How to Package Functional Medicine for Widespread Adoption

With the growing prevalence and cost burden of chronic disease, it has never been more important to disseminate the most promising approaches to replacing conventional disease management programs focused on long-term symptom management with models aimed at actual disease regression and long-term cost containment. Functional medicine offers a scalable and promising solution to this problem. There is a rapidly growing workforce of physicians and other health care practitioners who have invested in the training necessary to apply root-cause-focused functional medicine interventions with their patients. However, the challenges of sustaining this type of practice in the fee-for-service reimbursement system have restricted access to functional medicine by pushing many practitioners to operate outside of the third-party payer system in small, cash-based practice models.

Outdated payment models and misaligned incentives have conspired to arrest the forward progression of medicine. While an incredibly promising driver of long-term value, functional medicine requires practitioners to invest time with patients-particularly at the onset of the relationship in order to successfully find and address the causes of chronic disease. In a system designed to motivate and reward providers based on the volume of services delivered above the value of those services, this investment of time, along with the reliance on other lifestyle medicine interventions that are poorly reimbursed by payers, is often crippling to functional medicine practices. As the payer system slowly evolves to reward value, stakeholders must devise new ways to commercialize functional medicine at scale in a fashion that appropriately rewards practitioners while protecting payers from the potential for poorly controlled, spiraling costs.

Packaging functional medicine in fixed-price, bundled episodes of care targeted to specific populations offers a promising solution. This approach intuitively appeals to consumers and many payers, and it empowers and focuses practitioners on value-optimizing care pathways to achieve desired outcomes. By establishing an all-inclusive price, and targeting episodes to specific members of the population, this approach provides payers with the necessary degree of control to start taking steps toward large-scale deployment.