3 Reasons a Foot-Forward Approach to Chronic Care Management Has Real Legs

Effectively managing chronic conditions has proven to be a very elusive pursuit. Our healthcare system has not been able to curb the relentless rise in prevalence the last several decades. Even worse, we also have not been able to slow the progression of chronic conditions among individuals and effectively minimize the health and financial impacts of issues such as diabetes, cardiovascular disease, chronic kidney disease, vascular disease and neuropathy. So, how do we make the leap that is required to finally get ahead of chronic disease? By focusing on the feet.

The feet provide a foundational opportunity to reduce chronic disease spending.

The feet are fueling a large portion of the expense related to chronic disease. For example, diabetic foot complications account for $52.8 billion of the $176 billion spent annually on diabetes care. The kicker is that 85% of these complications are preventable with timely intervention. Simply focusing more on foot-related health can make a massive dent in rising costs related to chronic conditions.

The feet are a crystal ball for future health.

Reducing foot-related complications is just the first step in understanding how important it is to start with the feet when managing chronic disease. We can also gain incredible predictive insight from the feet to gauge health risks and anticipate avoidable complications.

Because the feet are the farthest body part from the heart and central nervous system, they are first to manifest signs of deterioration and therefore, serve as an early warning system. The feet tell you what is about to happen in the rest of the body. You can accurately assess overall health, while predicting and preventing future health issues by following the feet.

According to an article by Dan Baumgardt, a clinical neuroscientist and anatomist at the University of Bristol…

“Feet are wired up to nerve fiber tracts from the brain so you can stand, balance and wiggle your toes. They’re also plumbed by blood vessels, which lead all the way from the heart. The appearance and function of our feet then can indicate viral infections, diseases of the cardiovascular system and even neurological disorders. Diabetes, kidney failure and even thyroid disorders can affect the feet.”

Dr. Joy Rowland with the Cleveland Clinic echoes this sentiment.

“We can definitely see evidence of different disease processes in the feet, whether it’s on the skin or in the toenails or just in general,” she said. “A patient presents with swelling of the skin or feet, sometimes it’s related to heart disease or kidney disease or lymphedema or vascular disease.”

There are countless use cases for leveraging the foot to identify current, or predict future, health concerns. Here’s a very practical example. Deep vein thrombosis (DVT) is a very serious condition that can evolve quickly into a medical emergency. DVT occurs when a blood clot forms in one or more of the deep veins in our body, most frequently occurring in the lower legs. While it can cause leg pain and swelling, in some cases the symptoms are not obvious to an individual.

Over the course of 300,000+ in-home visits, our team has many case studies where upon a direct examination of an individual’s foot and lower legs, we identify swelling and redness and refer them to their doctor. More times than not, it is confirmed the person has a blood clot that could dislodge at any time and ignite a catastrophic outcome such as a heart attack or stroke. Early identification allows doctors to take simple steps such as prescribing a blood thinner or possibly injecting the clot with medication to dissolve it. As a result, intentional lower extremity monitoring and care, paired with thoughtful care coordination, is making a lifesaving difference.

The feet are the greatest door opener of all time.

The final advantage of a foot-focused approach to chronic disease is that it creates an unprecedented opportunity for engagement. Starting with foot care (medical pedicures) allows you to jump start engagement with members by delivering a practical and highly valued service that many seniors seek out as a matter of self-preservation.. Because it’s a joyful experience and addresses an unmet need, it doesn’t “feel” like a clinical intervention to the member.

Nearly one-third of seniors report being unable to perform basic self-care tasks, like trimming nails or washing feet. On a daily basis our community health workers, who are also licensed nail technicians, encounter individuals who have not had someone touch or examine their feet for an extended period of time. Many of them have sores or other concerns that are in need of immediate attention. For many of them, foot issues are creating instability with their gait and opening them up to serious fall risks.

The Future for Foot-Forward Chronic Disease Management

Imagine if you could harness the predictive power of more than 3 million foot photos, and related clinical notes, from actual patients to build a model that can accurately assess overall health and predict which patients are at higher risk for potential complications. Last fall, our company announced an initiative focused on building AI capabilities to do just that. This technology will enhance our ability to stratify risk and forecast future needs for each member to get out in front of potential complications. All by using the foot as a crystal ball. This is a very practical example of how the foot can take the lead in evaluating and managing costly conditions such as diabetes and cardiovascular disease.

Research shows this approach has legs. In fact, when comparing a home-based care management model that leads with the feet to blockbuster pharmaceuticals aimed at managing chronic conditions, the home-based foot-forward program outpaces leading medications in both clinical outcomes and total cost of care savings. Even better, the home health program returned at least a 2:1 ROI, while the vastly more expensive medications failed to break even when it came to cost versus savings.

Lastly, while the foot is a great first step in changing the way we manage chronic disease, we have to ensure we follow that up with comprehensive approach to chronic care management. This means conducting “whole health” assessments, facilitating regular check-ins with clinicians, creating and maintaining care plans and referring individuals to care as appropriate. Fusing robust support from an integrated care team with the highly effective entry point the feet provide will help us improve chronic care management by leaps and bounds moving forward.

If you are interested in learning more about Belle’s approach or want a personal consultation for your population, please contact our team today.