The ROI of Healing: Dr. Padmaja Patel's Lifestyle Medicine Revolution

Welcome to the Reverse Mullet Healthcare Podcast by BP2 Health . We're here at the ACLM Conference in Orlando , Florida 2024 . Sunny Florida 20th anniversary . Right .

Who are you ? I'm Dave Pavlik the Mullet . Man . I'm the Mullet man today .

And I am Ellen Brown . And I'm Justin Politti . And we're here with one of my favorite ACLM people , dr Patel , and , yeah , american College of Lifestyle Medicine Annual Conference and super excited to be here . I think what's so exciting is we have our little unicorn on the table of always searching for the unicorns of healthcare , and what's so amazing to me about ACLM is like the whole function of ACLM is a unicorn right .

So not only is it like thousands of unicorns walking around , it's also an entire you know board certification . That really is unicorn status in terms of healthcare . So I can't tell you how many people that I've talked to that you know that . Well , what are you doing ?

What's the podcast about ? And I explained it to them and tell them what we do is BP2 . And they go yeah , I'm almost board certified , I'm sitting for the exam next month . I can't wait .

It's like like I literally yeah , four or five different people that I talked to just kind of randomly- yeah , there's a lot of people sitting right now . There's a lot of buzz . Yeah , I know they're supposed to be studying , but instead they're here , yeah . So it's actually part of attending this conference .

Very nice , oh , I thought you said getting in front of BP2 Health was part of it . It should be . It's a new part of the curriculum Hold on a second . We just talked to the no nevermind Carry on yeah , you're not going to remember we talked to get that on the curriculum .

Oh , brenda , brenda , yes , brenda , we need to get . Let Brenda know that we're a new part of a couple of CMEs , for maybe one . Yeah , just one half . Yeah , you just have to .

Yeah , anyways , without further ado Dr . Patel , so glad you're here . Yes . You're a very find .

Oh no , maybe I can find you , but I can't extract you to get you into the booth . So yeah , so tell us about yourself . Oh , happy to be here , alan . You .

You've been someone that I've been following too , so , uh , on a social media , and that's how I found you , but uh , she's not on social media come on I haven't seen one lot of her posts are actually getting viral , as I hear , she has a huge fan following there , so I'm one of those . But no , I think more about how I find that what you actually write on your post on social media and LinkedIn is something I resonate so much with , and it's like , wow , someone is exactly writing what I'm thinking , right , and so you articulate so well and with so much humor and fun , and so , yeah , I think we're kindred spirits here .

We are kindred spirits , yeah , and you're the same , and Ellen was ACLM before she knew what ACLM was . Yes , I was , I've been living an ACL dream . It's just like my husband and I took a year and a half RV trip before there was van life and before there was blogging , like it's right . It's like Brenda with her commitment to ACLM before most people .

She's Forrest Gump , oh I am . I'm like Forrest . Gump . Trendsetter yeah .

Didn't even know it , so yeah . So tell us about what you're working on , what you're passionate about yeah . So so anyway , but I'm an internal medicine trained clinician and then certified in lifestyle medicine , obviously . So I've had fortunate , you know , as a primary care clinician .

We all go through the same , uh , sort of journey of , you know , getting tired of doing this more of the same , and fortunately I found lifestyle medicine that literally changed my personal and professional trajectory . Um , I would have retired from healthcare if I had not found lifestyle medicine and I don't think I'm the only one saying that . there are so many clinicians here either are they are burned out , you know from doing what they do , or they're looking for another revenue to uh find how can they deliver meaningful care and find purpose and meaning along the way , right ?

So this is what Lifestyle Medicine delivers , and I'm so delighted that I had the opportunity of delivering and establishing a program at a local health system in Midland Texas where I developed many of this intensive therapeutic lifestyle program , and what really changed me the most was more around the transformations that I actually witnessed . You know I saw people like some of my patients are related . You know they came back as a follow-up and I didn't even recognize them .

It was like that kind of a transformation ? After what period of time ? In three months ? Three months Wow , yeah , it was like that kind of a transformation .

After what period of time ? In three months , three months , wow , yeah , three months . Patients completely getting off their medications If they were on insulin , reversing their diabetes , reversing their cholesterol hyperlipidemia and things like . So this is not what we had seen or at least I had seen in my traditional primary care practice , right ?

So that's brought me all the passion and excitement , what we had seen or at least I had seen in my traditional family care practice , right ? So that's that's brought me all the passion and excitement . Wow , can we do this ? How can I do this ?

And more of it , right , like I didn't want to just practice my own clinic , I wanted to actually have that impact , bigger impact . So I aligned with the local health system and then now I'm so excited to be part of this bigger community here at ACLM and in my leadership role I want to replicate more of the success that I've actually seen in my private practice and with health systems to really see how we can do this on a bigger scale . So that's my big agenda even as I step into my leadership role within ACLM is to really demonstrate the value proposition of lifestyle medicine across different payment models .

Do I hug you ? Do I hug you ? I think this is the first time I've ever hugged a guest . She does .

She usually gives a fist pump . But that was just hug-worthy right there . this is why we are meant to be friends in in your example I'm sure there are many of of a patient that you know came back three months later and you didn't recognize them . What are the ?

What are the um interventions you're deploying , that that are lifestyle medicine related ? All of them , some of them ? What ? What works the best ?

You know , so early in my private practice I didn't have the resources to really bring in team-based care . You know , in your private practice you don't have the resources , you can't afford it in fee-for-service payment models . So a lot of that relied on just educating them , providing them some pamphlets , educational material or websites , so you know . So I had actually a prescription that we would give them .

So you know , watch this video , look at this website . Here are the recipes . You know all these stuff that we gave and they go home . And you know those who were really motivated would continue , but there was no support system early on .

Clearly , then I realized that there needs to be a very structured program and we needed to integrate health coaching , bringing into behavioral aspect and also bringing nutritional counseling with a registered dietitian , and so that's why I joined a health system to bring around this entire interdisciplinary team-based care as part of our approach . But I have seen so , for example , in my community I co-founded another non-profit called Our Healthy City . So our biggest mission there is to more around educating community around the benefits of whole food plant , predominant dietary pattern and lifestyle medicine .

We would conduct and we still do annual food as medicine event and we would have about 500 members from our community just come listen to one day seminar . We would invite all these big professionals and speakers from around the world sometimes , but the key is that they just learned , they heard about it , they watched some presentations and then they go home and we've seen people losing 70 pounds , 80 pounds on their own right , without any further . They just got motivated from a one-day event .

Yeah , that's what I'm saying . So there are many ways to think about this . It's not everyone needs to have a structured medical program . This community element is equally important for support and education , and so all of these pieces have to be plugged in together , even for doctors , many of our intensive programs , yes , we can demonstrate good outcomes , but if we don't have an ongoing support in the community , it's very hard to sustain .

that Keeps coming up . Community . Community yeah . That's the key here is to talk about lifestyle .

Analysis is not just what happens in an office setting . Yeah . It's much more than that , and you can see it here , right . Very much so .

The models that we see it's across , and so my passion and excitement comes from it's not just I mean predominantly primary care . We want to integrate lifestyle medicine across the board , but we also have it in specialty care . Which is amazing . We have it in different settings Yep Right , inpatient , outpatient , you and me , yep and across different payment models , so it's like ubiquitous , it can be anywhere , yep Right , and so that's the beauty of this foundational care that we talk about .

So what are some of your thoughts on ? You mentioned scale a little earlier . What are some of your thoughts on how you can scale this across the country ? Yeah , so when COVID-19 happened , during the pandemic , I had a program which was , you know , in-person , intensive group program , and obviously we couldn't gather right , so I had to put that program on a virtual platform and I had no idea how that would work .

I was actually very nervous . I was like how ? are we gonna ? How do we , how do you motivate ?

And you know all of that . And then , first group I saw I mean there was this person , one of my patients , who lost like 40 pounds in 10 weeks . His hemoglobin A1C dropped from 7.9 to like 6.

2 . Wow , it's just a dramatic change . And he convinced me that virtual model can be equally effective . And then I continued doing in-person groups versus virtual groups and eventually published the study as well that the outcomes clinical as well as biometrics , all of them exactly same .

There's no difference . So that gives me hope that lifestyle medicine is really , you know , it doesn't have to be limited within . Yeah , there's a huge confidence . Exactly , there's a clear model that can be delivered across virtual platform , and that's what we need to do .

Yeah , totally agree . Yeah , I mean , one of the things you know I really believe is we have to , you have to get away from like , if you think about sick care is sick care and you think about health care is health care . I think when we talk about health care , this obsession or attachment to bricks and mortar , it just it becomes , it's unsustainable , it's too capital intensive , it doesn't have the kind of economic model that makes sense . And especially when we talk about lifestyle health , I mean lifestyle disease and lifestyle health .

You know , the thing that has really struck us is , in every conversation , I think , except two , the whole group visit model comes up . Right , because it's this again it goes back to Justin's question about scale . So we have to solve for a clinician shortage and for just access and also for administrative burden , all of those things . And then you add the group model .

Not only does it solve that whole component , it also adds that pillar of community , which is something we spoke about . Spoke to some clinicians today that are focused on equity and like rural , and you know they said it's the isolation that exists in rural communities especially . Right , that group model . So it's just , it's amazing and again , it makes all the sense .

That's what blows my mind about lifestyle medicine is it's so simple . It is , and I tell you that's part of the problem . Also , sometimes I think early on . What I felt when I learned about ACLM and the messaging around is that it's too simple .

It is so simple that people don't take it seriously . How could this be real ? Yeah , how can it be real and so ? exercise and eat better Sleep .

Stay away from all the fat foods . Don't drink all the time and smoke . Yeah , what yeah ? So I think we are intentional now in terms of how we communicate lifestyle medicine and we're talking more about the value proposition , right , what exactly it brings , which is the quintuple aim of healthcare , and so we're making sure that people get the value and what it is , not just how we deliver lifestyle medicine , which is the six pillars , which is how we deliver , but what exactly is the outcome .

Agreed . That's what we need to talk about . You know me , I am convinced that lifestyle medicine is going to be , it could be , the solution , one of the core solutions and bridges to taking that 2 trillion out of the system of lifestyle disease , cardiometabolic syndrome , because it can take . We already have a whole workforce of clinicians that are they're already clinically board certified and so to be able to train them additionally , right to complement what they're already doing , to say , hey , here's a .

I think the piece you pointed out that we have to do is we have to move the needle on the economic model , we have to realign the incentives , we have to , and then that money can be redistributed . And that's our champion is . You know , this is value-based care . That's what we're starting to implement is .

And payers are coming around , they are like each one's always in its own spot , right , but the reality is you pay for the intervention and then you pay for the progress that you're making right . So it is a it's an to Ellen's point , it's an incentive-based component that's recognizing hey , you know , know what you're getting paid for the reductions in metabolic , yeah , improvement in metabolic , uh , function along the spectrum . So to me , that's a fairness piece , because right now they share the same yeah , the danger is all right .

You put this in and then it accrues directly to the insurance company without any , exactly without any credit going to the people who are doing it right . You're so well said . All of us have delivered lifestyle medicine very successfully and it didn't matter because it was in fee-for-service rule Nobody cares about the quality , cost-saving outcomes , nobody cares , it's just the episodic billing and collection is all that we care about the productivity yeah it's a number .

But , as you said , payers are coming recognizing the value . I don't know if you attended , but we had a panel discussion earlier today and for the first time in the history of ACLM , we had two major payers on the stage . We went in and watched . That says a lot .

The change is happening . I have two of them tomorrow . Okay , great . Thank you .

So we had Susanna Bernheim , which is the acting CMO of CMMI , which is the CMS Innovation Center , and we had Kate Goodrich , CMO of Humana , and we've been working with these two big pairs for some time as part of our Innovators Council and otherwise , so it's a groundswell right . It's a real exciting time for the field to see so much interest from pairs and they recognize this . And I think all these things that we hear about whether it's it's employers having to pay so much for their benefit plan next year with 7% to 8% increased war , whether it is this AMA plans going- through the headwinds , the 95% of C8 .

Whoops . I think these are all wonderful opportunities for lifestyle medicine , oh , totally , totally . This is exactly where we need to insert lifestyle medicine as a solution , because it has the potential to no , it is . It is an ultimate solution .

So think of that , get healthier so you , you were in private practice and then you went to work for a system , system in texas yeah and like so was the leadership always kind of behind this lifestyle medicine . In terms of the finances , you know we need dieticians , we need this staff , we need that staff . It's going to cost you but in the long run it's going to be . No , you know , what was interesting is that it's a safety net hospital in a small community .

Okay . And we had redefined our vision , mission and values to make Midland the healthiest community in Texas . So the way we approached lifestyle medicine was more of a broader solution , right Strategy like how are we going to get there ? So , initially , where I started was what are the pain points for my health system ?

Right , look at that pain points for my health system , right ? Look that . And well , as a self-insured entity , they were paying almost what ? $3 million more than the budgeted amount every year .

So we said , okay , let's do something for the employee health . And so in about a year of intervention which is the same intervention we keep talking about intensive therapeutic lifestyle change program , which is a group medical visit , and had about 150 employees that go through that intervention , we demonstrated $3 million cost of AIDS . Right , so that ? opened up the world .

Like okay , we proved the model ROI because you have to do the business and otherwise you know it's hard to change that needle here and support . I think . So one was this alignment with their overall goal . Second , we demonstrated the ROI .

And the third was that we wanted to create a program that would actually lifestyle medicine program , that would create a robust payments model , so with a reimbursement structure , which was this intensive cardiac rehab that we brought . So we brought the Ornish program initially and then later changed to Pritikin intensive cardiac rehab . But it brought revenue to my lifestyle medicine center , which allowed me to develop a new programs , hire more staff , you know . So I went about not opening a center first , but I went about looking at okay , what are the pain points , let's solve that , get the confidence of the executives , and then expand and create revenue first before you talk about opening a center .

So all of these kind of come together . That's great . I think it's great that the you know the mission is to have the healthiest community in Texas and cost isn't going to be a barrier . Let's figure it out .

Yes , that's impressive , yeah . Yeah , it's amazing , so we could talk for like a long time and I know that you're needed to like continue to circulate . Yes , there will be many more hugs . Yes because we are going to do some big stuff .

We are here to try to help . you know we're completely committed to this and thank you , thank you , no , I think , thank you for here being here this year . This brings a sort of a new exciting excitement among our members . You excitement among our members .

You know I love them passing through . Yeah , they're like there's like bright lights we've got . What is this we've got ? I've got them in my head categorized as podcast curious and podcast serious .

Oh so the curious , the curious ones , kind of go by , they look in , they're like I'm a little not sure I want to get behind that camera over there . And then the serious ones are like where's your sign up ? but my favorite are the ones that are like just sort of come in , oh and it's like hi , hi , like , all right the microphone did you ? Well , let's just sit down and go so here's a coffee and a mic tomorrow's .

Tomorrow we've got a jam packed , I think we have to start like putting blocks so we can actually go get some water . You know , but and I do think we are I think we're gonna have at least one of those payers you referenced , right ? Yes , I think so . Maybe two , maybe two .

Yeah , that's the rumor on the street , but yeah , so super excited you took the time yes , thank you so much thank you . You will certainly be part of a full episode . You know great work you're doing . Thank you we will , she will , for sure yeah , you make sure she does right ?

Well , make sure she does . Don't worry , that's an easy task just don't make me do it right yeah exactly all right well , thank you thank you so much .