The Reverse Mullet Healthcare Podcast

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

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Healthcare has reached what Shawn Martin from the American Academy of Family Physicians calls an "inflection point" unlike any other. Joining us at the American College of Lifestyle Medicine Conference, Martin shares how our system's overwhelming focus on late-stage disease intervention has created a financial and clinical disconnect that's pushing us toward a breaking point.

The conversation reveals a startling truth: our healthcare system wasn't built to help people become healthy. Instead, as Martin explains, interventions have historically been designed "to save a hospital money, to save the employer money, to save the insurer money" rather than helping patients live better lives. This misalignment of incentives has created what one host calls our collective "Wile E. Coyote moment" - we've run off the cliff of sustainability and haven't yet looked down.

But within this crisis lies unprecedented opportunity. Lifestyle medicine emerges as a catalyst for transformation, offering physicians tools to not just manage chronic disease but potentially reverse it. For the 130,000 family physicians represented by AAFP across 95% of US counties, this approach reconnects them with the type of care they envisioned providing when entering medicine. It's not about expensive technology or complicated protocols - it's about returning to foundations of health that have been overlooked in our complex system.

Listen now to understand how combining lifestyle medicine with emerging value-based payment models could finally align financial incentives with patient outcomes and rebuild healthcare on a foundation of health rather than disease.

Justin Politti:

Welcome to the Reverse Mullet Healthcare Podcast. We are live at the ACLM Conference, the American College of Lifestyle Medicine.

Ellen Brown:

He did it. Yeah, there you go 2024, orlando, florida.

Justin Politti:

I'm Justin Politti, I'm Dave Pavlik. I'm Alan Brown.

Ellen Brown:

I'm Justin Politti. I'm Mullet man, but we're here with Sean Martin and I'm super excited because I think your organization is integral to what's happening today. You know we had Susan Benegas on yesterday and she used the term catalyst for transformation.

Sean Martin:

Yeah.

Ellen Brown:

And you have been in this uphill battle with family practice for the AFP of how do you enable family practice, primary care, to fulfill what it's capable of fulfilling, right, and it's such a challenge with the RVU model and a fee-for-service model and just what we've been up against, and you know we've been coming at it from a payment transformation perspective. And how do we get outcomes-based models? You know value-based care models, all these things in place, and I feel like lifestyle medicine is truly this catalyst to transformation, because it's a tool to allow success, you know. So I'm really glad you joined.

Ellen Brown:

Well, thank you for having me so tell us about AAFP and tell us about your work and lifestyle, medicine and linkage, et cetera.

Sean Martin:

Sure. So the American Academy of Family Physicians is founded in 1947 as the American Academy of General Practice. We became AAFP in 1971 for a variety of reasons. Part of it was a transformational movement around the practice and the scope and community-based care and community health centers. Lots of things were happening in the United States and kind of the post-Medicare community-based care models were emerging. Community-based care models were emerging but family medicine kind of came out of that community-based movement to connect health and health professionals at the community level in response to kind of a very hospital-centric time period around Medicare, which still exists today in many ways.

Sean Martin:

We represent 130,000 family physicians and medical residents across the country. We have a member at least the last time we counted in 95% of US counties. They move around a little bit but we have a very robust footprint across the country and, more likely than not, if there's people living in a community there's probably a family physician somewhere nearby. We're an organization. We're a professional organization. We really do three things. We do member support. We have a very robust education apparatus, helping members be successful both in clinical practice but also in their careers and profession, and then we're a big advocacy organization and doing all the work that you just talked about at the beginning A little. You know, it was a little depressing to hear all the things that we got to work on Sorry.

Justin Politti:

Well, we're energized about it so.

Sean Martin:

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

Ellen Brown:

Yeah, so you guys want to. I'm always the yapper, yeah, now what do you find the biggest?

Justin Politti:

barriers to moving it forward.

Sean Martin:

Just the concepts of primary care or lifestyle medicine.

Justin Politti:

Lifestyle medicine.

Sean Martin:

I think the barriers to the concepts of primary health care in the United States are the same for lifestyle medicine is the same as it was for health promotion, disease prevention and like all these concepts have faced the same headwinds in the United States and it's because we have built a healthcare system from a benefits and financing perspective that is heavily focused on late stage intervention of disease we don't focus with, except for children, you know, and like there's this moment in time with children who were very health and prevention focused but by the time they reach, you know, young adolescents, we've moved away from that. But we're a healthcare system largely focused on late intervention of disease. And how do we not ignore people that need intervention to live a better life because of their disease state, but kind of pivot backwards earlier in the lifespan to start creating a more healthy population moving forward? And I say this all the time it, you know, it upsets people, but we're never going to solve our problems if we're trying to solve it at plus 50 years old.

Sean Martin:

I mean we, just we can't. I mean that's like swimming against the strongest current. You know we're going to have to get way upstream and try to create healthier populations in the future, which, in results, you know could lower the economic pressure on our healthcare system and individuals and create a healthier population.

Ellen Brown:

But it's interesting because I feel like we're coming into this magic moment where, because we're spending 2 trillion, so it's kind of like the creep. Right, healthcare used to be to your point. Like we did. We built this very, I say, sick care, which is a bit draconian statement, but people understand that. Right, we built this system for keeping you alive, right?

Ellen Brown:

You're really sick. We treat you, we keep you alive, we treat you. And I think now, with the rapid, exponential growth of lifestyle disease, cardiometabolic disease syndrome you know we're spending 2 trillion on that it's it's really largely bankrupting a lot of folks. And now all of a sudden, people see that and so I almost feel like we're at this magic moment where we don't even have to debate about quote unquote wellness and prevention, which I a hundred percent agree with your point about we need to keep moving down is we have this huge opportunity in front of us. I mean, I've been shocked at the number of people that have said, even at late stage in your sixties, right, that lifestyle medicine can truly reverse disease. You know, and it's like wait, we have this tool that we can put in our toolkit that could actually give an option to reverse disease, not just treat it right. And as that takes hold and we show success, we could then say, okay, now we can keep moving down right.

Ellen Brown:

We can use it as a tool to improve the health overall and not get to the point we've been getting to you know.

Justin Politti:

Well, yeah, we've collectively lost our minds, it's true.

Ellen Brown:

No, you said this yesterday and it was so true.

Justin Politti:

And we have a common sense solution in front of us and we just need to advertise it. But we are, we're full, delusional, and now we have a common sense solution in front of us and we just need to advertise it, like I I mean like. But we are, we're in, like, we're full delusional and now, like, we're awake. You know what I'm saying this is an epiphany.

Sean Martin:

He actually had t-shirt ideas now it's um, so I, I, I actually agree with that as um. Those aren't the words. I would have um in my professional role.

Sean Martin:

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

Ellen Brown:

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

Justin Politti:

Again manage.

Ellen Brown:

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

Ellen Brown:

There are millions of people that do want to get healthy and we give them the intervention to say here now we have an outcomes-based model to reinvest, to actually reinvest those dollars for a health system. They make a lot more margin on sharing 50% of the savings of a diabetic patient that just saved $30,000 in the year than they did on the margin of a stay.

Sean Martin:

You know what I'm saying.

Ellen Brown:

And I'm not talking about all of a sudden just like yanking all the inpatient admissions out it's. There's a real opportunity here to leverage the payment models that we have and align them with the practice of medicine, using such simple tools as lifestyle medicine.

Justin Politti:

You know what if we're all healthy? What if we're all healthy?

Sean Martin:

Well, I mean that's true, right. Like I mean that's the concept of just prolonging the onset of disease by a week, a month, a year. Like I mean just the impact that has at scale in a population like this. But I have two comments because, like I think you're making an excellent point, we, you know, for a long time, interventions in or demonstration projects or innovation, particularly in primary care, were all designed to produce an outcome from someone other than the patient. So it was to save a hospital money, to save the employer money, to save the insurer money. There was never a system designed to help the patient be healthier and live a better life.

Sean Martin:

And I think, to CMMI's credit and to a lot of people in the marketplace, that has changed. People are becoming much more focused on this concept of whole person care, helping people live their best healthy life, no matter what state they may find themselves in at the time. So I think that conversation has changed a little bit, which gives us a new opportunity to align financing models and care models around. You know some of these new concepts and I think that's why lifestyle medicine is having a moment. I think that's why you're seeing the appropriate like how does it get incorporated into more comprehensive care models so that it's not a niche, you know, practice model. I think that's where, at AFP, lifestyle medicine should reemerge as a component of comprehensive primary care right Everybody should be doing this you know, and you should be doing it for children.

Sean Martin:

You know, these approaches to this concept of care do not have an age limit or anything else. I mean these are just a good approach to better patient care.

Ellen Brown:

Yeah, they don't have to be concierge, they don't have to be only for the rich, and I think that's it, like just we've lost our minds Like it's how to live healthy. It's like just we've lost our minds like it's how to live healthy. It's like you don't have to go buy some special implement. Or it's like just sleep more and move your body and eat healthy and right.

Justin Politti:

It's like no, and I haven't shared. I haven't shared this. I've been thinking all week like oh boy, oh boy, wait, no, this, this is the roadrunner wiley coyote kind of moment. Uh, wiley coyote runs off the cliff and all of a sudden crashes down because guess what? It's unsustainable, the whole system, the way we're funding everything. And we've hit that moment collectively, as society.

Ellen Brown:

Yeah, we're running, we're like really close.

Justin Politti:

Right. So, honey, I'll have the Acme pillow ready for us.

Ellen Brown:

Justin's underneath. Is there going to be an anvil falling on?

Justin Politti:

us, or is there a pillow, an Acme pillow? Yeah, I don't know, we'll find out.

Ellen Brown:

Well, we know you have to get on with the day, and we know this is always a tight time frame. We really appreciate you joining us.

Sean Martin:

Yeah, thanks for being here. Thank you guys for having me. I mean, we've got Roadrunner.

Justin Politti:

Yeah, we go everywhere Like it's like a pain.

Ellen Brown:

And feel free to jump in against the Roadrunner there?

Justin Politti:

I didn't I wanted to give you an out. I wanted to give you an out, so thank you for having me and you're welcome on for a full discussion.

Sean Martin:

I would actually welcome that. Now, my mind I'll be better prepared mentally for what I'm getting into you think so? But thank you for having me, thanks for the opportunity to share a few thoughts, and I look forward to the next time. This is not grandpa's podcast.

Ellen Brown:

No, but we do have a lot of people don't understand it's party in the front, business in the back but, you make it too boring and people are like, yeah, I get enough of that at work every day but you make it too silly and it's not helpful, and so our goal is to hopefully kind of balance the two. Weave it in, yeah, so thank you.

Sean Martin:

And I don't want to be. I want to say one last thing yeah, please.

Sean Martin:

I think I've been at this a long time. I think we are at an inflection point that is different than any other time that I can remember, and I think COVID created that in many respects oriented to essential kind of false truths that exist. One, it reoriented people around the fact that they do want to be healthy. I mean, you started to see kind of a refocus of the population on wanting to be healthy. And two, it reoriented the healthcare system that it wasn't actually doing a good job. It was not, you know, prepared to really meet the moment, and not the people inside the healthcare system, but the structure of the system itself was not really designed to meet that moment. And you know, now it's. You know, do we how fast can we build? Can we stack bricks fast enough to build something different, or do we just kind of fall back into the routine?

Ellen Brown:

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

Sean Martin:

I feel like lifestyle medicine.

Ellen Brown:

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

Ellen Brown:

I guess, that's it Right. It's like a tool to you know, super pump up what you already have, or like retool it without rebuilding.

Justin Politti:

Yeah, and it's something that you electrify it.

Ellen Brown:

Thank, you, I'm thinking of Greece Electrified.

Justin Politti:

Yeah, electrified, Just electrified.

Ellen Brown:

I was like really I was trying to make a point and now I'm seeing Olivia Newton-John.

Justin Politti:

Exactly John Travolta.

Sean Martin:

So I think the uniqueness is I was thinking about this yesterday of, for most physicians particularly primary care physicians, I think, people that are community-based physicians the concept of lifestyle medicine is probably very well oriented with their worldview of the type of care they wanted to provide when they went into medicine. So it's inviting them back to this concept of patient care that I think they probably saw at the beginning. That's been taken away from them by a variety of factors over many years, and so there's a lot of optimism around it. And it's not a you know it's. It's not an EHR, it's not a digital health tool Like it's something they can do every single day with every single patient, and it has a kind of tactical feel to it, right, like they can touch it and feel it every day and it's a relationship.

Ellen Brown:

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

Justin Politti:

Thank you for your time. Thank you.