The Reverse Mullet Healthcare Podcast

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

• BP2 Health

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"I would have retired from healthcare if I hadn't found lifestyle medicine." These powerful words from Dr. Patel capture the transformative potential not just for patients, but for burned-out healthcare professionals seeking meaning in their work. 

Speaking with us at the American College of Lifestyle Medicine Conference, Dr. Patel shares the remarkable journey that led her from traditional internal medicine to becoming a champion of lifestyle medicine approaches. Her patients' transformations were so dramatic that after just three months, some were unrecognizable - completely weaning off insulin, reversing diabetes, normalizing cholesterol levels, and losing significant weight. These weren't incremental improvements but complete health transformations.

What makes Dr. Patel's story particularly compelling is her strategic approach to integrating lifestyle medicine into healthcare systems. Rather than starting with idealism, she targeted specific pain points for her health system. As a self-insured entity spending $3 million over budget on employee healthcare annually, the system was receptive when her intensive therapeutic lifestyle change program for 150 employees demonstrated exactly $3 million in cost savings within a year. This perfect ROI opened doors for expansion, allowing her to build comprehensive programs incorporating health coaches, registered dietitians, and community-based interventions.

The pandemic forced Dr. Patel to transition her in-person programs to virtual platforms, yielding a surprising discovery: virtual lifestyle medicine programs produce identical clinical and biometric outcomes to in-person interventions. This breakthrough has enormous implications for scaling these solutions nationwide without capital-intensive facility investments, potentially addressing both clinician shortages and healthcare access issues simultaneously.

Ready to transform your approach to healthcare? Explore how lifestyle medicine can revitalize your practice, improve patient outcomes, and create sustainable healthcare models that address both clinical and economic challenges. The revolution in healthcare isn't coming - it's already here.

Dave Pavlik:

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

Justin Politti:

Sunny Florida 20th anniversary. Right. Who are you? I'm Dave Pavlik the Mullet.

Ellen Brown:

Man.

Justin Politti:

I'm the Mullet man today.

Ellen Brown:

And I am Ellen Brown.

Justin Politti:

And I'm Justin Politti.

Ellen Brown:

And we're here with one of my favorite ACLM people, dr Patel, and, yeah, american College of Lifestyle Medicine Annual Conference and super excited to be here. I think what's so exciting is we have our little unicorn on the table of always searching for the unicorns of healthcare, and what's so amazing to me about ACLM is like the whole function of ACLM is a unicorn right. So not only is it like thousands of unicorns walking around, it's also an entire you know board certification. That really is unicorn status in terms of healthcare.

Justin Politti:

So I can't tell you how many people that I've talked to that you know that. Well, what are you doing? What's the podcast about? And I explained it to them and tell them what we do is BP2. And they go yeah, I'm almost board certified, I'm sitting for the exam next month. I can't wait. It's like like I literally yeah, four or five different people that I talked to just kind of randomly- yeah, there's a lot of people sitting right now.

Ellen Brown:

There's a lot of buzz.

Justin Politti:

Yeah, I know they're supposed to be studying, but instead they're here, yeah.

Dave Pavlik:

So it's actually part of attending this conference. Very nice, oh, I thought you said getting in front of BP2 Health was part of it.

Justin Politti:

It should be.

Dave Pavlik:

It's a new part of the curriculum Hold on a second.

Ellen Brown:

We just talked to the no nevermind Carry on yeah, you're not going to remember we talked to get that on the curriculum.

Justin Politti:

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

Ellen Brown:

Yeah, just one half.

Justin Politti:

Yeah, you just have to.

Ellen Brown:

Yeah, anyways, without further ado Dr. Patel, so glad you're here.

Justin Politti:

Yes.

Ellen Brown:

You're a very find.

Padmaja Patel:

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

Padmaja Patel:

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

Ellen Brown:

We are kindred spirits, yeah, and you're the same, and Ellen was ACLM before she knew what ACLM was.

Justin Politti:

Yes, I was, I've been living an ACL dream.

Ellen Brown:

It's just like my husband and I took a year and a half RV trip before there was van life and before there was blogging, like it's right. It's like Brenda with her commitment to ACLM before most people.

Justin Politti:

She's Forrest Gump, oh I am.

Dave Pavlik:

I'm like Forrest.

Ellen Brown:

Gump.

Justin Politti:

Trendsetter yeah.

Ellen Brown:

Didn't even know it, so yeah. So tell us about what you're working on, what you're passionate about yeah.

Padmaja Patel:

So so anyway, but I'm an internal medicine trained clinician and then certified in lifestyle medicine, obviously. So I've had fortunate, you know, as a primary care clinician. We all go through the same, uh, sort of journey of, you know, getting tired of doing this more of the same, and fortunately I found lifestyle medicine that literally changed my personal and professional trajectory. Um, I would have retired from healthcare if I had not found lifestyle medicine and I don't think I'm the only one saying that.

Padmaja Patel:

there are so many clinicians here either are they are burned out, you know from doing what they do, or they're looking for another revenue to uh find how can they deliver meaningful care and find purpose and meaning along the way, right? So this is what Lifestyle Medicine delivers, and I'm so delighted that I had the opportunity of delivering and establishing a program at a local health system in Midland Texas where I developed many of this intensive therapeutic lifestyle program, and what really changed me the most was more around the transformations that I actually witnessed. You know I saw people like some of my patients are related. You know they came back as a follow-up and I didn't even recognize them.

Ellen Brown:

It was like that kind of a transformation? After what period of time? In three months?

Justin Politti:

Three months Wow, yeah, it was like that kind of a transformation.

Padmaja Patel:

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

Padmaja Patel:

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

Ellen Brown:

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

Justin Politti:

She does. She usually gives a fist pump.

Ellen Brown:

But that was just hug-worthy right there.

Justin Politti:

this is why we are meant to be friends in in your example I'm sure there are many of of a patient that you know came back three months later and you didn't recognize them. What are the? What are the um interventions you're deploying, that that are lifestyle medicine related? All of them, some of them? What? What works the best?

Padmaja Patel:

You know, so early in my private practice I didn't have the resources to really bring in team-based care. You know, in your private practice you don't have the resources, you can't afford it in fee-for-service payment models. So a lot of that relied on just educating them, providing them some pamphlets, educational material or websites, so you know. So I had actually a prescription that we would give them. So you know, watch this video, look at this website. Here are the recipes. You know all these stuff that we gave and they go home.

Padmaja Patel:

And you know those who were really motivated would continue, but there was no support system early on. Clearly, then I realized that there needs to be a very structured program and we needed to integrate health coaching, bringing into behavioral aspect and also bringing nutritional counseling with a registered dietitian, and so that's why I joined a health system to bring around this entire interdisciplinary team-based care as part of our approach. But I have seen so, for example, in my community I co-founded another non-profit called Our Healthy City. So our biggest mission there is to more around educating community around the benefits of whole food plant, predominant dietary pattern and lifestyle medicine. We would conduct and we still do annual food as medicine event and we would have about 500 members from our community just come listen to one day seminar. We would invite all these big professionals and speakers from around the world sometimes, but the key is that they just learned, they heard about it, they watched some presentations and then they go home and we've seen people losing 70 pounds, 80 pounds on their own right, without any further.

Justin Politti:

They just got motivated from a one-day event.

Padmaja Patel:

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

Justin Politti:

that Keeps coming up.

Padmaja Patel:

Community.

Ellen Brown:

Community yeah.

Padmaja Patel:

That's the key here is to talk about lifestyle. Analysis is not just what happens in an office setting.

Ellen Brown:

Yeah.

Padmaja Patel:

It's much more than that, and you can see it here, right.

Dave Pavlik:

Very much so.

Padmaja Patel:

The models that we see it's across, and so my passion and excitement comes from it's not just I mean predominantly primary care. We want to integrate lifestyle medicine across the board, but we also have it in specialty care.

Ellen Brown:

Which is amazing.

Padmaja Patel:

We have it in different settings Yep Right, inpatient, outpatient, you and me, yep and across different payment models, so it's like ubiquitous, it can be anywhere, yep Right, and so that's the beauty of this foundational care that we talk about.

Dave Pavlik:

So what are some of your thoughts on? You mentioned scale a little earlier. What are some of your thoughts on how you can scale this across the country?

Padmaja Patel:

Yeah, so when COVID-19 happened, during the pandemic, I had a program which was, you know, in-person, intensive group program, and obviously we couldn't gather right, so I had to put that program on a virtual platform and I had no idea how that would work.

Dave Pavlik:

I was actually very nervous. I was like how?

Padmaja Patel:

are we gonna? How do we, how do you motivate? And you know all of that. And then, first group I saw I mean there was this person, one of my patients, who lost like 40 pounds in 10 weeks. His hemoglobin A1C dropped from 7.9 to like 6.2. Wow, it's just a dramatic change. And he convinced me that virtual model can be equally effective. And then I continued doing in-person groups versus virtual groups and eventually published the study as well that the outcomes clinical as well as biometrics, all of them exactly same. There's no difference. So that gives me hope that lifestyle medicine is really, you know, it doesn't have to be limited within.

Ellen Brown:

Yeah, there's a huge confidence.

Padmaja Patel:

Exactly, there's a clear model that can be delivered across virtual platform, and that's what we need to do.

Ellen Brown:

Yeah, totally agree. Yeah, I mean, one of the things you know I really believe is we have to, you have to get away from like, if you think about sick care is sick care and you think about health care is health care. I think when we talk about health care, this obsession or attachment to bricks and mortar, it just it becomes, it's unsustainable, it's too capital intensive, it doesn't have the kind of economic model that makes sense. And especially when we talk about lifestyle health, I mean lifestyle disease and lifestyle health. You know, the thing that has really struck us is, in every conversation, I think, except two, the whole group visit model comes up. Right, because it's this again it goes back to Justin's question about scale. So we have to solve for a clinician shortage and for just access and also for administrative burden, all of those things.

Ellen Brown:

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

Padmaja Patel:

It is, and I tell you that's part of the problem. Also, sometimes I think early on. What I felt when I learned about ACLM and the messaging around is that it's too simple. It is so simple that people don't take it seriously.

Justin Politti:

How could this be real?

Padmaja Patel:

Yeah, how can it be real and so?

Justin Politti:

exercise and eat better Sleep.

Ellen Brown:

Stay away from all the fat foods. Don't drink all the time and smoke. Yeah, what yeah?

Padmaja Patel:

So I think we are intentional now in terms of how we communicate lifestyle medicine and we're talking more about the value proposition, right, what exactly it brings, which is the quintuple aim of healthcare, and so we're making sure that people get the value and what it is, not just how we deliver lifestyle medicine, which is the six pillars, which is how we deliver, but what exactly is the outcome.

Ellen Brown:

Agreed.

Justin Politti:

That's what we need to talk about.

Ellen Brown:

You know me, I am convinced that lifestyle medicine is going to be, it could be, the solution, one of the core solutions and bridges to taking that 2 trillion out of the system of lifestyle disease, cardiometabolic syndrome, because it can take. We already have a whole workforce of clinicians that are they're already clinically board certified and so to be able to train them additionally, right to complement what they're already doing, to say, hey, here's a. I think the piece you pointed out that we have to do is we have to move the needle on the economic model, we have to realign the incentives, we have to, and then that money can be redistributed. And that's our champion is. You know, this is value-based care.

Dave Pavlik:

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

Dave Pavlik:

You put this in and then it accrues directly to the insurance company without any, exactly without any credit going to the people who are doing it right.

Padmaja Patel:

You're so well said. All of us have delivered lifestyle medicine very successfully and it didn't matter because it was in fee-for-service rule Nobody cares about the quality, cost-saving outcomes, nobody cares, it's just the episodic billing and collection is all that we care about the productivity yeah it's a number. But, as you said, payers are coming recognizing the value. I don't know if you attended, but we had a panel discussion earlier today and for the first time in the history of ACLM, we had two major payers on the stage.

Ellen Brown:

We went in and watched. That says a lot. The change is happening.

Justin Politti:

I have two of them tomorrow.

Ellen Brown:

Okay, great.

Justin Politti:

Thank you.

Padmaja Patel:

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

Ellen Brown:

Whoops.

Padmaja Patel:

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

Ellen Brown:

It is an ultimate solution.

Justin Politti:

So think of that, get healthier so you, you were in private practice and then you went to work for a system, system in texas yeah and like so was the leadership always kind of behind this lifestyle medicine. In terms of the finances, you know we need dieticians, we need this staff, we need that staff. It's going to cost you but in the long run it's going to be.

Padmaja Patel:

No, you know, what was interesting is that it's a safety net hospital in a small community.

Ellen Brown:

Okay.

Padmaja Patel:

And we had redefined our vision, mission and values to make Midland the healthiest community in Texas. So the way we approached lifestyle medicine was more of a broader solution, right Strategy like how are we going to get there? So, initially, where I started was what are the pain points for my health system? Right, look at that pain points for my health system, right? Look that. And well, as a self-insured entity, they were paying almost what? $3 million more than the budgeted amount every year. So we said, okay, let's do something for the employee health. And so in about a year of intervention which is the same intervention we keep talking about intensive therapeutic lifestyle change program, which is a group medical visit, and had about 150 employees that go through that intervention, we demonstrated $3 million cost of AIDS. Right, so that?

Dave Pavlik:

opened up the world.

Padmaja Patel:

Like okay, we proved the model ROI because you have to do the business and otherwise you know it's hard to change that needle here and support. I think. So one was this alignment with their overall goal. Second, we demonstrated the ROI. And the third was that we wanted to create a program that would actually lifestyle medicine program, that would create a robust payments model, so with a reimbursement structure, which was this intensive cardiac rehab that we brought. So we brought the Ornish program initially and then later changed to Pritikin intensive cardiac rehab. But it brought revenue to my lifestyle medicine center, which allowed me to develop a new programs, hire more staff, you know. So I went about not opening a center first, but I went about looking at okay, what are the pain points, let's solve that, get the confidence of the executives, and then expand and create revenue first before you talk about opening a center. So all of these kind of come together.

Justin Politti:

That's great. I think it's great that the you know the mission is to have the healthiest community in Texas and cost isn't going to be a barrier. Let's figure it out. Yes, that's impressive, yeah.

Ellen Brown:

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

Padmaja Patel:

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

Justin Politti:

You excitement among our members. You know I love them passing through. Yeah, they're like there's like bright lights we've got. What is this we've got? I've got them in my head categorized as podcast curious and podcast serious. Oh so the curious, the curious ones, kind of go by, they look in, they're like I'm a little not sure I want to get behind that camera over there. And then the serious ones are like where's your sign up?

Ellen Brown:

but my favorite are the ones that are like just sort of come in, oh and it's like hi, hi, like, all right the microphone did you? Well, let's just sit down and go so here's a coffee and a mic tomorrow's. Tomorrow we've got a jam packed, I think we have to start like putting blocks so we can actually go get some water.

Justin Politti:

You know, but and I do think we are I think we're gonna have at least one of those payers you referenced, right? Yes, I think so. Maybe two, maybe two. Yeah, that's the rumor on the street, but yeah, so super excited you took the time yes, thank you so much thank you.

Ellen Brown:

You will certainly be part of a full episode. You know great work you're doing.

Justin Politti:

Thank you we will, she will, for sure yeah, you make sure she does right? Well, make sure she does.

Ellen Brown:

Don't worry, that's an easy task just don't make me do it right yeah exactly all right well, thank you thank

Justin Politti:

you so much.