Why Treating Root Causes Could Solve America's Healthcare Crisis with Caroline Collins

Welcome to the Reverse Mullet Healthcare Podcast from BP2 Health . We are live at the ACOM Conference in Orlando , florida . I'm your host , justin Politti , dave Pavlik . Ellen Brown .

We are here in the American College of Lifestyle Medicine Conference and we are here with somebody that was one of the first people I met in my exposure into lifestyle medicine . Oh . And , yes , Okay , Caroline was one of the first folks that I talked to and it was , I don't know . I just really appreciated the work that you're doing and the challenges that you face and we just talked with Caroline's with Emory , physician at Emory and has a very exciting , yes , challenging job of bringing lifestyle medicine into an academic medical center .

Outstanding . Yes , so with all of that tell us about yourself . Yeah , I'm an internal medicine doctor focusing on lifestyle medicine at Emory , so I also teach medical students and residents about internal medicine , but also how to integrate lifestyle medicine into the care of patients at Emory . Yeah , so , yeah , so tell us about what Emory is doing with lifestyle medicine and , and yeah , ask some questions .

And this is a great time to be at Emory . I really feel like there's a movement towards integrating lifestyle medicine into all the care and and not just the care of patients , but the care of employees and really focusing on research and how we do this right . I do think that most people in healthcare want to do the right thing , but we don't know how , and so that's where people who know a lot about lifestyle medicine can be the voice of change , and that's what I'm trying to be at Emory right now .

So we're doing a lot of research on how do we spread the word to other faculty members , because , believe it or not , this is not taught in medical school . Most of us did not get this training in residency either , so we have to start with the teachers , we have to teach the teachers , and so that's what I'm doing right now with my research is educating faculty members , so then we can help residents and medical students understand how to integrate this into practice , because medical students and residents are going to be the future doctors not just internal medicine .

They're going to be surgeons , they're going to be cardiologists , they're going to be the specialists too . We all need to be on the same page in healthcare to make this a real change . What led you to this lifestyle medicine path ? You know , in my own life , my own family , I saw the havoc our lifestyle was having on us .

My parents both had diabetes or prediabetes . My mother unfortunately had breast cancer and I thought we need to make a change , and that's when I started researching more about how we can change what we're eating , how we can move more , how what we do in our everyday lives matter . I always tell my patients this and I tell my family members this I can't give you a pill or an injection to make you healthy . It's really about how we live our lives , and that's got to be the most important thing .

We talk to people about . You mentioned momentum that you said there's . Now what do ? you think , what's the trajectory been like ?

Is it just the last couple of years , has it ? been like over five or 10 years , where lifestyle medicine started to become this movement . I am building on what those who came before me started . So Dr Sharon Berquist at Emory and Tina Morgan both started this movement at Emory many years ago so about 10 years ago really and there was slow uptake first , but as we have grown , grown in numbers , we've become a louder voice together and I think that's important to realize .

It's not just one person , it's really a group of people , it's a team that can make this happen . Especially at a large academic institution like Emory , it really takes a team and that's where we have found success together . So now we are doing the research , but we're about to open our lifestyle and weight management clinic at Emory as well , focused on lifestyle medicine , and that shows me that Emory is serious about this , if they are willing to give us dedicated time to focus on lifestyle medicine .

So tell us about what you're going to do with that clinic Like . Is there a like ? Ajay was just on . He's from St Francis at Tulsa and you know he has an eight week intensive intervention that's available to those that want to participate that get referred in .

Also has the . You know you can see us once every three months . There's different ways to interact with lifestyle medicine , depending on the person's level of commitment , et cetera . Yeah , what we're doing is starting with Emory employees and pre surgical patients , because those are patients who rehabilitation Exactly so we are .

We are optimizing the patient's care before they have surgery to help reduce their risk of complications during and post-surgery . So that's been our value proposition to the surgeons Let us help you do this so the patients can be healthier , moving forward . You talked about your family and your person . I think everybody has sort of a personal journey that has brought us to these places , especially with lifestyle medicine .

And we were talking on the previous episode about prehabilitation and you know my own mom is the perfect example of ended up with unexpected . You know she was in septic shock from a undiagnosed diabetic long term . Then it turned into a kidney infection , you know the drill right . And then what ?

Because she came in , you know , basically dying of septic shock . You know they just went downhill fast , icu and AFib and ischemic stroke and like you know the whole thing that you're trying to avoid . But the crazy part is she came back the following year to address the kidney stone issue , right , and in that hospitalization she didn't even have to have insulin . They didn't have to , they didn't have to intubate her , like it was a completely different surgical process , it was outpatient .

It's amazing . I don't think people understand at a practical level that when you have these chronic , untreated , uncontrolled comorbidities , that what that does in an acute care setting is just dramatically different than when you're just moderate , like it's a small little change that makes a massive difference economically . I couldn't agree more . I've seen the same thing in my mother's life and also my patients' lives .

If you can help people be their healthiest selves , that's going to make a big difference if they do need to be hospitalized and how sick they get and how much medicine that they truly need while they're hospitalized . So that's why I really think that this is one of the most important answers to the healthcare crisis we're facing . I was just at another conference in Washington DC talking about healthcare policy and how do we change where we are going , how do we change the trajectory of healthcare in the United States and change the cost curve ?

Because we're going to have to do something to bend the curve , and this is the answer in my mind . Yeah , pay people to be healthy . Exactly , our incentives are misaligned right now , both from a provider perspective , but then also just from a patient perspective . Yeah , it's like we've collectively lost our minds .

honestly , I know it's funny , but not funny I'm wearing a mullet and sunglasses in an interview . At nine o'clock in the morning , right ? Yeah , yeah , yeah . You know , one of the presenters said you know it's funny , this is common sense , but it's not common sense .

It's not . We need to make it common sense . Yeah , the financial side is something that you know we talk a lot about , and you know it's . What was one of the things that struck me when you and I talked initially was your point .

You know I had asked you . I said , well , so is Emory deploying this with all primary care right ? Like , are you guys going to use this where you train all of your primary care physicians in lifestyle medicine and then they can start treating patients , addressing the root cause ? And you know , your statement to me was we're an rvu model and that doesn't fit into the traditional rvu model , and so I think that is that that is the friction point .

You know , don't you guys think ? well , no , there's a CFO somewhere going whoa , whoa , whoa , whoa , whoa , whoa . You know how are we going to . How are we going to pay for this ?

How are we going to pay for this ? I ? mean . The hard truth is that when people become physicians , you do so because you want to see people be healthier .

But when you get into the system , you're incentivized to see patients . If your patients are healthier , who's going to be admitted to the hospital ? Right , right , who is going to fill your clinic schedule , right ? I don't think most people , most physicians , think of it that way , but I know that health executives may , because you need your hospitals to be full .

You need your clinics to be full . No , we've built these huge structures that would be empty , exactly have to be retrofitted . That's where value-based care can come in . I think we need to be careful with value-based care , because you do want to again align incentives .

I think it's folly to incentivize A and expect B Absolutely , and that's what we're doing right now . Yeah , no , and it's a cultural shift . You know , I was with the head from HAP , you know from Henry Ford , and I was with their chief legal counsel and she was talking about the fact that it's a real disconnect where they're embracing at the corporate levels , they're really embracing value-based care and trying to put that into place . But from a cultural level you have to , from the , you know , again you're pushing your physicians in an RVU mindset but then you're signing up with value-based care .

It's a conflict and you have to , culturally , you have to align those things and it doesn't happen overnight . No , it's like schizophrenia . Yeah , it is . It is so well .

I think we could probably solve all of the woes if we stayed here . But there's , there are there's a line , the sure size are presenting and I think you nobody wants to miss that . So , but we appreciate you coming and excited to talk more and really excited for the work that you're doing to be a champion of lifestyle medicine . We're there for you , cheering you in the background when you get a little burned out from the , from the uphill battle .

So thank you . Thank you for inviting me . I'd love to come back . Okay , great , have a great day .

Thank you .