A Landmark Accomplishment for ACSM & Exercise is Medicine® (EIM) – Part I of Implementing the EIM Solution!

By Adrian Hutber, Ph.D. & Phillip Trotter
Adrian Hutber, Ph.D. Phillip Trotter

Adrian Hutber, Ph.D., has served as vice president of Exercise is Medicine® at ACSM since 2008, after previously serving as vice president of a major fitness corporation and as the director of the distance education division at Human Kinetics. During his time at ACSM, Dr. Hutber has helped to establish seven EIM Regional Centers and 43 EIM National Centers, all with the goal of making physical activity assessment, prescription and referral part of health care systems globally.

Phil Trotter, B.S., leads the EIM Solution “on the ground.” The EIM Solution is the key component of EIM that brings about implementation of community networks that include local health systems, health providers and resources necessary to make physical activity and exercise a standard element in the delivery of health care to all patients.

This commentary summarizes perhaps the most exciting news about Exercise is Medicine® since its inception in 2007. For reasons of scope and complexity, the presentation is divided into Parts I and II. Part I presents a short overview of EIM and key details from a special press conference held late last month at the National Press Club in Washington, D.C. (see: https://youtu.be/u_GkwT0bFpw). This part also identifies the roles of the EIM Solution, the EIM Global Center and the EIM Global Research and Collaborative Center, all of which are key components needed to implement EIM in large U.S. health systems. Part II will follow soon in a future issue of SMB.

A Brief Synopsis of EIM. EIM’s most fundamental mission has been to establish physical activity as an issue to be addressed in every physician-patient office visit and, by virtue of that interaction, engage physicians in writing individual scripts for each patient. The philosophy, concepts and implementation models of EIM are based on scientifically sound and persuasive evidence as to the health values of regular physical activity. Such a system, if implemented in communities across the U.S. and worldwide, holds great promise for disease prevention and controlling ever-rising health care costs.

In the early going, tireless efforts by many EIM volunteer and staff leaders advanced understanding and enthusiasm for these concepts. As a result, EIM is supported by a global network of collaborating centers – a network that is still growing. Now, moving forward, EIM has developed methods and protocols capable of demonstrating effectiveness and practicality when implemented in health care settings. The next stage, and the subject of this commentary, is the plan for full-scale implementation in a large health system. Two critical components required for this phase include carefully coordinated involvement of community stakeholders and simultaneous integration of a rigorous system to evaluate the real-life effectiveness of EIM program. EIM, as an entity, is complex and has many working parts.

A Health Care System in Transformation. Today in the U.S., chronic diseases are responsible for 80 percent of health care costs. One major consequence is that payers (employers, insurers, Medicaid and Medicare) are demanding that health systems share fiscal responsibility for interventions that successfully decrease both the prevalence and economic burden of these chronic diseases. A key strategy to bring this about is a transformation of the health care system – from one that is focused on volume to a system focusing on value-based care. So, instead of the longstanding “fee for service” model, there is great momentum building for replacement it with a model that rewards achievement of successful patients’ health outcomes. With this new model has come remarkable opportunities for exercise professionals and facilities, providing them with the opportunity to play a significant role in the prevention and intervention of chronic diseases.

The National Press Club Announcement of February 23rd. The American College of Sports Medicine (ACSM), American Council on Exercise (ACE) and the Medical Fitness Association (MFA) came together at the National Press Club in Washington, DC to announce that they were uniting under the Exercise is Medicine® (EIM) platform. The purpose of this collaboration is to support the building of what EIM identifies as Community Care Teams – these include trained personnel who can deliver chronic disease prevention and intervention programs. A health care-relevant analogy is that this EIM model builds into each community an “exercise pharmacy,” i.e. referring to personnel, facilities and places where the health care provider, with confidence, sends their patient on a trusted pathway to fill a given prescription for disease prevention. Clinicians have long acknowledged that physical activity, at the very least, is an important factor for both the prevention and management of chronic diseases. With health care systems now widely adopting the Population Health Management (PHM) care model, regular physical activity and exercise is now a must-have lifestyle behavior priority.

This PHM care model helps to describe the evolution underway that is designed to improve health across the continuum of care. The capacity-building needed to make possible these community-level connections between the PMH model and the “exercise pharmacies” has been underway for several years – through planning and guidance provided by EIM’s Global Center (EIM-GC)and its Global Research and Collaboration Center (EIM-GRCC). The challenge is where to refer these population groups for participation in accessible, safe and uniformly effective prevention and intervention programs. In simple terms, many health systems are reluctant to refer patients to a community resource that cannot demonstrate quality assurance of service equivalent to what patients receive within that same community’s clinical settings. This quality assurance is exactly what the EIM Solution provides. EIM’s programs and credentialed professionals provide the engagement methodology needed for advancing patients toward a physically activity lifestyle – including attention to the duration, frequency and intensity of activity necessary to develop behavior-change outcomes that lead to self-management and a return on investment for health systems.

Editorial Note: Part II of this commentary will focus on how the EIM Solution will be applied and the role of EIM-GRCC in evaluating and validating a system of metrics to demonstrate effectiveness of implementation.