Ajay Joseph - Treating Root Cause When the Faucet Won't Stop

Welcome to the Reverse Mullet Healthcare . Podcast from BP2 Health . We are still in Orlando at the American College of Lifestyle Medicine Conference 2024 in sunny Orlando Florida . I'm one of your hosts Dave Pavlik , Justin Politi .

Ellen Brown , and we are here with Jay Joseph . Dr Jay Joseph , and super excited . I had the pleasure of meeting you in Tulsa , I guess , back in August , and was immediately really excited about the work that you're doing . You were in the Smitten Smitten .

Okay , yes , I was immediately smitten All right . But , humor aside , I just had a huge amount of admiration for the challenge that you face of bringing lifestyle medicine to a traditional health system and , as you know , that's , I think , where we align well , as we have been in that traditional healthcare space for 30 years and we really , when we stumbled into lifestyle medicine , what probably you ? know a year ago , we realized that this really could be that sort of bridge right , that that could allow us to reverse cardiometabolic disease for significant portion of of the population .

But that's a big uphill battle in terms of reimbursement , payment models and it can be done right and so yeah . So tell us about your program and what you're doing . Also , how did ? you wind up in Tulsa .

So that's interesting . My background I did my training at Rush University and I was trained by Dr Kim Williams , whom you saw yesterday . Yesterday he's one of the pioneers in the lifestyle medicine movement and , uh , when I was training to be an interventional cardiologist where you do another fellowship to go in and put stents in so he showed me , uh , he , he basically have you have a checkout interview and he showed me a picture of a guy mopping the floor while the faucet is open and he said you know , aj , this is what you're going to be doing , right ?

so that was kind of an epiphany for me , and so it's been a journey for the past nine years now since then . So , uh , I I just I love the way I , I just I'm passionate about lifestyle medicine and I did see that this way working right now there is an opportunity and , uh , and there's the need for , of course , oklahoma is 49th out of 50 states in terms of heart disease , so there's a big need for lifestyle medicine there . Wow , yeah , so . So how did you stumble into lifestyle medicine ?

yeah , I uh . So one of the things that Dr Williams working with Dr Williams was , uh , every patient every time is what his model , his approach was . So you speak about lifestyle management with every patient and that kind of got me thinking as to like you don't necessarily need to make everybody a vegan or run a marathon every day , but if you can make those small changes at every encounter . That's what I've seen , the effects and his working in his clinic and that's the practice that I've been doing .

And of course I I stumbled into aclm about six years back . I mean coming here every year for the past six years and you see the . You see the dramatic effects lifestyle medicine can do in patient stories , physician wellness . It really fulfills that quintuple aim of healthcare and there are a few .

I don't know of any other field and I'm being biased towards lifestyle medicine , I guess , but I don't know any other field in medicine that can fulfill that quintuple aim of healthcare . Yeah , and I think the differentiation for me because I am very familiar with other approaches , right that do try to address the root cause is they don't necessarily have the same right that do try to address the root cause is they don't necessarily have the same right or wrong , the same amount of trust clinically , they don't have the same necessary research and kind of efficacy behind it .

The other piece is that it doesn't just complement and fit in and sort of layer on to what we call traditional medicine . Again , I'm not saying that traditional Western medicine is the right answer , it's just the reality of our system . And then finally , the cost of it is there is a lot of diagnostic expense associated with some of those other approaches to doing the same thing and I just the simplicity of the six pillars is just money , right ? I think what we need to understand is that every guideline , every guideline , you name it .

You name diabetes , you name blood pressure , cholesterol guidelines , heart disease guidelines , heart failure , CAD , you name any guideline that you can think of . The first statement in every guideline is focus on diet and lifestyle , and for ever , since the past 100 years at least , we've been skipping that first step and jumping two hoops and going to the third or fourth step ? Yeah , going to jumping those three hoops and just going down there . So what ACLM and Lifestyle Medicine does is they're just going back to the basics and just basically just following the guidelines .

Yeah , Somebody said . One of our guests said the other day we think maybe it's too simple . It sounds too simple , yeah , so how could it be effective ? So effective ?

Yeah , you got any questions down there , sunglasses . Wait , what were you calling him in high-five Marbles , hide behind marbles , because he said he had marbles yesterday . But that was because he was like done in the afternoon but like he's fresh now I am . Went out and did a big walk oh he's like .

I did like 10 000 steps . He's fresh . Yep , I did , I did the 5k twice in your sleep . There's a lot of rural areas in oklahoma like explain to us , or explain to our listeners , how lifestyle medicine can help solve that , address those issues .

Yeah , so how about I give an example of one of my patients ? Yes , please , that'll set the example . That's kind of set the , and when you do that , can you tell us kind of your program ? I love your program , yeah .

So what our program is ? It consists of two parts . We have a dedicated lifestyle medicine clinic where we see patients in all shapes and colors and referrals and all kinds of shades of life . So share I actually .

I think it's a really important differentiation . When I talk about your program to people , one of the things that really sticks out is how you utilize referrals Right , so can you speak to that a little ? So every specialty has a pain point which lifestyle medicine addresses . For example , gi has pain point aminamine .

Pain point amine , a medical condition that they're trying to address and they don't have a mechanism to address that . As an example , fatty liver . Right , let's take an example for fatty liver . Fatty liver is almost purely a metabolic condition , cardiometabolic condition , where you don't have any medications for that .

So if a GI doctor sees fatty liver , basically what they tell them is to go home and eat healthy and live a healthy lifestyle . But how is that patient going to do it ? How is he going to get there ? So that's for GI .

For OBGYN , there's preterm labor . 70% of preterm labor is from lifestyle conditions . You have pcos , which is a , which is again a lifestyle related condition . You have mild cognitive impairment , as you've all seen from the owner study that you know that .

You know there's a , there's a big way where you can potentially reverse it . Uh , I mean , the list is long , right , cancer survivor should be . You name pediatric obesity . So each specialty has a pain point which lifestyle medicine medicine can address .

So our clinic model is basically you know what ? Just give us your pain points , just give us all your , all your specialties , just give us your pain points and let us act as a bomb for you , for those , those patients where you have no option . You are telling them to go home and eat healthy , and we'll do that . As for primary cares , you know primary care see 20 patients and they have 15 things to do in that 20 minute encounter .

Expecting primary cares to take another 20 minutes to practice lifestyle medicine in that 20 minute encounter , it's just not logical . So what we reach lifestyle medicine to primary care is that we know you want to do this . We know you want to talk to your patients about lifestyle medicine and all these advices , but you don't have the time . So just outsource that piece to us , so we're going to take care of that aspect so that we can help you get better outcomes .

So that's the model of our clinic , where everything funnels into this and then , based on each patient's individualized needs , we formulate a plan for them . That could be either following up in our clinic every three months , seeing a dietician in between , or , if they choose , to go really gung-ho about it . We have a teaching kitchen , an intensive lifestyle medicine program which consists of five shared medical appointments spread over eight weeks . It's done in our health zone , our health facility .

You get teaching , kitchen classes run by a chef , dietitian visits , stress management sessions . You get exercise training with a trained exercise physiologist . You get two months of free membership to the gym . So it's a much more hands-on , much more dedicated , more intensive program .

So those are the two approaches that we've had and we've seen some phenomenal results . Yeah , there it goes again with the shared medical . That's the best way to do practice lifestyle medicine , no question about it . Well , and the way that they've figured out which I think is really smart for listeners that are on the technical side of this is if you do it right and you pair it with an actual physician visit associated with that group visit , you can bill it at an E&M code level and not just the group billing code , and so it's a much more robust revenue reimbursement .

Obviously , outcomes , shared savings is the way to go , but if you're in that fee-for-service service line model so kind of going back to Justin's point , tell us how your model works with those that are kind of rural . Is there an element that helps there ? I think for the first , we are trained . We're all human beings , we all have our biases .

We tend to think that you know what the folks in rural areas are not going to make , the changes that we expect them to make . I'll give you a story of a gentleman in rural Oklahoma , came in with a attack , had to do a stent on him , and this is a rancher . He's a rancher , he's lived on meat and potatoes all his 60 , 70 years . And that was a moment for him and he said you know what I'm going to .

You tell me what I need to do . I'm going to do it Right . So he went back home and he has changed his lifestyle for himself . And the beauty of lifestyle medicine is is that it's not just that index patient right , it's the ripple effect that happens .

He changes his lifestyle of his wife , his kids , his friends , his family . I mean , that's the beauty of lifestyle medicine . So he has been a champion of lifestyle medicine in his own small town . So , that's the beauty of lifestyle medicine .

Yeah , no , it's amazing . We talked yesterday about kind of that tipping point , like when you have that moment in your life that you're willing to make a change . So , unfortunately , I think what we have to we're like on a tight schedule today . We're back to back today and I want to be respectful of your time but , we most definitely will be bringing you for a full episode , because you're such a good case study of how to do this .

So yeah , because you're such a good case study of how to do this . Thank you . Thank you so much . Have a great day .

Thank you All right , thank you Bye .