
The Reverse Mullet Healthcare Podcast
Ellen Brown, Justin Politi, and Dave Pavlik bring their 90 collective years of healthcare experience to BP2 Health where they're on a mission to effect real change in the industry. Connect with BP2 Health Here: https://bp2health.com/contact/
The Reverse Mullet Healthcare Podcast
Why Treating Root Causes Could Solve America's Healthcare Crisis with Caroline Collins
Healthcare's identity crisis sits at the heart of our inability to truly help patients get healthy. Dr. Caroline Collins, an internal medicine physician at Emory University, joins the Reverse Mullet Healthcare Podcast to reveal how she's championing lifestyle medicine inside one of America's leading academic medical centers.
What happens when a physician decides to focus on the root causes of disease rather than just treating symptoms? Dr. Collins shares her personal journey, sparked by witnessing diabetes and cancer in her own family, that led her to become a voice for change at Emory. "I can't give you a pill or an injection to make you healthy," she tells patients. "It's really about how we live our lives."
The conversation unveils Emory's groundbreaking work in lifestyle medicine research and their upcoming lifestyle and weight management clinic focusing on employee health and pre-surgical optimization. This "prehabilitation" approach demonstrates how preparing patients before surgery dramatically reduces complications and costs—transforming potential ICU stays into outpatient procedures.
The most revealing moments come when discussing healthcare's fundamental misalignment of incentives. "If patients are healthier, who's going to fill your clinic schedule?" This exposes the uncomfortable truth: our current system financially rewards sickness, not health. Dr. Collins describes the "schizophrenic" nature of healthcare organizations pushing volume-based metrics while simultaneously embracing value-based care contracts.
Ready to understand why common-sense approaches to health aren't common practice? Listen now and discover what it takes to transform healthcare from within the system itself.
Welcome to the Reverse Mullet Healthcare Podcast from BP2 Health. We are live at the ACOM Conference in Orlando, florida. I'm your host, justin Politti, dave Pavlik.
Ellen Brown:Ellen Brown. We are here in the American College of Lifestyle Medicine Conference and we are here with somebody that was one of the first people I met in my exposure into lifestyle medicine.
Justin Politti:Oh.
Ellen Brown:And, yes, Okay, Caroline was one of the first folks that I talked to and it was, I don't know. I just really appreciated the work that you're doing and the challenges that you face and we just talked with Caroline's with Emory, physician at Emory and has a very exciting, yes, challenging job of bringing lifestyle medicine into an academic medical center.
Justin Politti:Outstanding.
Caroline Collins:Yes, so with all of that tell us about yourself. Yeah, I'm an internal medicine doctor focusing on lifestyle medicine at Emory, so I also teach medical students and residents about internal medicine, but also how to integrate lifestyle medicine into the care of patients at Emory.
Ellen Brown:Yeah, so, yeah, so tell us about what Emory is doing with lifestyle medicine and, and yeah, ask some questions.
Caroline Collins:And this is a great time to be at Emory. I really feel like there's a movement towards integrating lifestyle medicine into all the care and and not just the care of patients, but the care of employees and really focusing on research and how we do this right. I do think that most people in healthcare want to do the right thing, but we don't know how, and so that's where people who know a lot about lifestyle medicine can be the voice of change, and that's what I'm trying to be at Emory right now. So we're doing a lot of research on how do we spread the word to other faculty members, because, believe it or not, this is not taught in medical school. Most of us did not get this training in residency either, so we have to start with the teachers, we have to teach the teachers, and so that's what I'm doing right now with my research is educating faculty members, so then we can help residents and medical students understand how to integrate this into practice, because medical students and residents are going to be the future doctors not just internal medicine.
Caroline Collins:They're going to be surgeons, they're going to be cardiologists, they're going to be the specialists too. We all need to be on the same page in healthcare to make this a real change.
Justin Politti:What led you to this lifestyle medicine path?
Caroline Collins:You know, in my own life, my own family, I saw the havoc our lifestyle was having on us. My parents both had diabetes or prediabetes. My mother unfortunately had breast cancer and I thought we need to make a change, and that's when I started researching more about how we can change what we're eating, how we can move more, how what we do in our everyday lives matter. I always tell my patients this and I tell my family members this I can't give you a pill or an injection to make you healthy. It's really about how we live our lives, and that's got to be the most important thing. We talk to people about.
Justin Politti:You mentioned momentum that you said there's. Now what do?
Caroline Collins:you think, what's the trajectory been like? Is it just the last couple of years, has it?
Justin Politti:been like over five or 10 years, where lifestyle medicine started to become this movement.
Caroline Collins:I am building on what those who came before me started. So Dr Sharon Berquist at Emory and Tina Morgan both started this movement at Emory many years ago so about 10 years ago really and there was slow uptake first, but as we have grown, grown in numbers, we've become a louder voice together and I think that's important to realize. It's not just one person, it's really a group of people, it's a team that can make this happen. Especially at a large academic institution like Emory, it really takes a team and that's where we have found success together. So now we are doing the research, but we're about to open our lifestyle and weight management clinic at Emory as well, focused on lifestyle medicine, and that shows me that Emory is serious about this, if they are willing to give us dedicated time to focus on lifestyle medicine.
Ellen Brown:So tell us about what you're going to do with that clinic Like. Is there a like? Ajay was just on. He's from St Francis at Tulsa and you know he has an eight week intensive intervention that's available to those that want to participate that get referred in. Also has the. You know you can see us once every three months. There's different ways to interact with lifestyle medicine, depending on the person's level of commitment, et cetera.
Caroline Collins:Yeah, what we're doing is starting with Emory employees and pre surgical patients, because those are patients who rehabilitation Exactly so we are. We are optimizing the patient's care before they have surgery to help reduce their risk of complications during and post-surgery. So that's been our value proposition to the surgeons Let us help you do this so the patients can be healthier, moving forward.
Ellen Brown:You talked about your family and your person. I think everybody has sort of a personal journey that has brought us to these places, especially with lifestyle medicine. And we were talking on the previous episode about prehabilitation and you know my own mom is the perfect example of ended up with unexpected. You know she was in septic shock from a undiagnosed diabetic long term. Then it turned into a kidney infection, you know the drill right.
Ellen Brown:And then what? Because she came in, you know, basically dying of septic shock. You know they just went downhill fast, icu and AFib and ischemic stroke and like you know the whole thing that you're trying to avoid. But the crazy part is she came back the following year to address the kidney stone issue, right, and in that hospitalization she didn't even have to have insulin. They didn't have to, they didn't have to intubate her, like it was a completely different surgical process, it was outpatient. It's amazing. I don't think people understand at a practical level that when you have these chronic, untreated, uncontrolled comorbidities, that what that does in an acute care setting is just dramatically different than when you're just moderate, like it's a small little change that makes a massive difference economically.
Caroline Collins:I couldn't agree more. I've seen the same thing in my mother's life and also my patients' lives. If you can help people be their healthiest selves, that's going to make a big difference if they do need to be hospitalized and how sick they get and how much medicine that they truly need while they're hospitalized. So that's why I really think that this is one of the most important answers to the healthcare crisis we're facing. I was just at another conference in Washington DC talking about healthcare policy and how do we change where we are going, how do we change the trajectory of healthcare in the United States and change the cost curve? Because we're going to have to do something to bend the curve, and this is the answer in my mind.
Justin Politti:Yeah, pay people to be healthy.
Caroline Collins:Exactly, our incentives are misaligned right now, both from a provider perspective, but then also just from a patient perspective.
Justin Politti:Yeah, it's like we've collectively lost our minds.
Ellen Brown:honestly, I know it's funny, but not funny I'm wearing a mullet and sunglasses in an interview. At nine o'clock in the morning, right? Yeah, yeah, yeah.
Caroline Collins:You know, one of the presenters said you know it's funny, this is common sense, but it's not common sense. It's not. We need to make it common sense.
Ellen Brown:Yeah, the financial side is something that you know we talk a lot about, and you know it's. What was one of the things that struck me when you and I talked initially was your point. You know I had asked you. I said, well, so is Emory deploying this with all primary care right? Like, are you guys going to use this where you train all of your primary care physicians in lifestyle medicine and then they can start treating patients, addressing the root cause? And you know, your statement to me was we're an rvu model and that doesn't fit into the traditional rvu model, and so I think that is that that is the friction point. You know, don't you guys think?
Justin Politti:well, no, there's a CFO somewhere going whoa, whoa, whoa, whoa, whoa, whoa. You know how are we going to. How are we going to pay for this? How are we going to pay for this? I?
Caroline Collins:mean. The hard truth is that when people become physicians, you do so because you want to see people be healthier. But when you get into the system, you're incentivized to see patients. If your patients are healthier, who's going to be admitted to the hospital? Right, right, who is going to fill your clinic schedule, right? I don't think most people, most physicians, think of it that way, but I know that health executives may, because you need your hospitals to be full.
Justin Politti:You need your clinics to be full. No, we've built these huge structures that would be empty, exactly have to be retrofitted.
Caroline Collins:That's where value-based care can come in. I think we need to be careful with value-based care, because you do want to again align incentives. I think it's folly to incentivize A and expect B Absolutely, and that's what we're doing right now.
Ellen Brown:Yeah, no, and it's a cultural shift. You know, I was with the head from HAP, you know from Henry Ford, and I was with their chief legal counsel and she was talking about the fact that it's a real disconnect where they're embracing at the corporate levels, they're really embracing value-based care and trying to put that into place. But from a cultural level you have to, from the, you know, again you're pushing your physicians in an RVU mindset but then you're signing up with value-based care. It's a conflict and you have to, culturally, you have to align those things and it doesn't happen overnight.
Justin Politti:No, it's like schizophrenia.
Ellen Brown:Yeah, it is. It is so well. I think we could probably solve all of the woes if we stayed here. But there's, there are there's a line, the sure size are presenting and I think you nobody wants to miss that. So, but we appreciate you coming and excited to talk more and really excited for the work that you're doing to be a champion of lifestyle medicine. We're there for you, cheering you in the background when you get a little burned out from the, from the uphill battle.
Caroline Collins:So thank you. Thank you for inviting me. I'd love to come back.
Ellen Brown:Okay, great, have a great day.
Caroline Collins:Thank you.