her care team to intervene. They quickly addressed her medication-related problems and helped her obtain a home blood glucose monitor. Simultaneously, the care team was also able to identify lifestyle interventions in addition to clinical interventions and counseled Jane on proper diet, exercise interventions, and stress management. They also connected her with a transportation service and helped her schedule an appointment with her physician. All of these different types of interventions work together to address all of Jane’s needs and allow her to live her healthiest life.

Simplify care coordination with automation

Tailored recommendations generated automatically for care team members can make lifestyle intervention programs more efficient and cost-effective by streamlining care delivery. By leveraging technology, health plans and providers can scale their programs to reach more patients, and as a result, improve health outcomes, reduce healthcare costs, and increase quality scores.

For example, a platform like Arine’s can analyze patient data and integrate evidence-based clinical guidelines to automatically generate personalized care plans. Once it has identified a high-risk patient, it can trigger an intervention from the appropriate member of the care team.

Additionally, the platform can identify potential care gaps and automatically create a list of questions for the care team member to ask the patient to gather additional insights. Using that data, the team can identify potential barriers to lifestyle changes for the patient and areas where patients need the most support.

Refine interventions with machine learning

By integrating machine learning insights in their medication management programs, health plans and provider organizations can continuously optimize how they deliver patient care. Machine learning algorithms can analyze the outcomes of each intervention to find those that have the most impact on health outcomes and cost. These insights can be used to tailor each subsequent intervention to the needs of a specific high-risk patient population.

A powerful approach to high-risk patient care

Lifestyle interventions are powerful but underused tools in high-risk patient care. Lifestyle interventions also often need to be combined with other interventions, such as medication therapy, to address the complexities of managing multiple chronic medical conditions and managing the whole person. Health plans and providers that implement these approaches and leverage technology can see returns not only in cost reduction but also in improved health outcomes for their population.

Download Arine’s white paper to learn more about how comprehensive medication management can help address the lifestyle modification gap, optimize patient health, and improve quality of care measures.