Shawn Martin on Healthcare’s Inflection Point: Realigning Incentives to Prioritize Health

Welcome to the Reverse Mullet Healthcare Podcast . We are live at the ACLM Conference , the American College of Lifestyle Medicine . He did it . Yeah , there you go 2024 , orlando , florida .

I'm Justin Politti , I'm Dave Pavlik . I'm Alan Brown . I'm Justin Politti . I'm Mullet man , but we're here with Sean Martin and I'm super excited because I think your organization is integral to what's happening today .

You know we had Susan Benegas on yesterday and she used the term catalyst for transformation . Yeah . And you have been in this uphill battle with family practice for the AFP of how do you enable family practice , primary care , to fulfill what it's capable of fulfilling , right , and it's such a challenge with the RVU model and a fee-for-service model and just what we've been up against , and you know we've been coming at it from a payment transformation perspective . And how do we get outcomes-based models ?

You know value-based care models , all these things in place , and I feel like lifestyle medicine is truly this catalyst to transformation , because it's a tool to allow success , you know . So I'm really glad you joined . Well , thank you for having me so tell us about AAFP and tell us about your work and lifestyle , medicine and linkage , et cetera . Sure .

So the American Academy of Family Physicians is founded in 1947 as the American Academy of General Practice . We became AAFP in 1971 for a variety of reasons . Part of it was a transformational movement around the practice and the scope and community-based care and community health centers . Lots of things were happening in the United States and kind of the post-Medicare community-based care models were emerging .

Community-based care models were emerging but family medicine kind of came out of that community-based movement to connect health and health professionals at the community level in response to kind of a very hospital-centric time period around Medicare , which still exists today in many ways . We represent 130,000 family physicians and medical residents across the country . We have a member at least the last time we counted in 95% of US counties . They move around a little bit but we have a very robust footprint across the country and , more likely than not , if there's people living in a community there's probably a family physician somewhere nearby .

We're an organization . We're a professional organization . We really do three things . We do member support .

We have a very robust education apparatus , helping members be successful both in clinical practice but also in their careers and profession , and then we're a big advocacy organization and doing all the work that you just talked about at the beginning A little . You know , it was a little depressing to hear all the things that we got to work on Sorry . Well , we're energized about it so . But you know it's a wonderful organization .

You know people come to Family Medicine for all the right reasons . So , but , um , you know it's a wonderful organization . When you know people come to family medicine for all the right reasons and you know it's just a opportunity , I really appreciate the opportunity to try to help make their world better so they can make other people's world better , and that's why I'm here at lifestyle medicine and I think we're just it's a continued pursuit . Yeah , so you guys want to .

I'm always the yapper , yeah , now what do you find the biggest ? barriers to moving it forward . Just the concepts of primary care or lifestyle medicine . Lifestyle medicine .

I think the barriers to the concepts of primary health care in the United States are the same for lifestyle medicine is the same as it was for health promotion , disease prevention and like all these concepts have faced the same headwinds in the United States and it's because we have built a healthcare system from a benefits and financing perspective that is heavily focused on late stage intervention of disease we don't focus with , except for children , you know , and like there's this moment in time with children who were very health and prevention focused but by the time they reach , you know , young adolescents , we've moved away from that .

But we're a healthcare system largely focused on late intervention of disease . And how do we not ignore people that need intervention to live a better life because of their disease state , but kind of pivot backwards earlier in the lifespan to start creating a more healthy population moving forward ? And I say this all the time it , you know , it upsets people , but we're never going to solve our problems if we're trying to solve it at plus 50 years old . I mean we , just we can't .

I mean that's like swimming against the strongest current . You know we're going to have to get way upstream and try to create healthier populations in the future , which , in results , you know could lower the economic pressure on our healthcare system and individuals and create a healthier population . But it's interesting because I feel like we're coming into this magic moment where , because we're spending 2 trillion , so it's kind of like the creep . Right , healthcare used to be to your point .

Like we did . We built this very , I say , sick care , which is a bit draconian statement , but people understand that . Right , we built this system for keeping you alive , right ? You're really sick .

We treat you , we keep you alive , we treat you . And I think now , with the rapid , exponential growth of lifestyle disease , cardiometabolic disease syndrome you know we're spending 2 trillion on that it's it's really largely bankrupting a lot of folks . And now all of a sudden , people see that and so I almost feel like we're at this magic moment where we don't even have to debate about quote unquote wellness and prevention , which I a hundred percent agree with your point about we need to keep moving down is we have this huge opportunity in front of us .

I mean , I've been shocked at the number of people that have said , even at late stage in your sixties , right , that lifestyle medicine can truly reverse disease . You know , and it's like wait , we have this tool that we can put in our toolkit that could actually give an option to reverse disease , not just treat it right . And as that takes hold and we show success , we could then say , okay , now we can keep moving down right . We can use it as a tool to improve the health overall and not get to the point we've been getting to you know .

Well , yeah , we've collectively lost our minds , it's true . No , you said this yesterday and it was so true . And we have a common sense solution in front of us and we just need to advertise it . But we are , we're full , delusional , and now we have a common sense solution in front of us and we just need to advertise it , like I I mean like .

But we are , we're in , like , we're full delusional and now , like , we're awake . You know what I'm saying this is an epiphany . He actually had t-shirt ideas now it's um , so I , I , I actually agree with that as um . Those aren't the words .

I would have um in my professional role . But I do think this concept of we've lured ourselves into this false optimism about what actually is important in the healthcare system and I think it's a real disconnect . You've made the point . It's a financial disconnect to individuals , it's a healthcare disconnect to individuals .

It's a healthcare disconnect to individuals . Like people want to live healthier lives , and I mean , if you engage them and you give physicians and care teams the resources to help people see a different alternative , more often than not they take that alternative . And the healthcare system isn't designed and I made this comment yesterday in my talk here the healthcare system is not designed from a benefit and financing structure for these conversations to take place . They actually disincentivize those conversations from taking place and I think we just , you know , we just we have to align the outcomes we want with the care that we're asking people to provide and I think right now the care that we're providing is aligned with , you know , all the wrong things in many respects .

But I do think and that's why I say it's . This moment is I do actually get very optimistic when I look at all of the value-based payment models that we have accessible to us through both CMMI , through direct-to-employer , through commercial , all of those different Medicaid . I get hopeful because I think a lot of people have been uncomfortable to jump into those models because they've been doing chronic care management . Again manage .

It's like let's just manage the person , let's try and just avoid a readmission , whatever . We're not reversing anything right , we're not focusing on changing behavior . And I look at this and I say , wait a minute . Okay , if we could just deploy lifestyle medicine with cohorts of people , to your point , that actually want to get healthy .

There are millions of people that do want to get healthy and we give them the intervention to say here now we have an outcomes-based model to reinvest , to actually reinvest those dollars for a health system . They make a lot more margin on sharing 50% of the savings of a diabetic patient that just saved $30,000 in the year than they did on the margin of a stay . You know what I'm saying . And I'm not talking about all of a sudden just like yanking all the inpatient admissions out it's .

There's a real opportunity here to leverage the payment models that we have and align them with the practice of medicine , using such simple tools as lifestyle medicine . You know what if we're all healthy ? What if we're all healthy ? Well , I mean that's true , right .

Like I mean that's the concept of just prolonging the onset of disease by a week , a month , a year . Like I mean just the impact that has at scale in a population like this . But I have two comments because , like I think you're making an excellent point , we , you know , for a long time , interventions in or demonstration projects or innovation , particularly in primary care , were all designed to produce an outcome from someone other than the patient . So it was to save a hospital money , to save the employer money , to save the insurer money .

There was never a system designed to help the patient be healthier and live a better life . And I think , to CMMI's credit and to a lot of people in the marketplace , that has changed . People are becoming much more focused on this concept of whole person care , helping people live their best healthy life , no matter what state they may find themselves in at the time . So I think that conversation has changed a little bit , which gives us a new opportunity to align financing models and care models around .

You know some of these new concepts and I think that's why lifestyle medicine is having a moment . I think that's why you're seeing the appropriate like how does it get incorporated into more comprehensive care models so that it's not a niche , you know , practice model . I think that's where , at AFP , lifestyle medicine should reemerge as a component of comprehensive primary care right Everybody should be doing this you know , and you should be doing it for children . You know , these approaches to this concept of care do not have an age limit or anything else .

I mean these are just a good approach to better patient care . Yeah , they don't have to be concierge , they don't have to be only for the rich , and I think that's it , like just we've lost our minds Like it's how to live healthy . It's like just we've lost our minds like it's how to live healthy . It's like you don't have to go buy some special implement .

Or it's like just sleep more and move your body and eat healthy and right . It's like no , and I haven't shared . I haven't shared this . I've been thinking all week like oh boy , oh boy , wait , no , this , this is the roadrunner wiley coyote kind of moment .

Uh , wiley coyote runs off the cliff and all of a sudden crashes down because guess what ? It's unsustainable , the whole system , the way we're funding everything . And we've hit that moment collectively , as society . Yeah , we're running , we're like really close .

Right . So , honey , I'll have the Acme pillow ready for us . Justin's underneath . Is there going to be an anvil falling on ?

us , or is there a pillow , an Acme pillow ? Yeah , I don't know , we'll find out . Well , we know you have to get on with the day , and we know this is always a tight time frame . We really appreciate you joining us .

Yeah , thanks for being here . Thank you guys for having me . I mean , we've got Roadrunner . Yeah , we go everywhere Like it's like a pain .

And feel free to jump in against the Roadrunner there ? I didn't I wanted to give you an out . I wanted to give you an out , so thank you for having me and you're welcome on for a full discussion . I would actually welcome that .

Now , my mind I'll be better prepared mentally for what I'm getting into you think so ? But thank you for having me , thanks for the opportunity to share a few thoughts , and I look forward to the next time . This is not grandpa's podcast . No , but we do have a lot of people don't understand it's party in the front , business in the back but , you make it too boring and people are like , yeah , I get enough of that at work every day but you make it too silly and it's not helpful , and so our goal is to hopefully kind of balance the two .

Weave it in , yeah , so thank you . And I don't want to be . I want to say one last thing yeah , please . I think I've been at this a long time .

I think we are at an inflection point that is different than any other time that I can remember , and I think COVID created that in many respects oriented to essential kind of false truths that exist . One , it reoriented people around the fact that they do want to be healthy . I mean , you started to see kind of a refocus of the population on wanting to be healthy . And two , it reoriented the healthcare system that it wasn't actually doing a good job .

It was not , you know , prepared to really meet the moment , and not the people inside the healthcare system , but the structure of the system itself was not really designed to meet that moment . And you know , now it's . You know , do we how fast can we build ? Can we stack bricks fast enough to build something different , or do we just kind of fall back into the routine ?

And it's interesting you say that , because I was really at an inflection point myself in my career a year and a half ago . We all were , and lifestyle medicine to me is . I don't know , justin will come up with a good analogy . You might .

You seem like a good analogy person . I'm not Is . I feel like lifestyle medicine . Maybe it's like the speed drying mortar , that that it's like you can take we have .

We have certain elements in the care system that we built today , right , that can be deployed , like all of the primary care physicians that we have . But now , all of a sudden , we give them lifestyle medicine as a board certification on top and another way to practice medicine for the patients that want to reverse disease . Right , and now all of a sudden , it's like boom , boom , boom , boom , boom , boom , boom . Because you're not , you don't have to recreate the wheel .

I guess , that's it Right . It's like a tool to you know , super pump up what you already have , or like retool it without rebuilding . Yeah , and it's something that you electrify it . Thank , you , I'm thinking of Greece Electrified .

Yeah , electrified , Just electrified . I was like really I was trying to make a point and now I'm seeing Olivia Newton-John . Exactly John Travolta . So I think the uniqueness is I was thinking about this yesterday of , for most physicians particularly primary care physicians , I think , people that are community-based physicians the concept of lifestyle medicine is probably very well oriented with their worldview of the type of care they wanted to provide when they went into medicine .

So it's inviting them back to this concept of patient care that I think they probably saw at the beginning . That's been taken away from them by a variety of factors over many years , and so there's a lot of optimism around it . And it's not a you know it's . It's not an EHR , it's not a digital health tool Like it's something they can do every single day with every single patient , and it has a kind of tactical feel to it , right , like they can touch it and feel it every day and it's a relationship .

That's what we've heard over and over again , is the relationship that they can , they can build with the simplicity of this yeah right , it's like back to basics , so anyways , all right awesome . Thank you for your time . Thank you .