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Published 4/23/21

IFM strategic priorities include the continued support of research efforts to build the evidence base for functional medicine. In recent years, partner organization Cleveland Clinic Center for Functional Medicine has published two studies providing evidence that functional medicine improves outcomes when compared to conventional primary care. The first study, published in 2019, demonstrated global improvements in patient-reported, health-related quality-of-life outcomes in patients treated with functional medicine compared to those treated in a family care clinic.¹ In 2020, Cleveland Clinic published a study suggesting that inflammatory arthritis patients treated with functional medicine showed improvement in all primary outcomes compared to standard of care alone.²

Now, in a new study published in the journal BMJ Open, Cleveland Clinic researchers examined the value and effectiveness of functional medicine–based shared medical appointments (SMAs).³ SMAs have shown promise in treating chronic conditions since they were first proposed in 1999, but prior to this study, they have not been studied as a tool to deliver functional medicine–based care. In the study, researchers compared patient outcomes and costs after the ten-week SMA program, called Functioning for Life (FFL)®, with individual functional medicine care at the Cleveland Clinic Center for Functional Medicine. Researchers found that after three months, both groups showed improvements in biometrics and health-related quality of life (HRQoL) patient-reported outcomes. Patients in SMAs exhibited greater improvements in patient-reported physical and mental health scores and lost more weight than those who had individual appointments. The SMAs were also less costly to deliver than individual appointments.

FFL is a 10-week functional medicine–based SMA format that utilizes IFM tools, including food plans and mindfulness tools. It includes five condition-specific cohorts: weight management, autoimmune, digestive disorders, women’s health, and diabetes. Each cohort uses a multidisciplinary team to provide condition-specific education related to nutrition, lifestyle, and behavioral health recommendations. Four sessions are co-led by a medical provider (MD/DO/NP/PA) and health coach and six sessions are led by a registered dietitian. Each session includes education on lifestyle and behavior change, and each patient also receives a limited individual medical evaluation with the medical provider. Patients are empowered to make positive decisions regarding food and become advocates for healthy lifestyles within their homes and communities.

Researchers used propensity score matching to compare changes in HRQoL and biometric outcomes between SMAs and individual appointments. Propensity score matching is a statistical technique that attempts to reduce bias due to confounding variables in the treatment versus control group. In total, 2,455 new patients from the Center for Functional Medicine (SMAs 226 and individual appointments 2,229) were included.

The results, measured 12 weeks after treatment began, showed the following:

• Both groups had higher Patient-Reported Outcome Measurement Information System (PROMIS) scores (1.34 higher for individual visits, 3.12 for SMAs).
• Both groups also experienced improved biometrics (lower blood pressures and weight loss).
• SMA patients had a significantly greater improvement in PROMIS Global Physical Health (GPH) T-scores than patients receiving individual appointments (by 1.78 points).
• SMA patients were also more likely to experience improvements of five or more points (seen as a clinically important difference; 38% vs. 26%, NNT=8), but the differences were not significant (p=0.07).
• SMA patients had a significantly greater improvement in their weight than patients receiving individual appointments (-3.8 vs. -2.4 kg; mean difference -1.4).
• Both groups showed equal improvement in their systolic and diastolic blood pressures.
• SMA patients received more caregiver time per patient than those in individual appointments (14.0 hours vs 3.5 hours).
• SMAs cost less to deliver ($1,549 vs. $1,633 per patient) and generated greater revenue ($4,204 vs. $3,780 per patient).

Based on these results, SMAs are an efficient and cost-effective way to deliver functional medicine care in the context of a trained functional medicine collaborative care team for some of the most commonly diagnosed chronic conditions. SMAs provide more opportunity for interaction with care team members and for patient education than traditional care, taking one of the most time-consuming elements of individual functional medicine visits—repeating the same baseline elements of dietary, lifestyle, and behavior change to each patient individually—and moves it to a group setting.

The potential to provide functional medicine care within the insurance model using a shared medical appointment approach could broadly increase accessibility of functional medicine, allowing more people access to care for common chronic conditions. The value created by both improving outcomes and reducing costs provides important validation for the functional medicine approach and presents a compelling argument for expanding access to functional medicine.

References

1. Beidelschies M, Alejandro-Rodriguez M, Ji X, Lapin B, Hanaway P, Rothberg MB. Association of the functional medicine model of care with patient-reported health-related quality-of-life outcomes. JAMA Netw Open. 2019;2(10):e1914017. doi:1001/jamanetworkopen.2019.14017
2. Droz N, Hanaway P, Hyman M, Jin Y, Beidelschies M, Husni ME. The impact of functional medicine on patient-reported outcomes in inflammatory arthritis: a retrospective study. PLoS One. 2020;15(10):e0240416. doi:1371/journal.pone.0240416
3. Beidelschies M, Alejandro-Rodriguez M, Guo N, et al. Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study. BMJ Open. 2021;11:e048294. doi:1136/bmjopen-2020-048294