Connecting the health and wellbeing of patients of patients directly to the bottom line isn’t just good business; it is a visionary approach that shows how healthier outcomes can actually drive healthier profitability. Continued success in demonstrating the correlation between clinical and financial outcomes will be a catalyst for generating societal wellbeing that paves the way for others to adopt value-based care.  And in doing so, we create a more sustainable and effective healthcare ecosystem. In this Race to Value, the true race isn’t about speed; it is about the journey to improved outcomes. Strategic and transformational partnerships guided by an enabling vision to improve population health will ultimately create a healthcare system that we can be proud of.

In this episode, you will hear from Kyle Wailes, the Chief Executive Officer and Board Member of value-based care company, Wellvana.  Kyle Wailes is someone on a mission to demonstrate how fully-capitated models in primary care, empowered by the right partnerships to create enablement, will ultimately drive patient behavior change.  Under his leadership, Wellvana is an industry-leading example of a company that is connecting the healthy outcomes of patients directly to healthier profitability. With the tools, technologies, analytics, and resources for healthcare providers to successfully and seamlessly transition to value-based care, Wellvana is getting outstanding results and growing at an exponential rate for such a young company.  This is highlighted by the recent announcement of their partnership with AdventHealth to revolutionize primary care in the state of Florida.  Don’t miss this important interview to learn more about VBC enablement, high-touch primary care and clinical integration, the power of storytelling, patient behavior change, lifestyle medicine, and the current state of private equity investment in healthcare!

Episode Bookmarks:

01:30 Connecting healthy outcomes of patients to healthier profitability.  (A High-Touch Approach for High Performers)

02:00 Introduction to Kyle Wailes, Chief Executive Officer and Board Member at Wellvana.

04:00 Big Announcement — AdventHealth partners with Wellvana to transition its Florida primary care network to VBC

05:00 Wellvana is the first value-based care enablement organization in the country to partner with a multi-state/national health system.

06:00 Kyle provides more details on how Wellvana’s recently announced partnership will impact the delivery of healthcare in Florida.

06:30 “Building clinically integrated primary care networks across the country requires flexibility.”

07:00 Expanding primary care impact through interdisciplinary roles (e.g. case management, care coordination, pharmacy integration, social work, coding)

07:45 Health systems across the country are extremely distressed with expenses growing 2X as fast as Medicare payments.

09:30 “The pandemic has been an accelerant overall to drive the adoption of value-based care.”

09:45 The opportunity to reposition primary care in the health system setting, taking it from loss leader to profit center, as a strategic cornerstone for transformation.

10:00 A health system focused only on fee-for-service can lose up to $200-300K per employed PCP.

10:30 “Clinically integrated primary care networks can drive better clinical outcomes, but they can also drive profit and growth as well.”

11:00 Flexibility in growing a PCP network through either an employed or affiliated model.

11:30 Kyle’s personal journey as a professional athlete, student of neuroscience, and value-based healthcare executive.

12:30 “The Story of the Chinese Farmer” – a parable that illustrates the idea that events that initially seem bad or good can lead to unexpected outcomes.

14:00 Kyle provides perspective on the highs and lows of life and how that translates to theculture at Wellvana.

15:00 Lessons learned from playing competitive sports (discipline, hard work, and preparation in winning…while also overcoming losses).

16:00 Wellvana has raised $140 million in capital since 2021 and is now in 22 states, reaching more than 100K lives through multiple payers, Medicare Advantage and ACO REACH.

17:30 Building large high-touch primary care networks at scale requires behavior change.

18:15 Aligning a high-quality specialty network with tech-enabled primary care to achieve appropriate procedural utilization and lower costs.

19:00 Merging High-Touch with High-Tech (“Technology as a standalone solution doesn’t work well in healthcare today. You have to wrap services around it to drive behavior change.”)

19:45 Building Capabilities to Improve Care for High-Risk Patients (“The ability to transition into fully-capitated risk is impossible for a doctor to do on their own.”)

20:30 The connection between improved patient outcomes and higher profitability — a patient success story showing how high-touch care management reduced avoidable ED utilization.

22:00 The power of effective storytelling in value-based care transformation.

24:00 Kyle discusses how Wellvana utilizes storytelling to revitalize care teams and provider partners in creating positive change.

26:00 The Challenging Politics of Value-Based Care (differing ideologies, debates about government involvement, conflicting interests and lobbyists, uncertainty about implementation, economic concerns, partisan politics).

27:30 Kyle shares insights from his involvement in advocating for value-based care on Capitol Hill.

28:30 The evidence that fully-capitated models work despite low market penetration in Medicare (e.g. MA <10% full-risk, ACO REACH).

29:00 How Wellvana educates legislators on the importance of frontloading savings payouts and provider aggregation in networks to drive success in fully-capitated risk.

30:00 Advocacy in patient communities is just as important as political advocacy.

31:00 How Wellvana engages and educates patients on the purpose of value-based care and care planning.

32:00 “To win long-term in this industry, you’re going to have manage medical spend more effectively. We do this by engaging patients in way that can drive behavior change.”

33:30 Wellvana co-founder, Charlie Martin:  “Building a Sustainable Economic Model for Lifestyle Medicine”

34:45 Kyle discusses the importance of Lifestyle Medicine in creating a holistic, patient-centered wellness model.

35:45 Wellvana is conducting a clinical trial study on LM with the goal of applying broader findings that drive behavior change at scale.

37:30 Are investors placing more bets on value-based care enablement?

38:30     The runway for value-based care companies in the current investment landscape and why PCPs relationships are so critical to success.

39:30 Digital health and AI solutions will support primary care value transformation.

40:00 Nashville as the epicenter of healthcare investment.

41:00 ACO REACH as an inflection point for adoption of fully-capitated risk in the primary care setting?

42:00 How fully-capitated models will strengthen the connection between improved SDOH interventions and Health Equity outcomes.

43:45 Kyle discusses the future of Wellvana in terms of continued growth and sustained high performance.

46:00 “Success in value-based care is not about the speed; it is about overall outcomes and finding the right partners to take risk.”

Unlocking wellness and reshaping healthcare involves the profound bridge between Lifestyle Medicine and the Social Determinants of Health, a blueprint found in the wisdom of the Blue Zones. Blue Zones are regions of the world where people are known to live longer, healthier lives compared to the global average, often to 100 years of age. These areas have gained attention from researchers and health enthusiasts because they provide valuable insights into the factors that contribute to longevity and well-being.  Researchers have reverse-engineered longevity to find the common denominators and found that these Blue Zones are all places where people enjoy a diet rich in plant-based foods, regular physical activity, strong social connections and community support, and a sense of purpose or meaning in life. Given these lifestyle factors that contribute to the remarkable longevity and well-being of the people in these Blue Zones, we need to find a way to replicate them in our uniquely American society, which is often limited by modern fast-paced living, processed foods, and social structures that de-prioritize these essential elements of health and well-being. If population health success is at the intersection of Blue Zones and Lifestyle Medicine, how can drive the necessary realignment of financial incentives for value-based care?

In this enlightening episode of Race to Value, we dive deep into the world of healthcare transformation with Dr. Dexter Shurney, President of the Blue Zones Well-being Institute. He is responsible for creating innovative health and well-being solutions that have broad impact. The Blue Zones Institute is a “Living Lab” to create, study, and codify best practice, including a whole-person approach to care, that can be replicated across regions and communities, including those of greatest need. In this episode, we explore the potential for wellness through the lens of Blue Zones research, discuss the impact that chronic disease has on declining U.S. life expectancy, uncover the profound connection between stress-induced inflammation and chronic disease, and address the impact of both racism and SDOH variables on health equity.  Additionally, we go deep into the tenets of lifestyle medicine and how it aligns with the broader movement value-based care. Tune in for a thought-provoking conversation that unveils the pathway to healthier lives, stronger communities, and a brighter future in healthcare!

Episode Bookmarks:

01:30 Introduction to Dr. Dexter Shurney and the wellness potential of applying Blue Zones research.

03:30 After peaking in 2014, US life expectancy has declined each subsequent year, trending far worse than peer countries.

04:00 Chronic diseases remain our nation’s greatest killer, erasing more than double the years of life as all overdoses, homicides, suicides, and car accidents combined.

04:30 The death rate gap between the rich and poor has grown almost 15x faster than the income gap since 1980.

05:30 We have the answers to address declining life expectancy…but haven’t put in place the right policies to solve the problem.

06:00 Referencing the new Netflix docuseries, “Live to 100:  Secrets of the Blue Zones”

06:30 People living in Blue Zones often live to be 100 and do not suffer from high rates of chronic disease.

07:00 “Blue Zones countries spend far less than the U.S. on healthcare, and their good health is driven by things others than genetics.”

07:45 “Drug overdoses, homicides, and suicides with our youth are all deaths of despair. It touches back to people being lonely and not connected to friends, family, and society.”

09:00 The common denominators of long life expectancy (plant-based diet, regular physical activity, strong social connections and community support, and a sense of purpose or meaning in life).

09:30 Finding ways to replicate Blue Zones in our uniquely American society, which is often limited by modern fast-paced living, processed foods, and social structures that de-prioritize health and well-being.

10:00 There are 75+ Blue Zones projects in the U.S. showing transformation by reverse engineering research from the original Blue Zones.

10:30 Singapore is an example of an emerging Blue Zone that has put in place the right policies to ensure continued health improvement.

11:00 Applying Blue Zones principles in underserved and marginalized communities has proven successful.

11:30 Healthcare systems are not the only player in a Blue Zone transformation. You must form community-based partnerships!

12:00 Making the connection between stress-induced inflammation and chronic disease.

12:30 The release of stress hormones and inflammatory agents that affect the immune system (e.g. cortisone, norepinephrine, cytokines).

13:00 A chronic burden of stress leads to allostatic load, which refers to the cumulative physiological wear and tear on the body that occurs in response to chronic stressors.

15:00 “The common path to disease is inflammation, and stress is the common denominator.” (stress can come from lack of sleep, poor diet, or even stress itself)

16:00 Referencing the work of Arlene Geronimus: “Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society”

16:30 The acute and chronic stressors of living in an underserved community.

17:00 Lifestyle medicine reduces stress levels in patients to improve overall health and wellbeing.

17:30 Addressing “Weathering” and “Allostatic Load” at a community-level.  Delivering Lifestyle Medicine at an individual level.

18:30 Over half of all Medicare beneficiaries are treated for five or more chronic conditions which account for over 75% of Medicare spending.

19:00 The alarming statistics of health disparities in racial and ethnic minority communities.

20:30 Eliminating the root cause of inflammation through Lifestyle Medicine will reduce the prevalence of chronic disease.

22:30 Genetics are not the prime determinant of chronic disease (e.g. identical twins growing up in separate environments)

23:30 Black women with a college degree have higher rates of maternal mortality than white women without a high school education.

24:00 Addressing socioeconomic status doesn’t always solve the problem of health disparities due to institutional racism.

25:30 Don’t be too quick to blame the patient for poor compliance; lack of trust and poor living environments determine behavioral choices.

27:00 The example of how lack of good employment options (due to discrimination) leads to chronic stress and poor health.

31:00 In talking about value-based care, we must ask ourselves “value for whom”?

32:00 Why many employers may not see “value” in VBC.

32:30 Not a single HEDIS measure exists for the reversal (elimination) of chronic disease!

33:30 Changing quality metrics to realign incentives for lifestyle medicine.

35:00 Referencing prior Race to Value episode (Ep 87 – The Future of Value: Lifestyle Medicine and the Reversal of Chronic Disease, with Dr. Dean Ornish)

35:30 The concept of Food as Medicine (“When diet is wrong, medicine is of no use. When diet is correct, medicine is of no need.”)

37:00 Referencing Geisinger Fresh Food Farmacy and prior Race to Value episode (Ep 70 – The Geisinger Value Journey, with Dr. Jaewon Ryu)

38:00 The success of a Food as Medicine strategy is ensuring that the food tastes good!

39:30 Finding ways to pay for Food as Medicine initiatives (think of it just like you would a prescription for a drug on a formulary).

41:30 The cost vs. benefit investment decision in food prescriptions for chronically ill patients.

42:30 Unlike drug prescriptions, food prescriptions will not have an adverse reaction.

42:45 50% of patients will no longer need their food prescriptions after 12 months.

44:00 Large employers will spend over $10 million a year on wellness programs that are largely ineffective.

45:45 “Half of Americans receive their healthcare through an employer. It is a great place to start with wellness, and the incentives there are more pure.”

46:30 Employers that focus on workforce wellness perform better overall at a financial level.

47:30 EAP employee participation is in the single digits, despite employees dealing with overwhelming amounts of stress.  We must remove the stigma!

51:00 Transformation at the Venn Diagram intersection of Blue Zones and Lifestyle Medicine.

In this week’s episode, we embark on a journey into the realm of transforming rheumatology care with tech-driven value-based care. Autoimmune conditions affect millions of people worldwide, causing chronic inflammation, pain, and a host of complex challenges.  These patients often receive substandard care, as it takes almost 2.5 years to receive a diagnosis and patients often wait six months to receive an appointment with a rheumatologist!  This is often a neglected patient population in the movement to value-based care, but what if there was a new frontier of care that leveraged technology and a value-based approach to transform the lives of those living with autoimmune conditions?

This podcast explores how a virtual specialty practice, centered on improving patient outcomes and reducing healthcare costs, is driving the transformation of rheumatology care.  We are joined today by Anuj Patel (Founder) and Dr. Elizabeth Ortiz, the CEO (Chief Medical Officer) from a new startup company called Motto Health. Anuj is a seasoned digital health innovator and operator with over 15 years of experience in the healthcare industry. And Dr. Elizabeth Ortiz is a board-certified rheumatologist with patient care experience ranging from large public medical centers to concierge practices.

Episode Bookmarks:

01:30 Where does rheumatology care intersect with the world of value transformation?

02:45 Introduction to Anuj Patel and Dr. Elizabeth Ortiz, the Founder and Chief Medical Officer respectively for Motto Health.

03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.

05:00 The rheumatology workforce faces a deficit of physicians trained to provide high-quality care to patients with rheumatic diseases (only 0.5 rheumatologists per 100,000 people).

06:00 Chronic inflammatory conditions are very expensive to treat (e.g. the average healthcare cost for a patient with Rheumatoid Arthritis is $32k per year).

06:30 Why aren’t ACOs and other Risk Bearing Entities actively addressing this patient segment like they do patients with diabetes, CHF, COPD, or even kidney disease?

06:45 The epidemiological fragmentation of chronic diseases across the care delivery landscape.

07:30 Lack of overall marketplace adaptation in rheumatology care and treatment (e.g. specialty pharmacy injectables) to the shift in value-based care.

09:00 The wide breadth of conditions in the specialty of rheumatology and how that creates a “black box” for other physicians to understand.

10:15 Patients waiting so long to see a rheumatologist that it takes, on average, 2.5 years for a patient to receive a confirmatory diagnosis!

10:30 Rheumatology provider shortage worsening (50% of adult and 32% of pediatric rheumatologists projected to retire over the next 10 years).

11:30 The window of opportunity for clinical outcomes improvement if chronic autoimmune and inflammatory diseases are diagnosed early.

12:30 Limited capacity for rheumatologists to see new patients due to long persistence of disease and the shortage of providers.

13:00 How virtual care can increase access by offloading the maintenance burden of managing a large patient panel.

13:30 Enablement of expanded geographic access through a virtual care model.

13:45 “Virtual care delivery can democratize access for patients in need of rheumatological care.”

14:00 In Texas, 213 of 254 counties in the state do not have a practicing rheumatologist leading to 5M people without access to care.

14:45 A huge opportunity in value-based rheumatological care is to tackle the exorbitant specialty drug costs for drugs like Remicaid or Humira that have an annual cost of $70k.

15:00 Mark Cuban’s online pharmacy announced that it will be selling a biosimiliar of Humira for a steep discount.

15:30 Since 2016, AbbVie has raised the price of Humira 30X from $522 per syringe to $2,984 per syringe.

17:30 Biosimiliar adoption should not be over-indexed in value-based care. We must first prioritize site of care and treatment plan adherence.

18:30 Inpatient hospital settings cost much more for drug infusions. (VBC opportunity to shift infusions to the practice setting.)

19:15 The importance of an integrated Lifestyle Medicine model in managing chronic inflammatory conditions.

20:00 Dr. Ortiz explains how biologics have changed the landscape of rheumatology care.

21:00 The factors to consider when safely titrating a patient off of an expensive biologic drug.

22:00 Sleep and stress management are more important than diet when controlling an autoimmune condition.

23:00 The prevalence of Rheumatoid Arthritis among employees can lead to a substantial burden on employers in terms of productivity loss, absenteeism, and healthcare costs.

25:00 Providing better access to rheumatology care for employers providing health benefits to their workers.

26:30 Treating patients sooner leads to lower healthcare costs and improved workforce productivity for employers.

27:00 Rheumatological care requires more than just the specialist – the need for physical therapy and diet and health coaching.

28:00 Allostatic load (the cumulative physiological wear and tear on the body that occurs in response to chronic stressors) impacts inflammation.

28:30 The connection between allostatic load and inflammation as a contributing factor to health inequities in underserved populations.

29:30 Dr. Ortiz discusses the relationship between stress and autoimmune conditions; however, stress management is underutilized as a treatment tool.

30:00 Allostatic load over time can actually lead to the development of an overactive immune system which then, in turn, leads to an autoimmune disease.

30:30 Adverse childhood events, PTSD, and the stress of discrimination leading to more severe chronic diseases in African American population.

31:00 How do stressful social structures lead to devastating outcomes with Lupus in African American populations?

33:00 “The data shows that diet, stress management, sleep, exercise, and a sense of community all favorably impact clinical outcomes with Rheumatoid Arthritis.”

34:00 The benefits of an anti-inflammatory Mediterranean diet and exercise in managing inflammatory conditions.

34:45 The importance of health coaching in implementing lifestyle programs to improve patient engagement and accountability.

36:00 Longer life expectancy in Blue Zone regions due to improve connection with community.

36:45 The psychological impact of social isolation during COVID-19.

37:00 Research shows how chronic inflammation can significantly impact mental health and increase the risk of developing depression and anxiety disorders.

38:30 Dr. Ortiz discusses the bidirectional relationship between inflammation and mental health and how mental health issues complicate patient outcomes.

40:30 How Motto Health’s virtual care platform brings additional benefits of team-based care and scalability in rheumatology care and mental health support.

41:30 Combining collaborative and longitudinal care to reach an inflection point in the virtual delivery of behavioral health care.

43:00 Dr. Ortiz on the essential role of rheumatology care and other specialties in understanding and addressing Long COVID.

45:00 Challenges to expand rheumatological capacity – no increases in fellowships in practice and over half of the rheumatologists in practice are experiencing burnout.

45:30 Enhanced partnership between rheumatology and primary care to alleviate lack of rheumatological capacity.

46:00 The need for more integrated services that are reimbursable to improve care of autoimmune patients.

47:00 Medical education costs and high student loan debt burden causes a shortage of rheumatologists.

47:45 Anuj shares his vision for the value-based future for rheumatology care.

48:45 How capitation arrangements and incentives alignment creates a long-lasting, longitudinal care model in rheumatology.

50:45 What is Motto Health and how does it bring VBC and consumerism to rheumatological specialty care?

Nearly 75% of Americans are overweight, including 42% who have obesity. The pandemic has heightened the problem, since many of us find comfort in food, and delivery services like Door Dash and Uber Eats make it easier than ever to consume calories while barely getting off the couch to answer the door.  This obesity epidemic has huge implications on value-based care due to the impact it has on chronic morbidity, increased mortality, and unrelenting demands on the utilization of limited healthcare resources. Chronic conditions associated with obesity include, but are not limited to, type-2 diabetes, hypertension, hypercholesterolemia, and heart disease. These diseases have a destructive effect on the US healthcare system, and leaders in value-based care must start thinking about lifestyle medicine and evidence-based nutrition interventions.  While there are many apps and tools for consumers or patients to use to lose weight on their own, programs that incorporate medically-assisted weight management and obesity care yield the best outcomes.

Rather than weight loss as a sidebar suggestion once a disease state is diagnosed, weight loss can be a potent catalyst for disease prevention within value-based care. Dr. Jamy Ard is the Co-Director of the Weight Management Center at Atrium Health Wake Forest Baptist. Joining him this week in the Race to Value is Rich Steinle, CEO of Carium – a technology company that partners with clinicians to offer a complete, virtual care platform ensuring every person – regardless of location, demographic or disease state – has access to quality, personalized care, education, and tools to support health and wellness goals. In this episode, we discuss the importance of partnerships between healthcare providers and technology companies to empower clinicians, patients, and their caregivers. Do you want to learn more about how real-time, aggregated health data and analytics can guide clinical decision-making in obesity? Well, this is an interview that you will not want to miss. Within a platform-enabled, virtual care ecosystem, weight management care teams can achieve positive outcomes that deliver on the promise of value-based care!

Episode Bookmarks:

01:30 An introduction to the concept of Virtual Weight Loss Management in Value-Based Care

02:00 Background on Dr. Jamy Ard (Atrium Health Wake Forest Baptist) and Rich Steinle(Carium)

03:30 Subscribe to our newsletter and leave us a Review and Rating on Apple Podcasts!

04:00 Chronic conditions associated with obesity include type-2 diabetes, hypertension, hypercholesterolemia, and heart disease.

04:45 Direct medical costs attributed to obesity account for $147 billion. Lost productivity due to obesity cost $303 billion. Adding chronic diseases make obesity a $1 Trillion problem!

06:00 Dr. Ard speaks to the economic challenges of obesity – “Obesity is a multifocal chronic relapsing disorder. It is a disease epidemic that can be addressed through patient engagement.”

07:00 The limitations of medical education in training doctors on nutrition and how to effectively treat and manage patient obesity.

08:30 Dr. Ard discusses the Weight Management Center at Atrium Health Wake Forest Baptist and the challenges with patient engagement in an obesogenic environment.

09:00 The impact of the COVID-19 pandemic on societal obesity and how technology empowers an effective patient engagement strategy.

10:00 Rich discusses the diametrically opposed reality that treating obesity is typically conducted as a prescription upon the onset of chronic disease (instead of as a prevention).

11:30 How technology can extend team-based care to provide a conduit for meaning patient engagement and treatment interventions.

12:00 Technology can be leveraged to address community health and equity, especially for patients living in food deserts.

13:00 How can a trusting business partnership between a care delivery organization and a technology company embolden relationship-based care for value transformation?

14:30 Dr. Ard on how technology can identify care gaps and then inform the agile development of intervention solutions.

15:00 “Technology doesn’t replace providers. It instead enables the provider to do more than what they can do alone.”

15:30 “A data-assisted approach to obesity care (e.g. patient-reported outcomes, physiologic monitoring) can enable personalized medicine.”

17:00 Rich outlines the tenets of relationship-based care – a common vision, trust, and innovation.

19:45 Demonstrating results with innovation can create expanded scale and reach in clinical efficacy.

21:00 How can research into the science of behavior change improve our understanding of how to influence health-related behaviors, such as diet, exercise, and medication adherence.

22:30 Lifestyle medicine as the starting point for any treatment strategy.

23:30 Uncontrollable variables in an obesogenic environment (i.e. Social Determinants of Health) determine the development of a personalized treatment strategy.

25:00 Having a trusted resource provided real-time feedback and guidance can guide better lifestyle choices.

26:30 Tailored feedback provides the opportunity for more sustainable changes (versus self-monitoring)

26:45 How automation of a “one-to-many” engagement strategy can be reinforced with individualized feedback.

27:30 The saturation of DIY health applications and how it differences from a patient-centered care model that emphasizes trusting relationships.

28:30 The real-time continuous learning of engagement algorithms used in weight management programs.

29:30 Incorporating biometric data from wearables to care management programs capturing self-reported data.

31:30 Rich on how the founders of Carium had a vision for data-enabled predictive analytics in healthcare (based on prior experience with telecommunications industry).

33:00 Creating data visualizations and actionable insights to drive value-based care outcomes.

35:00 In the conventional treatment of obesity, we often rely on a “one-size-fits-all” approach despite significant pathophysiological heterogeneity among people with obesity.

36:45 Dr. Ard provides perspective on the opportunity for precision medicine and individualized care planning in the personalized treatment of obesity.

38:00 The heterogeneity of treatment response for obesity allows for much faster realization of patient outcomes (i.e. a short-term ROI opportunity for medical cost savings)

39:30 Precision medicine and individualized care planning allows for a more effective utilization of healthcare workforce.

40:30 Rich discusses how virtual care delivery and remote patient monitoring can provide the enablement to help clinicians “deliver care at the point of life.”

41:30 White labeling or co-branding of technology supports the curation of a trusted engagement platform.

42:30 An example of how the technology relationship between Carium and Dr. Ard helped improve data capture and integrity.

43:30 The importance of shared goals between providers and technology companies.

45:00 Healthcare needs a renaissance of human experience design in technology solutions.

46:30 Moving medicine from an episodic, fee-for-service paradigm will require patient-centered technology design.

50:00 Approximately 13-percent of US households report food insecurity, meaning that they lack consistent, dependable access to enough food for active, healthy living.

51:45 Dr. Ard on how tech-enabled VBC can support the elimination of health disparities related to obesity with low-income and minoritized populations.

56:00 Rich describes how the proliferation of obesity-specific patient engagement can extend to other areas of medicine (e.g. fetal maternal health, oncology).

56:45 Technological scarcity is a social determinant of health and we must “bridge the digital divide” if it exists.

57:30 Does income fragility mean that people do not have access to smart phones and broadband access?

60:00 Are we in the beginning of a 4th Industrial Revolution where scalable disruption of our current care delivery model will occur through digital transformation?

60:45 Why hasn’t the Internet transformed healthcare like it has all other industries?

62:00 Rich discusses what the future look like in the next few years with emerging advancements in AI, internet of things, 5G, wearables, and gamification of consumer health apps.

63:00 Dr. Ard on how providers will eventually prescribe technology applications to their patients and provide automated meal planning based on context and geolocation.

Did you know that musculoskeletal care is one of the biggest challenges facing the value transformation of healthcare?  Musculoskeletal healthcare spending is rising at an unsustainable rate – having doubled in the last decade!  Many of these procedures (such as knee replacements and spinal fusions) contribute to overspending on care that is not even needed, as it has been estimated that only 50% of MSK procedures are evidence-based. The rising costs ofmusculoskeletal care is now a top cost driver for employers and health plans. Yet despite rising costs, MSK outcomes for members haven’t gotten better over the last ten years. Studies have shown that, despite a dramatic increase in health care expenditures for patients with back and neck problems over the last decade, there has not been a corresponding improvement in patient clinical outcomes. In short, spending more money has not correlated with better outcomes.  We are in dire need of a value-based revolution in the provision of musculoskeletal care. The current system is clearly broken. Studies have demonstrated that common approaches to MSK care (surgery, imaging, injections, opioids) do not effectively resolve back and joint pain. And the challenges of escalating costs associated with such low value are too big to ignore.

There is a better way, and this week on the Race to Value, we interview two of the leading innovators in orthopedic value-based care! In this special episode, we will begin with an interview with Dr. Kevin Bozic, the chair of surgery and perioperative care at the Dell Medical School at The University of Texas at Austin. He is an internationally recognized leader in orthopedic surgery and value-based health care payment and delivery models and currently serves on the Board of Directors for the American Academy of Orthopaedic Surgeons – a clear signal from the AAOS that the specialty is moving into the value-based care arena. Our second interview on the podcast is with Dr. Kian Raiszadeh, the CEO and Co-Founder of Livara and SpineZone, an orthopedic surgeon who has created an innovative orthopedic care management system for payors, providers, and health systems to unify the patient experience and transition to orthopedic value-based care.

Episode Bookmarks:

01:30 Musculoskeletal healthcare spending is rising at an unsustainable rate – having doubled in the last decade!

01:45 It has been estimated that only 50% of MSK procedures are evidence-based.

02:00 Increased MSK spending in healthcare not associated with a corresponding improvement in patient clinical outcomes.

03:00 Introduction to Kevin Bozic, M.D., MBA and Kian Raiszadeh, M.D.

03:45 Upcoming conference in value-based orthopedics – OVBC on January 26th-28th

05:00 At the Musculoskeletal Institute at UT Health Austin, Dr. Bozic has created a MSK Integrated Practice Unit.

06:30 Dr. Bozic provides an overview of the Musculoskeletal Institute and how it functions as an Integrated Practice Unit.

07:30 “The vast majority of patients with musculoskeletal conditions do not require or benefit from surgery.”

08:00 The role of the primary care in treating MSK disease within a “musculoskeletal medical home”.

08:45 Comorbid conditions with chronic MSK disease (e.g. anxiety, depression, obesity) are rarely treated in a non-integrated model.

09:45 Holistic integration of primary care-based orthopedic physicians, APPs, physical therapists, dieticians, and social workers.

12:30 Dr. Bozic discusses the potential for condition-based bundled payments in the treatment of MSK disease.

13:45 The role of bundled payment care pathways in lowering overall costs with better clinical outcomes.

14:00 How reduction of inpatient post-acute care can result in lower episode spend with “no detrimental impact on patient outcomes.”

15:00 The big value opportunity — addressing the continuum of care across the spectrum of disease (not just focusing on the surgery).

16:00 Redesigning MSK delivery for optimizing outcomes associated with pain, functional status, and quality of life.

16:30 “Value is all about improving health outcomes in ways that over time reduce the cost of health care. Health is inherently less expensive than disease.”

17:00 The Value Institute for Health and Care and its work in improving health outcomes. (Reference podcast with Elizabeth Teisberg).

19:00 Dr. Bozic discusses the important of patient-reported outcomes (PROs) and how they are used in his musculoskeletal IPU.

20:45 How PROs provide an understanding of a patient’s baseline for pain, functional status, quality of life, and mental health.

23:30 Dr. Bozic provides his parting thoughts on physician leadership in the progression of VBC and the role that AAOS will play in this movement.

26:45 Dr. Raiszadeh and his founding of SpineZone and Livara to reverse the trend of overutilization in orthopedic care through integrated care delivery.

29:30 Dr. Raiszadeh provides perspective on the lack of value-based care from his years of practicing as an orthopedic surgeon.

31:00 “We can create a radically new patient experience in orthopedics allows patients to heal without surgical intervention.”

33:30 Dr. Raiszadeh describes the concept of Orthopedic Whole Health and how it evaluates patients comprehensively from the top-down.

35:30 The impact of obesity, anxiety, and depression on hormonal physiology that affects how patient sense musculoskeletal pain.

36:30 “MSK pain is like the canary in the coalmine. It is giving us an indication of something that is deeper, and that is what Orthopedic Whole Health addresses.”

37:30 The life altering perspective of orthopedic whole health and how this model can be built to scale.

38:00 Transitioning orthopedic care from a biomedical to a biopsychosocial model.

39:00 In the 1990’s, doctors began to view pain as a fifth vital sign, and they over-prescribed opioids (without focusing on safer and more holistic interventions).

40:00 Dr. Raiszadeh discusses the Bio Psychosocial Model of Pain Management in value-based care.

41:30 60-70% of orthopedic patients experience some degree of anxiety, depression, or shame and anger associated with childhood trauma.

42:30 How 1:1 and group sessions, expressive writing, and meditation can be used in MSK treatment.

43:30 Opioid dependency and risks of addiction in orthopedic care.

45:00 “How you feel is the overall foundation of health. It changes our entire chemical environment.”

46:00 The rise of consumerism in orthopedic care and how SpineZone’s consumer-centric model boasts an industry-leading net promoter score of 94.

47:30 Dr. Raiszadeh provides his insights about orthopedic consumerism and how to change a patient’s mindset for MSK treatment.

49:30 How orthopedic consumerism and bio psychosocial care aligns with employer expectations for risk-based payment.

50:30 Creating a MSK model that is non-transactional and opens one up to all aspects of life.

51:45 The launch of Livara – an orthopedic care management system to transition to value-based care at scale.

53:00 Using cost and clinical outcomes data to build a scalable platform that applies to all of orthopedics.

54:30 Leveraging data-driven algorithms to drive diagnosis and value-based care interventions.

57:00 Parting thoughts on the movement to value-based orthopedic care.

Community-based health transformation can be unleashed by uniting traditional allopathic medicine with lifestyle medicine.  To achieve a vision for population health, we will never change things by fighting the existing reality – we must instead innovate to render that old model obsolete.  On a mission to flatten the curve of healthcare costs, James Maskell has spent the past decade innovating at the cross section of functional medicine and community. To that end, he created the Functional Forum, the world’s largest integrative medicine conference with record-setting participation online and growing physician communities around the world. His organization and bestselling book of the same name, Evolution of Medicine, prepares health professionals for this new era of personalized, participatory medicine. His new project, HealCommunity, follows his second book “The Community Cure“, makes it easy for clinics and health systems to deliver lifestyle focused care effectively and frictionlessly. He is a high-demand speaker and impresario, being featured on TEDMED, HuffPostLive and TEDx, as well as lecturing internationally.

In this episode, you will learn about the impact of social isolation on chronic disease, functional group medicine, the development of a community layer as a foundation to the population care pyramid, Empowerment Group models, Human Social Genomics and precision medicine, behavior health and psychedelic therapies, and the power of lifestyle-enabled value-based care. Tune in this week to hear from a leading population health economist on a mission to win the Race to Value!

Episode Bookmarks:

01:30 Introduction to James Maskell (Community Builder and Healthcare Entrepreneur)

02:00 Books (Evolution of Medicine and The Community Cure) and theHealCommunity project

02:30 “Community is the most powerful force to transform health.  And Medicine has been slow to adapt to this reality…”

04:30 R. Buckminster Fuller: “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”

05:00 Blue Zone Regions and the Roseto Effect

06:00 Is Chronic Disease Reversible?

06:45 “The biggest driver of all-cause mortality is loneliness and social stress.”

08:00 “The combination of Lifestyle Medicine and Group Medicine are the potential foundation of the population care pyramid.”

08:30 How can insurance be restructured to rebuild the community layer?

09:30 Honoring our ancestry by resolving the isolation of modern living

09:45 The thesis by Raghuram Rahan that technology has ripped apart the fabric of traditional communities

12:00 Inspiration from Dr. Jeffrey Geller and his work with Empowerment Group Models, delivering care and providing social support to underserved populations

14:30 Innovation of medicine at the cross section community and health empowerment (the solution to loneliness)

16:15 Billing, reimbursement, and privacy challenges in implementing group visits

17:30 Value creation and the elegance of the empowerment group model

19:00 The social paradox: people’s willingness to share private information on Facebook rather than within a community health model

19:30 Development of skills and competencies for Group Medicine

21:00 The collective trauma of the pandemic has changed the way people engage together

22:30 Removing friction points in group medicine through virtual visits

23:30 The impact of human social genomics in precision medicine, disease prevention, and personalized care pathways

24:45 George Slavich, PhD and his work in Human Social Genomics

25:00 The cellular-level impact of stress and depression related to the loss of a social community

26:00 Is Group Medicine really the opposite of Precision Medicine?

27:30 The vision for Precision Public Health and the work of Dr. Christopher Mote

30:30 America’s Behavioral Health crisis and recent Mass Shootings

31:30 A comorbid behavioral health disorder makes a chronic disease cost 2-3 timesmore!

32:00 Emerging research in Psychedelic Medicine delivered in integrative mental health clinics (such as ketamine-assisted psychotherapy)

33:00 An economic perspective on the research related to Group Medicine and theBiopsychosocial Model

35:30 The promise of Psychedelic Therapy on PTSD and other major depressive disorders

36:45 Combining Psychedelic Therapy with Lifestyle Medicine delivered in groups

38:00 Functional Medicine and Knowledge Transfer (the doubling of medical knowledge every few months)

39:30 The hope for the future lies in the value-based care movement

40:00 Functional group medicine outperforms traditional hyper-individualized medicine in treating chronic disease (Cleveland Clinic Study)

42:00 Increased interest in functional medicine due to COVID-19

43:30 The competitive advantage and market economics of the community health model

46:00 Refocusing value-based payment reforms that emphasize clinical models for disease prevention and lifestyle medicine

47:45 Creating a “Lifestyle Medicine ACO” (e.g. Vytalize Health, self-funded employers)

49:30 The work of Dr. David Unwin in reversing Type 2 Diabetes and lowering healthcare costs

52:45 Leading advocates for Lifestyle Medicine (e.g. Dr. Dean Ornish, Dr. Mark Hyman, the ACLM, Mayor Eric Adams)

54:00 “Lifestyle Medicine is the future of Value-Based Care.”

55:00 How Governor DeSantis is focused on lifestyle medicine to address COVID-19

56:30 Lifestyle therapeutic interventions (e.g. plant-based eating, physical activity, restorative sleep, stress management, avoidance of risky substances, social connectivity)

58:45 What kinds of social determinants of health can effectively be addressed in the healthcare setting?

60:00 Digital transformation, Dr. Robert Pearl, and the benefits of telemedicine

61:00 Innovations in localized food growing and community-based group cooking

63:00 The threat of the Social Media Metaverse on mental health

67:45 More about James Maskell’s work in Value-Based Care and connecting with him on LinkedIn

It’s no secret that the Black community tops the list of groups afflicted by hypertension, stroke, diabetes, heart disease, kidney failure, and cancer. What the statistics do not show is the pain, misery, and despair that these conditions create—not only for the individual, but also for family and friends. As an African-American doctor, Dr. Richard Walker has studied these conditions among his patients for many years. Now, in his new book, “Black Health Matters”, Dr. Walker offers a number of commonsense ways to prevent, manage, and possibly eliminate these killers, turning the tide of African-American health. And he not only provides us with a construct for thought leadership in population health equity, he practices this type of care at his home-based primary care practice TVP-Care in Houston, Texas.

Dr. Walker has spent considerable time in researching the health and healthcare journey of African captives into slavery and understands what current African Americans now to need to do to survive nutritionally and culturally. He is truly on a mission to overcome the chronic ill health and early death that is so pervasive in Black communities. Most importantly, however, Dr. Walker is a leader in the value movement that believes traditional medicine should be merged with lifestyle medicine. He understands that African Americans can turn their health around by understanding and incorporating better nutrition, nutritional supplements, exercise, and regular healthcare checkups into their lives. In this important podcast discussion, we you will learn from a leading clinician and entrepreneur how we should go about improving Population Health Equity within African American communities in this Race to Value!

Episode Bookmarks:

01:30 Introduction to “Black Health Matters” and the work of Dr. Richard Walker in the health value movement

03:30 What does the use of the word “value” mean when it comes to community health?

05:00 Dr. Walker discusses his upbringing in Spanish Harlem and how that experience led him to become a physician leader seeking to advance health equity

07:00 The “mystery” of excessive hospitalizations due to sugar consumption and how that led to an epidemic of Type 2 Diabetes in the African American community

09:00 The misperception in the African American community that most common chronic diseases are genetic (instead of caused by environmental of lifestyle factors)

10:00 Dismantling the informational disadvantage that leads to a misunderstanding of Social Determinants of Health

12:00 The impact of the murder of George Floyd and the BLM social justice movement and how that inspired Dr. Walker to write “Black Health Matters”

14:30 How the collective experience of African Americans over the last 400+ years has been based on “waiting” (e.g. slavery, citizenship, civil rights)

16:00 “Taking care of your own life is all about taking charge of the environment by understanding the root causes that lead to disease.”

16:30 How poor nutrition in the African American community stems from the slavery era and persists to this day

17:30 The inadequate training of the healthcare workforce further exacerbates preexisting issues of poor health among African Americans

18:30 “Black Health Matters” is all about understanding the progenitors of chronic disease that are not genetic, and how to mitigate them in African American communities.

19:00 Environmental hazards and chemical toxicities are more common in underserved, minoritized communities

20:30 Research that confirms the presence of systemic issues in the healthcare industry related to institutional racism

22:00 “The concept of value-based care is transformational because it has the potential of changing the course in healthcare by recognizing the true value of the individual.”

23:30 Will value-based care bring us to the “Quintuple Aim” that includes health equity?

24:30 How the founding vision of Dr. Walker’s value-based, patient-centered medical practice has been informed by emerging payment models from CMS

27:20 Recent McKinsey & Company study estimating that up to $265 billion worth of care (representing up to 25 percent of the total cost of care) could shift to the home by 2025

28:30 Dr. Walker provides an overview of his MSO and primary care medical practice business model

31:30 Going upstream with patient-centered, reengineered primary care through an enabled access model that provides care in the home

32:30 Fostering trust and creating meaningful relationships between patients and providers through home-based care delivery

34:00 The enablement of remote patient monitoring, chronic care management, and telehealth to enhance home-based, primary care

34:30 Care coordination and chronic care management delivered by interdisciplinary teams supporting a primary care provider

35:30 “Smaller primary care patient panel sizes leads to better patient outcomes and providers with a better quality of life.”

36:30 “Micro” Social Determinants of Health that can be managed by the medical practice

39:30 Improving care for the 5% of the population driving healthcare expenditures is an economic opportunity for our country

41:00 Recent research showing significantly lower levels of telemedicine usage among Black patients, particularly those over age 65, as compared with white patients

42:00 “21st century care technologies – RPM, telehealth – are a gamechanger for primary care.”

44:00 The human-to-human relationship as the driving force of patient-centered, reimagined primary care (ex: the interaction of having tea with a patient in their home)

46:30 Dr. Walker describes the use of remote patient monitoring technology in his medical practice

47:30 The challenges of ethnogeriatric care focused on African Americans and the Aging Process can be overcome by addressing SDOH

50:00 The importance of workforce sufficiency and education to provide culturally-competent care

52:00 How concerns about implicit bias in care delivery may limit the progress of transformation (balancing the need to deliver the best care you can under the circumstances)

54:30 The role of the “Community Organizer” in bridging the gap in trust between patients and the healthcare system

56:30 The words of Dr. Martin Luther King, Jr: “Of all the forms of inequality, injustice in health is the most shocking and inhumane.”

58:00 Functional medicine as a more holistic approach to delivering whole-person care to the individual

60:00 Healthcare providers must recognize the need for human connection, love, and trusting relationships to ensure equity in health

62:30 WGU and the Institute for Advancing Health Value as an example “as a lighthouse for the rest of the academic world and the healthcare industry”

A bright future for the nation depends on the health and prosperity of rural America, and unfortunately, we are at a moment in time where life is not ideal in the rural heartland.  Although most rural Americans are generally satisfied with the overall quality of life and see their communities as safe, we are reaching a crisis when it comes to financial insecurity, trouble accessing affordable, high quality health care, a lack of high-speed internet access, housing problems, and isolation/loneliness. When it comes to health care, even though most rural Americans have health insurance, about one-quarter say they lack adequate health care access, as they have not been able to get the care they needed at some point in the past few years. Consequently, potentially preventable deaths from the five leading causes are consistently higher in rural counties, especially with heart disease.  (Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.)  All of this has culminated into a mistrust of the traditional, fee-for-service dominated healthcare system and created a “shadow population” of underserved minorities and the socially isolated who are dealing with significant cardiovascular metabolic disease.

The Arkansas Lincoln Project is an important population health program focused on improving cardiovascular health in highly underserved, under-resourced areas of the Arkansas Delta Region where economic and health disparities have life altering consequences for rural residents.  Joining us this week, we have two population health leaders sharing their insights about their work in deploying community-based cardiovascular health interventions led by community health workers. Chip Purcell is the director of cardiology research at the University of Arkansas Medical Sciences and the principal investigator of the Arkansas Lincoln Project.  Joining him is Dr. Jessica Barnes, the co-founder and CEO of 20Lighter, LLC – an award winning cardiometabolic health program, delivering dramatic reductions in inflammation and visceral fat.  Together they are winning the “Race to Value” by fighting cardiovascular metabolic disease in the Arkansas Delta, the worst region in the nation for healthcare quality and population health outcomes.

Episode Bookmarks:

01:30 The challenges of obesity and cardiometabolic disease disparities in Rural America

02:00 Rural Americans facing financial insecurity, poor healthcare access and hospital closures, a lack of high-speed internet access, housing problems, and isolation/loneliness

02:45 “Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.”

03:30 Introduction to Dr. Jessica Barnes (CEO of 20Lighter, LLC) and Chip Purcell (UAMS Cardiology Research and the principal investigator of the Arkansas Lincoln Project)

05:00 “Rural Americans tend to have higher rates of cigarette smoking, hypertension, and obesity, and report less leisure-time physical activity than their urban counterparts.”

06:20 The US News & World Report ranks Arkansas 50 out 50 states for overall healthcare quality with higher-than-average obesity rates and overall preventable hospital admissions

07:00 “Arkansas is the worst of the worst in health outcomes, and that is where we can make a difference.”

08:00 Mistrust of the healthcare system is pervasive in the Arkansas Delta Region

09:30 The exponential growth curve in building trust through improvement in individualized patient outcomes

10:00 Studying out-of-hospital, premature natural deaths as a proxy for determining population health needs in Eastern Arkansas (how the Lincoln Project began)

12:30 The use of geospatial mapping to identify the highest risk communities to target with cardiovascular health interventions led by community health workers

16:30 The economic challenges of Phillips County, Arkansas and the history of racial discrimination and conflict, including the Elaine Massacre of 1919 (the bloodiest racial conflict in history)

18:00 Implementation of the door-to-door novel intervention model to address cardiovascular health disparities

19:45 Guiding interventions to elicit behavioral change and the challenges of addressing multiple social determinants of health all at once

20:30 “Women are a very fast growing subset of the population that is struggling with cardiovascular disease.”

21:00 Lower income and higher poverty with women in rural areas creates another layer of challenges (e.g.  “inequities in the inequities”)

22:00 “Ultimately our vision is to introduce practical community-centered interventions that improve rural health.”

23:30 “Community Health Workers (CHWs) are the most under-utilized resource we have in healthcare right now.  They should be the face of healthcare to overcome patient mistrust of the system.”

26:00 How the Lincoln Project trains CHWs to navigate the medical and social resources available to improve population health outcomes

28:30 Ensuring patient compliance to support the behavioral changes needed to improve community health

29:30 Referencing recent study showing how Massachusetts General Hospital was able to reduce 30-day readmissions among ACO patients supported by trained community health workers

30:30 “Changing cardiovascular disease outcomes is a longer-term goal but utilization and compliance measures are interim measures of success in the short-term.”

31:30 “Community Health Workers actually come from the local, underserved community and really care about the community members they are helping.”

33:00 How 20Lighter (a unique, comprehensive cardiometabolic telehealth program)engaged African American women in a pilot program aimed at improving risk and burden of cardiovascular disease

38:30 The 20Lighter strategy to dramatically reduce inflammation and visceral fat in hypertensive and diabetic community members

44:00 Utilizing telehealth interventions to support precision medicine programs for rural patients at high cardiovascular risk

45:00 How COVID-19 enhanced the value of telehealth by healthcare consumers and patients

46:30 Tech + Touch = Scalability and Personalization

48:00 How a CHW holistic model of community outreach can help providers better communicate with patients and improve health literacy

49:45 Facilitating health literacy in Phillips County whose community members, on average, have a 4th Grade reading level

52:30 “Fee-for-service created a shadow population — usually underserved minorities and the socially isolated — who are unable or unwilling to involve themselves in healthcare.”

53:45 Why capitation will eventually transform the health of the rural South

54:30 Changing the way people think about wellness by overcoming the failed fads of the weight loss and employee wellness industries

As leaders in the value-based care movement, we must think about the synergism between lifestyle medicine and traditional Western medicine. The tenets of lifestyle medicine force us to think more holistically about medical treatment and prevention.  Under this construct, “Sleep is Medicine” because poor sleep is linked to obesity, heart disease, stroke, cancer, and dementia.  “Exercise is Medicine” because of its impact on a healthy heart, mind, and body.  “Love is Medicine” because mindfulness and gratitude is the key to peace and equanimity. And lastly, “Food is Medicine” because a whole food plant-based diet is proven to improve every aspect of health.  These four time-tested tenets encompass the SELF Principle of lifestyle medicine promoted by Dr. Sean Hashmi.

Sean Hashmi, MD, is the adult weight management lead for Southern California Kaiser Permanente. He is a board certified Internist, Nephrologist and Obesity Medicine Specialist practicing at Kaiser Permanente, Woodland Hills, California. In this role as Regional Director for Clinical Nutrition and Weight Management at Kaiser Permanente, Southern California, he’s responsible for developing a comprehensive obesity management strategy involving lifestyle medicine and obesity medicine for the 4.6 million members that Kaiser Permanente serves. He is driven by a lifelong commitment to be of service to others. He also provides evidence-based health, nutrition, and wellness research through his nonprofit organization, SELF Principle.

In this episode, you will learn how Sleep, Exercise, Love, and Food (SELF) translate into hope. And hope is the most powerful thing we can possibly have in health care. With hope, we can transform our broken “sick care” system to a true health care system.  And in doing so, we will win this Race to Value.

Episode Bookmarks:

01:30 Background and Introduction to Dr. Sean Hashmi

04:30 Life-defining experiences and personal challenges that led to the practice of lifestyle medicine

06:30 Dr. Hashmi’s Personal Why:  HOPE

08:30 “The greatest way to be selfish is to do something kind for someone.”

09:00 How a lack of financial resources led to a lack of healthcare access for Dr. Hashmi’s sister

09:45 Lessons in lifestyle medicine learned from his own wife’s health issues

10:45 The American College of Lifestyle Medicine and Dr. Hashmi’s SELF Principle

11:00 “Sleep, Exercise, Love, and Food translate into hope. And hope is the most powerful thing we can possibly have in health care.”

13:30 “Lifestyle medicine needs to be looked at synergistically with Western Medicine.  Everything in health begins and ends with lifestyle.”

14:30 The impact of lifestyle medicine on chronic disease (ex: dialysis treatment coupled with plant-based eating)

16:30 Healthcare providers need to learn more about evidence-based lifestyle medicine

17:00 How lifestyle medicine can improve life’s “moments” (quality of life and longevity)

17:45 Incorporating lifestyle medicine into everything we do (instead of it being a standalone program), e.g. prevention of 30-day rehospitalizations

22:00 Is the heart healthy benefit of eating vegetables only when they are consumed in raw form?

24:20 The Healthy Plate Model:  50% fruits and vegetables, 25% complex carbohydrates, and 25% protein (tofu, beans)

25:20 Consumption of whole fruits will lower HgbA1c results in diabetics in the long-run.

26:20 “Healthy” plant-based eating lowers incidence and prevalence of kidney disease.

27:00 The problems with plant-based meats and why whole vegetables are always preferable

28:20 Why the Blue Zones have such healthier people that live longer

31:00 Dr. Hashmi explains his work in obesity management at Southern California Kaiser Permanente

32:00 How clinicians can effectively counteract societal influences that lead to poor eating and other unhealthy lifestyle choices

34:00 The benefits of bariatric surgery will be undermined without a foundation of good lifestyle

35:00 Understanding the impact of poor food choices (ex. 3-5 hours of walking to undo one slice of cheesecake)

36:00 Creating ambassadors to carry the message of lifestyle medicine

38:45 The toll of physician burnout (“In real life, our heroes do get tired.”)

39:30 “Of all the people who need lifestyle medicine, healthcare workers need it the most.”

40:00 “Physician burnout often occurs because they didn’t follow the tenets of lifestyle medicine.”

41:00 Fill your own well.  (“Put your own oxygen mask on first before trying to help others”)

42:00 The expression of gratitude in the healing environment (finding hope)

43:30 Getting deep, restful sleep for the recommended 7-9 hours leads to weight loss and better health

44:30 The feeling of making an impact on a patient’s health (“the greatest drug in the world”)

45:00 Administrators often misunderstand the joy of medicine

46:00 Lifestyle medicine can help physicians restore their personal “Why”

47:30 Food insecurity is associated with $77 billion in excess health care expenditures each year.

48:00 How can you eat affordably on a plant-based diet?

49:30 Startup companies trying to address food insecurity and poor nutrition in underserved communities

50:30 The current trend in society to move away from red meat consumption

51:30 Making waves in society by raising awareness of lifestyle medicine

53:00 As much as one-third of health care spending in the U.S. each year is wasted, upwards of $700 billion each year

54:00 The misaligned financial incentives of fee-for-service medicine

55:00 The affordability of implementing lifestyle medicine programs and how they will improve population health outcomes

56:20 Leveraging technology to bring social connection and engagement (applying lessons learned in social media to lifestyle medicine)

58:00 “In lifestyle medicine, a physician doesn’t get paid by telling someone to eat more broccoli.  Instead, it aligns with value-based care by preventing disease and improving outcomes.”

59:00 Treating kidney disease costs the Medicare program $130B (7% total spending) even though it is 1% of the Medicare population

60:00 Dr. Hashmi discusses how lifestyle medicine can create a better way to care for patients with kidney disease 

61:00 How patients with kidney disease end up dying from heart disease!

62:00 Cutting down salt intake with patients suffering from CKD

63:45 Medications become more effective when combined with lifestyle medicine

65:00 “Value-based care is all about making outcomes better.”

66:00 The power of love and gratitude as a healing medicine

68:00 Making others feel valued is the most important virtue of a leader

69:30 Expressing gratitude to others in your family who allow you to do what you love.

70:00 Life’s moments define your legacy.  Create change by expressing gratitude.

72:00 “Value-based care is not just about the metrics and outcomes.  Take care of people first, and then focus on the process.”