The Reverse Mullet Healthcare Podcast

Transforming Healthcare Through Shared Medical Appointments: A Conversation with Dr. Kathleen Findlay

• BP2 Health

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What does it take to build a thriving lifestyle medicine practice in rural America? Dr. Kathleen Findlay takes us behind the scenes of her remarkable journey establishing a comprehensive lifestyle medicine program in her small Wisconsin hometown.

After 20 years away, Dr. Findlay returned home with a vision to transform healthcare delivery in her community. Starting with a simple knock on the CEO's door, she secured permission to create an integrative medicine practice that eventually evolved into a full-fledged lifestyle medicine program at a critical access hospital with rural health clinics. Despite the significant regulatory hurdles—from space limitations to coding restrictions that seemed to prohibit group visits—Dr. Findlay and her team found creative solutions to make lifestyle medicine work within the constraints of government-funded healthcare.

The heart of their success? Shared medical appointments that Dr. Findlay describes as creating a "family" among participants. These group sessions not only work financially within the Rural Health Clinic model but generate the community connections critically missing in rural healthcare. Their 12-session intensive lifestyle program expanded organically as patients wanted more, leading to innovations like culinary medicine without a teaching kitchen and partnerships with local fitness centers. Perhaps most impressive is how their model expanded to pediatrics, helping children struggling with anxiety and obesity through lifestyle interventions.

Looking for inspiration in healthcare transformation? Dr. Findlay's story shows that with leadership support, creative problem-solving, and unwavering dedication, lifestyle medicine can thrive even where it seems most improbable. 

Justin Politti:

Welcome to the Reverse Mullet Podcast from BP2 Health. We are live at ACLM Conference in Orlando.

Ellen Brown:

Florida. We are your hosts Justin Politti, dave Pavlik, ellen Brown and we are the American College of Lifestyle Medicine. This is day one we did have a hot one.

Justin Politti:

Is this not day two?

Ellen Brown:

Oh well, it's like the full first day.

Justin Politti:

I'm going to call this like day one.

Ellen Brown:

Okay, day one and a half, and I'm going to call this like day one, and I'm happy to report that Justin and I went to the HIIT class this morning. We did To kick it off right, and it was a HIIT, and so now we are ready to go.

Justin Politti:

Our glutes are fire Totally. We're like yes, I am on fire.

Ellen Brown:

So but we are here with our special guest. Why don't you introduce yourself?

Kathleen Findlay:

Sure, I'm Kathleen Findlay. I'm a lifestyle medicine physician from Western Wisconsin.

Ellen Brown:

All right, so tell us what you do. I mean, obviously you practice lifestyle medicine, but maybe a little bit more context, yeah.

Kathleen Findlay:

So I'm privileged to practice purely lifestyle medicine in Western Wisconsin at a small organization. We have a critical access hospital and three rural health clinics, and it's my hometown, so I'm thrilled to be back there after 20 years away and able to build a program that supports just overall health.

Ellen Brown:

So we work with FQHCs and CHCs and all the organizations that you're talking about, and how did you get lucky enough to have Lifestyle Medicine integrated into that sort of government space? That can be very difficult and full of friction.

Kathleen Findlay:

Yeah, so I owe that to the leadership of the organization. Six years ago we were getting ready to move home when my husband retired from the military and I went to the current CEO, went knocking on the door and said would you let me come and start an integrative medicine practice? She was kind enough to do that, so I was working on starting that. In the process I met my team members. I helped in wellness coach Lynn who's camp and Sherry wrote a registered dietitian. They were already doing this kind of work and community work at the facility so I knew I had to be there and so together we've built a program of intensive lifestyle modification and really been supported by the organization.

Kathleen Findlay:

About two years into the process I received a message from ACLM saying hey, you're boarded in integrative medicine. There's a crosswalk to be boarded in lifestyle medicine. That's actually where I was practicing anyway, on that end of the spectrum, really just trying to make holistic lifestyle change. So I went to the current chief administrative officer at the time and I said okay, listen, I don't think anybody in Baldwin Wisconsin cares if I have more alphabet soup behind my name and he said yes, they do, and you need to do this so that you can equip the entire organization.

Kathleen Findlay:

So we've had a change in leadership since then and continue to have incredible support for lifestyle medicine. And it has been a challenge trying to fit this within the confines of the Rural Health Clinic and those regulations. What are some of those challenges specifically? So there are specific coding rules. There are specific rules about space. We operate in a critical access hospital rural health clinic in a combined setting and some parts of the facility are critical access hospitals. Some are rural health clinic. I build out of the rural health clinic so I can't use the big conference room because it's in the car. So there's some unique things of trying to work out the logistics. Actually, the RHC regulations say that you can't have group visits and we practiced shared medical appointments but had to go through legal to make sure that everything was legal and we could do that. So it's just been a challenge of trying to work through those, understanding how we can fit this within the confines.

Ellen Brown:

That group billing is one of the topics here at the conference. Are you speaking on that?

Kathleen Findlay:

I'm not speaking on that, but I'd like to quote Dr Murski, who is kind of our lead in the area of that, and he said the other day in one of the sessions you know, lifestyle medicine and shared medical appointments are really synonymous and I would absolutely agree with him that there is great power in that shared medical appointment model.

Ellen Brown:

So is it the community aspect, like where people come, because I think that's something that's really missing, woefully missing, from health care how we sort of traditionally do it, and absolutely in the rural setting.

Kathleen Findlay:

You know, we know that our rural residents are more challenged with social interaction, and this epidemic of social isolation is real, and it's particularly real in our rural settings, and so this provides a great opportunity for that social interaction in ways that we never expected. I mean, it's phenomenal.

Ellen Brown:

So you're on the pilot and demos subcommittee for ACLM. Are there any demos or pilots that done recently that you can share?

Kathleen Findlay:

So the pilot that we've done at our facility has been to develop a 12 session intensive lifestyle program very similar to some of the other programs out there.

Kathleen Findlay:

But then we also continue to grow that to support our population.

Kathleen Findlay:

Once people get into the family, as we call it, because it really becomes like a family they want more, and so our dietician has developed a culinary medicine setting.

Kathleen Findlay:

We don't have a culinary teaching kitchen, but she figured out a way to bring in cutting boards and knives and help people learn how to prepare healthy food. We work with our fitness center and we have some classes over there that our patients can partake in. We have helped our PEDS program develop their own lifestyle medicine approach to help kids who are struggling with anxiety, obesity etc. So really continuing to just grow the model in many ways to just to try to support best health for our patients. And then, additionally, I recently completed a Master's of Healthcare Delivery Science from Dartmouth and part of that work was a group project and I was fortunate enough to have five other individuals come on board and support trying to further lifestyle medicine and we presented a novel payer approach to the Medicaid director of Wisconsin with some interest, but something we're continuing to try to push forward, to try to find better ways to reimburse this kind of care.

Ellen Brown:

So that's where we come in. We're in, we're there to help you. That is our commitment. We have been involved in payment transformation since the acronym ACO was coined, even before then, and we are very passionate about payment transformation that can actually reverse cardiometabolic conditions and chronic conditions and lifestyle disease. And once we stumbled in our journey of we don't want to continue to watch Pete right here we stumbled into lifestyle medicine and now we are huge fans and really trying to raise the voice to say, hey, if we want to talk about outcomes-based reimbursement, if we want to hit CMMI's objective of everyone all Medicare beneficiaries under some model of value-based care by 2030, we should be employing tools like lifestyle medicine. It's a simple and that's not simple, but it is simple to layer that in. It just answers so many things.

Kathleen Findlay:

Absolutely. It's just the basis of good medicine. That's what my colleagues ask, like what are you doing? That's different. I said I get to do the things that you don't have time to do in the current model, but we all should be doing this at the end. That's the end state, and in transforming healthcare we have to find a better way. There are not going to be enough providers to do the care that we need. We have to get back to that preventive care, that reversal care, so that we can have fewer patients. And I do have had colleagues that say well, you're trying to put us out of business. I said absolutely I am, but we'll never get there in our lifetimes right?

Ellen Brown:

No, we won't Not, with 80% to 90% of people that are not cardiometabolically healthy.

Kathleen Findlay:

Never, and you know again, we'll be fortunate to just take care of the population during my lifetime, and I think we have to find better ways to do that.

Ellen Brown:

And I think lifestyle.

Kathleen Findlay:

medicine is so well equipped for that. And the other piece is that it's across disciplines, so it's not just the family medicine docs. We've got cardiologists doing this, we have dieticians, We've got physical therapists. It's the basis of good medicine and we can all be doing it and there is no group like ACLM and it is phenomenal just the passion and drive that people have and the scrappiness.

Ellen Brown:

So I have one last question on this is I'm just that like I have so many questions, so to know that you're doing this through the government model of critical access hospitals and in RHCs, that's just such a niche that gets left behind, and so the fact that you've pulled it in is just it's spectacular. What do you think works? Are there any components that you feel really help it work, or where you've gotten creative?

Kathleen Findlay:

or I don't know. I think the shared medical appointment is fundamental and actually my partner just help it work or where you've gotten creative or I don't know. I think the shared medical appointment is fundamental and actually my partner just completed writing up kind of our model to try to help share this with other RHCs that are struggling to deliver this and trying to figure out how do we start this. But really, that shared medical appointment model, it works within the RHC for generating revenue. It creates the magic for the patients to really be engaged and be able to change their lives. The other thing that we didn't expect was working with patients so frequently. We start to understand their social determinants of health and are able to help them start to integrate some services for that. So that's really cool.

Ellen Brown:

Well, now I want to do a full episode. I'm not going to lie. So this is great. Can you come back tomorrow at 4? Sure, I'll be here. Thank you so much for joining us. Thanks for your time. I hope you have a great time at the conference.

Kathleen Findlay:

Yeah, it's going to be great. Thanks so much. I appreciate what you're doing and appreciate this opportunity.