Leaders at the intersection of primary care policy, payment, practice, and advocacy described the most promising steps national organizations are taking toward operationalizing whole-person care at the annual meeting of the American College of Lifestyle Medicine (ACLM) 2025.

CMS Innovation Center Testing Lifestyle Changes in Payment Models

Susannah Bernheim, MD, MHS,chief quality officer and acting chief medical officer for the Centers for Medicare & Medicaid Services Innovation Center (CMMI), noted a shift in the past year at CMMI. 

Part of the new strategy for the center is a focus on evidence-based prevention, Bernheim said. That includes testing innovations that integrate into payment models with a focus on lifestyle changes, particularly in nutrition and physical activity, to support prevention and management of chronic illness. 

“We are increasingly focusing more on outcomes such as disease progression or the lack of disease progression or remission,” she said. An example, she says, is collaborating with nephrologists on the Kidney Care Choices model, under which providers are assessed on whether they are successfully slowing patients’ trajectory toward dialysis and kidney failure.

“We also have the ability to allow providers in some contexts to offer incentives or rewards directly to beneficiaries,” she said. “In our ACO REACH model, providers can reward patients for engaging with chronic disease management programs.”

$50 Billion Program to Strengthen Rural Care

This month, CMS announced that all 50 states applied for the new $50 billion Rural Health Transformation (RHT) program to strengthen care access and quality and build the healthcare workforce in rural communities. Approved states will be announced by the end of this year.

Family physician John Findley, MD, healthcare strategist with the Heartland Whole Health Institute in Bentonville, Arkansas, called RHT “one of the most exciting opportunities in my career to reinvest in primary care and actively engage patients in their own communities closer to home. We all know we as a country have done a pretty poor job in investing in community-based organizations,” he said.

Shared Principles of Primary Care Updated

Ann Greiner, MCP, president and CEO of the Primary Care Collaborative (PCC), pointed to a recent PCC update of the 2017 Shared Principles of Primary Care to help guide improvements. “In the past year we updated them to better reflect whole-person primary care with an emphasis on health promotion, prevention, and community engagement and wellness for both the patient and the clinicians,” Greiner said, adding that 400 organizations have signed onto the updated principles. “That’s a marker of what people see as value,” she said.

Investment in Primary Care Is ‘Dismal’

Greiner pointed to a fundamental threat to advancing primary care. 

“If we’re going to prevent and manage chronic conditions, we have got to do a better job of investing in primary care. It is the driver of all successful value-based models. And it is crumbling,” she said.

Greiner said everyone should know that the proportion of the healthcare dollar that goes to primary care in the US is 4.7 cents. “It is dismal,” she said. 

A bright spot for the PCC, she said, is that when the organization started working with states to measure and report how they are doing with primary care spending, only two states were participating. “Now there are 22, and 10 states have set targets to increase primary care spending,” she said. “We’re gaining momentum.” 

Lifestyle medicine will feed the momentum to advance primary care, said Kate Goodrich, MD, MHS, former chief medical officer for Humana and former chief medical officer for CMS. “The experience of the patient in the healthcare system and the clinician in the healthcare system is pretty poor.” Lifestyle medicine may be a core solution to those problems and we are starting to see where it is working, she said.

More and more payers are increasing their value-based care contracts in Medicare. “That is at least some progress,” Goodrich said.

She highlighted two shifts she says will make the difference in transforming primary care. The first, she said, is investment in data and technology and leveraging the electronic health record “to be more than a filing cabinet.” It should be able to support clinicians at the point of care with insights that are easy to digest, she said. On the individual level, that would include information that a patient has entered an emergency department or has seen a specialist. On the broader level, it might involve information on a physician’s population of patients with diabetes, she added.

Goodrich said another necessary advancement is to have specialists, such as behavioral health specialists, nutritionists, or pharmacists embedded in the primary care practice. 

However, she noted, “None of this happens if you don’t change the payment system.”

Speakers reported no relevant financial relationships.

Marcia Frellick is an independent, Chicago-based healthcare journalist and a regular contributor to Medscape Medical News.