Natalie Digate Muth by Natalie Digate Muth
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While 2014 saw the full rollout of the Affordable Care Act (ACA) and healthcare reform, the implementation and testing of many of the ACA provisions began to take off in 2015.  

With staggering and unsustainable healthcare costs, worsening health of the American people—in many cases driven by the duel epidemics of obesity and diabetes, and a generally failing system—the goal of healthcare reform was to achieve what has long been an unsolvable puzzle: achieving simultaneously the “triple aim” of improved patient experience (including quality and satisfaction), lowered cost, and improved health outcomes. 

In 2015, the healthcare system in general continued to pursue the triple aim, with some notable trends and signs of progress along with some setbacks in the early years of what most healthcare experts predict will be a long-term transition to a system that relies more on value-based care than volume-based care. 

Here are a few of the highlights with the most relevance for health and fitness professionals: 

1. While the notion of population health existed before healthcare reform, its prominence and importance has continued to gain traction over the year.

The Institute of Medicine Roundtable on Population Health Improvements defines population health as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group. While not a part of the definition itself, it is understood that such population health outcomes are the product of multiple determinants of health, including medical care, public health, genetics, behaviors, social factors and environmental factors.” 

By its very nature, population health improvements intend to help groups of people optimize health and prevent debilitating and expensive diseases. This is the first step in a greater recognition of the effectiveness and importance of things like physical activity, which provides high value across a variety of diseases and conditions. In fact, in the recent years, many Schools of Public Health have begun to offer a Master of Public Health in physical activity.

2. The long-in-coming update of medical diagnostic coding from the ICD 9 to the ICD 10 occurred in October.

ICD 10 codes are much more specific than its predecessor and create a greater opportunity to evaluate patient care, make clinical decisions, identify public health trends and communicate across providers. ICD 10 also is more conducive to the addition of new codes for newly recognized diagnoses. For instance, the oft-discussed “exercise deficit disorder” in children who suffer health problems due to inactivity could one day be an ICD 10 code. Having a diagnosis naturally prompts addressing its treatment. 

3. The United States Preventive Services Task force released an updated recommendation that advises healthcare providers to screen at risk individuals for diabetes.

For those who do meet criteria for prediabetes, healthcare providers are advised to refer them to a lifestyle coaching program. The ACA gave these recommendations new bearing, as those graded A or B (the diabetes screening was graded a B) are supposed to be available to eligible patients with no co-pay. Meanwhile, Diabetes Prevention Programs, led by lifestyle coaches trained in nutrition, physical activity and behavior change, have continued to grow across the U.S., many of which are being paid for by insurance companies.

4. We saw an increase in adult obesity and stabilization in childhood obesity, making clear that there is still a long way to go to reverse the obesity epidemic.

Recognizing the importance of many factors that affect obesity risk and treatment, an Institute of Medicine working group published a framework to help outline how clinic-community integration can fuel change. [Disclosure: I served on the writing group of this framework as an ACE representative to the clinic-community integration working group of the Institute of Medicine Roundtable on Obesity Solutions.] 

5. The fallout of healthcare reform still remains to be seen.

This year saw some flux. Healthcare systems and private practices continue to consolidate and now many major insurers are attempting to do the same. Some insurers have dropped out of the exchanges, while others reported massive premium increases, sometimes up to 30 percent. A growing number of hospital systems have entered into the retail-based clinic market, working even harder to expand their reach and influence in their communities. The impact of these changes will become more apparent over the coming years.

6. Just as the fitness world has been disrupted by wearable technology and trackers, the healthcare system has been disrupted by rapidly advancing technology in electronic medical records.

This advancement in technology has allowed for improved record-keeping, patient management and integration, including a boom in telemedicine. 

While this year may be remembered in history as just another early year after the historic passage of a new healthcare system, it marks a transition in priorities and continues to open the door wider for a team of professionals from diverse fields—including fitness and health coaching—to work closely together to help optimize quality, access, and cost of care in a joint effort to improve population health.

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