A recent brainstorming session hosted by Dr. Geoffrey Moore of Sustainable Health Systems brought together Dr. Mike Parkinson (Past-President, American College of Preventive Medicine), Rick Lee (Healthrageous), Eric Levitan (Team Vimo) and Eric Ruth (Kellyn Foundation) to explore strategies for the CMS ELEVATE initiative — a cost-saving study structured like an ACO that requires a randomized controlled trial (RCT) design to demonstrate reductions in healthcare costs.
The Core Challenge
ELEVATE's design presents real hurdles: recruiting participants for RCTs is difficult, food cannot be provided as part of the intervention and linking lifestyle behavior change to measurable cost savings takes time. CMMI anticipates sample sizes of roughly 2,000 patients and controls, though CMMI’s anticipated effect sizes are conservative and if health benefits are bigger than expected the required number of subjects could be significantly lower. Quarterly reporting and IRB approval — particularly for exercise-based interventions — add further complexity.
Who to Target and How
Panelists agreed that focusing on patients with multiple chronic conditions yields the greatest health improvements and cost reductions. Rather than uniform programs, a tiered approach — similar to medication dosing — is more effective. Rick Lee shared data from a dual-eligible study showing significant cost reductions among participants receiving meal services and noted that reducing friction (e.g., convenient delivery) raised self-service rates from 50% to 85% within three meal orders.
Community Partnerships are Non-Negotiable
Eric Ruth described Kellyn Foundation's experience moving from transactional to truly collaborative community partnerships — a shift he credited as the organization's breakthrough moment. The group broadly agreed that viable ELEVATE applicants will likely have two to three strong community linkages and that hybrid models combining virtual and in-person components will outperform one-size-fits-all approaches. Mr. Ruth also suggested that using community nonprofits to fund provision of food could complement the program without violating grant restrictions (again, CMMI funds cannot be used to provide food).
Workflows, Data and Provider Burnout
Dr. Moore stressed that data collection must be integrated into routine clinical workflows — not layered on top of them. Paper questionnaires are out; digital solutions are essential. Dr. Parkinson flagged provider burnout as a serious concern, noting that excessive EMR data entry is a breaking point for many physicians. Study personnel will not like spending extra time after work hours entering data. Thus, having a data capture and management system that is complementary to workflows needs to be a central part of the project. The group discussed AI's potential role in data management while acknowledging the need for careful HIPAA compliance and institutional agreements. Dr. Parkinson shared the UPMC "Prescription for Wellness" as a model: health coaching embedded into medical workflows, triggered by physician referral, without overburdening clinical staff.
The Bigger Picture
Whether or not organizations apply for ELEVATE, panelists agreed that lifestyle and functional medicine practitioners need to reconfigure their services around a consumer-directed, ACO-style business model. As Dr. Moore noted, CMS currently views independent practitioners of any kind as fee-for-service cost drivers with no mechanism to credit them for reducing costs — the ACO model is the only current business model that offers some hope for functional and lifestyle medicine providers to get credit for lowering the costs of care.
The panel closed with a clear message: America needs the ELEVATE model to succeed. Disease reversal and risk reduction are the only real ways to bend the healthcare cost curve — and the field must now demonstrate that doing the right thing for patients also makes sound business sense.
Cited References
Vodovotz Y, Barnard N, Hu FB, et al. Prioritized Research for the Prevention, Treatment and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit. Front Med (Lausanne). 2020 Dec 22;7:585744. doi: 10.3389/fmed.2020.585744.
Maners RJ, Bakow E, Parkinson MD, et al. UPMC Prescription for Wellness: A Quality Improvement Case Study for Supporting Patient Engagement and Health Behavior Change. Am J Med Qual. 2018 May/Jun;33(3):274-282. doi: 10.1177/1062860617741670.
Parkinson MD, Hammonds T, Keyser DJ, et al. Impact of Physician Referral to Health Coaching on Patient Engagement and Health Risks: An Observational Study of UPMC's Prescription for Wellness. Am J Health Promot. 2020 May;34(4):366-375. doi: 10.1177/0890117119900588.
Budzowski AR, Parkinson MD, Silfee VJ. An Evaluation of Lifestyle Health Coaching Programs Using Trained Health Coaches and Evidence-Based Curricula at 6 Months Over 6 Years. Am J Health Promot. 2019 Jul;33(6):912-915. doi: 10.1177/0890117118824252.
Parkinson MD, Peele PB, Keyser DJ, et al. UPMC MyHealth: managing the health and costs of U.S. healthcare workers. Am J Prev Med. 2014 Oct;47(4):403-10. doi: 10.1016/j.amepre.2014.03.013.
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