LifeCare Alliance's Medical Nutrition Therapy service meets you at home

Tim Feran
For Columbus CEO
Team members of the LifeCare Alliance Medical Nutrition Therapy Program (Photo by Rob Hardin)

Before she became the director of LifeCare Alliance’s Wellness Department, Melinda Rowe owned a small business, “and I had learned a lot of things the hard way,” things that she was able to apply to the Wellness Department.

After the Central Ohio Diabetes Association became part of LifeCare Alliance in 2017, Rowe looked for a better way for the department’s team of registered dietitians to help patients with diabetes.

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“I knew we couldn’t compete with hospitals and big group classes,” she says. Remembering her days owning a small business, she decided that LifeCare would succeed if it found an unserved market. “So, I said, wait a minute—let’s go into the home. Hospitals don’t want to do that. It’s an unserved niche, we don’t have to worry about competition.”

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“So that’s where it began,” she says.

LifeCare’s Medical Nutrition Therapy Service, which is Columbus CEO's 2022 Healthcare Achievements Pathway to Population Health winner, offers in-home visits with registered dietitians. Patients with diabetes are referred to the service by physicians, stroke prevention centers, medical groups and other programs of LifeCare Alliance, like Meals-on-Wheels or Project OpenHand-Columbus (which serves people with HIV/AIDS).

While diet may not seem like a big problem in the near term for patients with diabetes, it can be a crucial component in their ability to maintain healthy blood sugar levels and prevent complications from the disease including stroke, heart disease and neuropathy (nerve damage).

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In theory, the program is a simple answer to the problem of reaching patients in need, but because it was unique “there was nothing to copy,” Rowe says. “The first year was painful. We found out what wasn’t working pretty quickly.”

One of the big issues: “In the beginning, people would reach out to case workers, dietitians, all sorts of different avenues,” to make an appointment with a dietitian.

The confusion could have damaged or even destroyed the program, but Rowe and her team decided that the best solution would be to have everything flow through their case manager.

Elana Burak, case manager at the Wellness Department, acts as a kind of matchmaker figuring out which dietitian’s personality and approach best aligns with a patient’s personality and needs.

It helps that Burak not only has a degree in social work but has Type 1 diabetes herself.

“I live it, I breathe it, I get it,” Burak says. “So this position was an ideal fit. I listen to their stories and connect them to one of our dietitians. After talking to a client, I can get a pretty good idea who they would connect with. I just can’t say enough about the dietitians here. I love every one of them. I sing their praises all day.”

“I’d like to say I follow some sort of theory, but to quote my late mother, she used the WW technique—whatever works,” Burak says.

The program’s focus on in-home, in-person visits hit a major speed bump when COVID-19 shut down many similar services.

Acting with characteristic nimbleness, Rowe and LifeCare Alliance obtained an allowance for online video visits—telehealth. “With this new allowance for telehealth, it can be a client decision and insurance will pay for it,” she says. “Prior to this, we could only offer it if a doctor initiated it.”

The program is a huge benefit to patients who have financial issues, other medical concerns, transportation issues or other factors that prevent them from visiting a doctor’s or dietitian’s office.

“People have busy lives, they can’t commit to classes, and getting them to come to two classes was difficult. Three was impossible,” Burak says.

“In hospitals, the no-show rate was pretty high,” for classes, Rowe says.

Proof that the Medical Nutrition Therapy service is improving health and saving lives: The 239 patients who received at-home, individual consultations in 2021 had a success rate of better than 90 percent in a combination of improvements in diabetes management, lifestyle behaviors and blood glucose levels

The service is so successful, in fact, that LifeCare Alliance has had to grow in response, adding electronic billing and charting, which in turn has created a new revenue source to fund the programs of LifeCare Alliance.

The service “is not something you can get on a website,” Rowe says. “You need a counselor, in person, helping with behavior modification and not just A1C (tracking blood glucose levels).”

Tim Feran is a freelance writer.

LifeCare Alliance Medical Nutrition Therapy Program

LifeCare Alliance’s Medical Nutrition Therapy service provides in-home visits with a registered dietitian to help patients with diabetes achieve better health care outcomes. The program is unique in that it partners with managed care organizations to provide treatment options to those who otherwise encounter frequent barriers to care.

Founded: 2018

Top Officers: Melinda Rowe, director, LifeCare Alliance Wellness Services

Features: In-home consultations in Franklin County customized to each person with diabetes-specific needs and situation conducted by a registered dietician.