Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Welcome to the Reverse Mullet Healthcare.
Speaker 2 (00:04):
Podcast from BP2 Health.
We are still in Orlando at theAmerican College of Lifestyle
Medicine Conference 2024 insunny Orlando Florida.
I'm one of your hosts DavePavlik, Justin Politi.
Speaker 1 (00:18):
Ellen Brown, and we are here with Jay Joseph.
Dr Jay Joseph, and superexcited.
I had the pleasure of meetingyou in Tulsa, I guess, back in
August, and was immediatelyreally excited about the work
that you're doing.
Speaker 2 (00:31):
You were in the Smitten Smitten.
Okay, yes, I was immediatelysmitten All right.
Speaker 1 (00:35):
But, humor aside, I just had a huge amount of
admiration for the challengethat you face of bringing
lifestyle medicine to atraditional health system and,
as you know, that's, I think,where we align well, as we have
been in that traditionalhealthcare space for 30 years
and we really, when we stumbledinto lifestyle medicine, what
probably you?
know a year ago, we realizedthat this really could be that
(00:57):
sort of bridge right, that thatcould allow us to reverse
cardiometabolic disease forsignificant portion of of the
population.
But that's a big uphill battlein terms of reimbursement,
payment models and it can bedone right and so yeah.
So tell us about your programand what you're doing.
Also, how did?
Speaker 2 (01:13):
you wind up in Tulsa.
So that's interesting.
My background I did my trainingat Rush University and I was
trained by Dr Kim Williams, whomyou saw yesterday.
Yesterday he's one of thepioneers in the lifestyle
medicine movement and, uh, whenI was training to be an
interventional cardiologistwhere you do another fellowship
to go in and put stents in so heshowed me, uh, he, he basically
have you have a checkoutinterview and he showed me a
(01:36):
picture of a guy mopping thefloor while the faucet is open
and he said you know, aj, thisis what you're going to be doing
, right?
so that was kind of an epiphanyfor me, and so it's been a
journey for the past nine yearsnow since then.
So, uh, I I just I love the wayI, I just I'm passionate about
lifestyle medicine and I did seethat this way working right now
(01:57):
there is an opportunity and, uh, and there's the need for, of
course, oklahoma is 49th out of50 states in terms of heart
disease, so there's a big needfor lifestyle medicine there.
Speaker 1 (02:07):
Wow, yeah, so.
So how did you stumble intolifestyle medicine?
Speaker 2 (02:11):
yeah, I uh.
So one of the things that DrWilliams working with Dr
Williams was, uh, every patientevery time is what his model,
his approach was.
So you speak about lifestylemanagement with every patient
and that kind of got me thinkingas to like you don't
necessarily need to makeeverybody a vegan or run a
marathon every day, but if youcan make those small changes at
every encounter.
That's what I've seen, theeffects and his working in his
(02:31):
clinic and that's the practicethat I've been doing.
And of course I I stumbled intoaclm about six years back.
I mean coming here every yearfor the past six years and you
see the.
You see the dramatic effectslifestyle medicine can do in
patient stories, physicianwellness.
It really fulfills thatquintuple aim of healthcare and
there are a few.
I don't know of any other fieldand I'm being biased towards
lifestyle medicine, I guess, butI don't know any other field in
(02:53):
medicine that can fulfill thatquintuple aim of healthcare.
Speaker 1 (02:56):
Yeah, and I think the differentiation for me because
I am very familiar with otherapproaches, right that do try to
address the root cause is theydon't necessarily have the same
right that do try to address theroot cause is they don't
necessarily have the same rightor wrong, the same amount of
trust clinically, they don'thave the same necessary research
and kind of efficacy behind it.
The other piece is that itdoesn't just complement and fit
(03:17):
in and sort of layer on to whatwe call traditional medicine.
Again, I'm not saying thattraditional Western medicine is
the right answer, it's just thereality of our system.
And then finally, the cost ofit is there is a lot of
diagnostic expense associatedwith some of those other
approaches to doing the samething and I just the simplicity
of the six pillars is just money, right?
Speaker 2 (03:38):
I think what we need to understand is that every
guideline, every guideline, youname it.
You name diabetes, you nameblood pressure, cholesterol
guidelines, heart diseaseguidelines, heart failure, CAD,
you name any guideline that youcan think of.
The first statement in everyguideline is focus on diet and
lifestyle, and for ever, sincethe past 100 years at least,
we've been skipping that firststep and jumping two hoops and
going to the third or fourthstep?
(03:59):
Yeah, going to jumping thosethree hoops and just going down
there.
So what ACLM and LifestyleMedicine does is they're just
going back to the basics andjust basically just following
the guidelines.
Speaker 1 (04:08):
Yeah, Somebody said.
One of our guests said theother day we think maybe it's
too simple.
Speaker 2 (04:12):
It sounds too simple, yeah, so how could it be
effective?
Speaker 1 (04:15):
So effective?
Yeah, you got any questionsdown there, sunglasses.
Speaker 2 (04:19):
Wait, what were you calling him in high-five Marbles
, hide behind marbles, becausehe said he had marbles yesterday
.
But that was because he waslike done in the afternoon but
like he's fresh now I am.
Speaker 1 (04:32):
Went out and did a big walk oh he's like.
I did like 10 000 steps.
He's fresh.
Yep, I did, I did the 5k twicein your sleep.
Speaker 2 (04:35):
There's a lot of rural areas in oklahoma like
explain to us, or explain to ourlisteners, how lifestyle
medicine can help solve that,address those issues.
Yeah, so how about I give anexample of one of my patients?
Speaker 1 (04:46):
Yes, please, that'll set the example.
That's kind of set the, andwhen you do that, can you tell
us kind of your program?
I love your program, yeah.
Speaker 2 (04:53):
So what our program is?
It consists of two parts.
We have a dedicated lifestylemedicine clinic where we see
patients in all shapes andcolors and referrals and all
kinds of shades of life.
Speaker 1 (05:03):
So share I actually.
I think it's a really importantdifferentiation.
When I talk about your programto people, one of the things
that really sticks out is howyou utilize referrals Right, so
can you speak to that a little?
Speaker 2 (05:15):
So every specialty has a pain point which lifestyle
medicine addresses.
For example, gi has pain pointaminamine.
Pain point amine, a medicalcondition that they're trying to
address and they don't have amechanism to address that.
As an example, fatty liver.
Right, let's take an examplefor fatty liver.
Fatty liver is almost purely ametabolic condition,
cardiometabolic condition, whereyou don't have any medications
(05:39):
for that.
So if a GI doctor sees fattyliver, basically what they tell
them is to go home and eathealthy and live a healthy
lifestyle.
But how is that patient goingto do it?
How is he going to get there?
So that's for GI.
For OBGYN, there's preterm labor.
70% of preterm labor is fromlifestyle conditions.
You have pcos, which is a,which is again a lifestyle
related condition.
You have mild cognitiveimpairment, as you've all seen
(06:01):
from the owner study that youknow that.
You know there's a, there's abig way where you can
potentially reverse it.
Uh, I mean, the list is long,right, cancer survivor should be
.
You name pediatric obesity.
So each specialty has a painpoint which lifestyle medicine
medicine can address.
So our clinic model isbasically you know what?
Just give us your pain points,just give us all your, all your
specialties, just give us yourpain points and let us act as a
(06:23):
bomb for you, for those, thosepatients where you have no
option.
You are telling them to go homeand eat healthy, and we'll do
that.
As for primary cares, you knowprimary care see 20 patients and
they have 15 things to do inthat 20 minute encounter.
Expecting primary cares to takeanother 20 minutes to practice
lifestyle medicine in that 20minute encounter, it's just not
logical.
So what we reach lifestylemedicine to primary care is that
(06:44):
we know you want to do this.
We know you want to talk toyour patients about lifestyle
medicine and all these advices,but you don't have the time.
So just outsource that piece tous, so we're going to take care
of that aspect so that we canhelp you get better outcomes.
So that's the model of ourclinic, where everything funnels
into this and then, based oneach patient's individualized
needs, we formulate a plan forthem.
(07:04):
That could be either followingup in our clinic every three
months, seeing a dietician inbetween, or, if they choose, to
go really gung-ho about it.
We have a teaching kitchen, anintensive lifestyle medicine
program which consists of fiveshared medical appointments
spread over eight weeks.
It's done in our health zone,our health facility.
You get teaching, kitchenclasses run by a chef, dietitian
(07:24):
visits, stress managementsessions.
You get exercise training witha trained exercise physiologist.
You get two months of freemembership to the gym.
So it's a much more hands-on,much more dedicated, more
intensive program.
So those are the two approachesthat we've had and we've seen
some phenomenal results.
Yeah, there it goes again withthe shared medical.
That's the best way to dopractice lifestyle medicine, no
question about it.
Speaker 1 (07:44):
Well, and the way that they've figured out which I
think is really smart forlisteners that are on the
technical side of this is if youdo it right and you pair it
with an actual physician visitassociated with that group visit
, you can bill it at an E&M codelevel and not just the group
billing code, and so it's a muchmore robust revenue
(08:05):
reimbursement.
Obviously, outcomes, sharedsavings is the way to go, but if
you're in that fee-for-serviceservice line model so kind of
going back to Justin's point,tell us how your model works
with those that are kind ofrural.
Is there an element that helpsthere?
Speaker 2 (08:20):
I think for the first , we are trained.
We're all human beings, we allhave our biases.
We tend to think that you knowwhat the folks in rural areas
are not going to make, thechanges that we expect them to
make.
I'll give you a story of agentleman in rural Oklahoma,
came in with a attack, had to doa stent on him, and this is a
rancher.
He's a rancher, he's lived onmeat and potatoes all his 60, 70
(08:42):
years.
And that was a moment for himand he said you know what I'm
going to.
You tell me what I need to do.
I'm going to do it Right.
So he went back home and he haschanged his lifestyle for
himself.
And the beauty of lifestylemedicine is is that it's not
just that index patient right,it's the ripple effect that
happens.
He changes his lifestyle of hiswife, his kids, his friends,
(09:02):
his family.
I mean, that's the beauty oflifestyle medicine.
So he has been a champion oflifestyle medicine in his own
small town.
So, that's the beauty oflifestyle medicine.
Speaker 1 (09:12):
Yeah, no, it's amazing.
We talked yesterday about kindof that tipping point, like when
you have that moment in yourlife that you're willing to make
a change.
So, unfortunately, I think whatwe have to we're like on a
tight schedule today.
We're back to back today and Iwant to be respectful of your
time but, we most definitelywill be bringing you for a full
episode, because you're such agood case study of how to do
(09:34):
this.
Speaker 2 (09:34):
So yeah, because you're such a good case study of
how to do this.
Thank you.
Thank you so much.
Have a great day.
Speaker 1 (09:37):
Thank you All right, thank you Bye.
Welcome to the Reverse Mullet Healthcare.
Speaker 2 (00:04):
Podcast from BP2 Health.
We are still in Orlando at theAmerican College of Lifestyle
Medicine Conference 2024 insunny Orlando Florida.
I'm one of your hosts DavePavlik, Justin Politi.
Speaker 1 (00:18):
Ellen Brown, and we are here with Jay Joseph.
Dr Jay Joseph, and superexcited.
I had the pleasure of meetingyou in Tulsa, I guess, back in
August, and was immediatelyreally excited about the work
that you're doing.
Speaker 2 (00:31):
You were in the Smitten Smitten.
Okay, yes, I was immediatelysmitten All right.
Speaker 1 (00:35):
But, humor aside, I just had a huge amount of
admiration for the challengethat you face of bringing
lifestyle medicine to atraditional health system and,
as you know, that's, I think,where we align well, as we have
been in that traditionalhealthcare space for 30 years
and we really, when we stumbledinto lifestyle medicine, what
probably you?
know a year ago, we realizedthat this really could be that
(00:57):
sort of bridge right, that thatcould allow us to reverse
cardiometabolic disease forsignificant portion of of the
population.
But that's a big uphill battlein terms of reimbursement,
payment models and it can bedone right and so yeah.
So tell us about your programand what you're doing.
Also, how did?
Speaker 2 (01:13):
you wind up in Tulsa.
So that's interesting.
My background I did my trainingat Rush University and I was
trained by Dr Kim Williams, whomyou saw yesterday.
Yesterday he's one of thepioneers in the lifestyle
medicine movement and, uh, whenI was training to be an
interventional cardiologistwhere you do another fellowship
to go in and put stents in so heshowed me, uh, he, he basically
have you have a checkoutinterview and he showed me a
(01:36):
picture of a guy mopping thefloor while the faucet is open
and he said you know, aj, thisis what you're going to be doing
, right?
so that was kind of an epiphanyfor me, and so it's been a
journey for the past nine yearsnow since then.
So, uh, I I just I love the wayI, I just I'm passionate about
lifestyle medicine and I did seethat this way working right now
(01:57):
there is an opportunity and, uh, and there's the need for, of
course, oklahoma is 49th out of50 states in terms of heart
disease, so there's a big needfor lifestyle medicine there.
Speaker 1 (02:07):
Wow, yeah, so.
So how did you stumble intolifestyle medicine?
Speaker 2 (02:11):
yeah, I uh.
So one of the things that DrWilliams working with Dr
Williams was, uh, every patientevery time is what his model,
his approach was.
So you speak about lifestylemanagement with every patient
and that kind of got me thinkingas to like you don't
necessarily need to makeeverybody a vegan or run a
marathon every day, but if youcan make those small changes at
every encounter.
That's what I've seen, theeffects and his working in his
(02:31):
clinic and that's the practicethat I've been doing.
And of course I I stumbled intoaclm about six years back.
I mean coming here every yearfor the past six years and you
see the.
You see the dramatic effectslifestyle medicine can do in
patient stories, physicianwellness.
It really fulfills thatquintuple aim of healthcare and
there are a few.
I don't know of any other fieldand I'm being biased towards
lifestyle medicine, I guess, butI don't know any other field in
(02:53):
medicine that can fulfill thatquintuple aim of healthcare.
Speaker 1 (02:56):
Yeah, and I think the differentiation for me because
I am very familiar with otherapproaches, right that do try to
address the root cause is theydon't necessarily have the same
right that do try to address theroot cause is they don't
necessarily have the same rightor wrong, the same amount of
trust clinically, they don'thave the same necessary research
and kind of efficacy behind it.
The other piece is that itdoesn't just complement and fit
(03:17):
in and sort of layer on to whatwe call traditional medicine.
Again, I'm not saying thattraditional Western medicine is
the right answer, it's just thereality of our system.
And then finally, the cost ofit is there is a lot of
diagnostic expense associatedwith some of those other
approaches to doing the samething and I just the simplicity
of the six pillars is just money, right?
Speaker 2 (03:38):
I think what we need to understand is that every
guideline, every guideline, youname it.
You name diabetes, you nameblood pressure, cholesterol
guidelines, heart diseaseguidelines, heart failure, CAD,
you name any guideline that youcan think of.
The first statement in everyguideline is focus on diet and
lifestyle, and for ever, sincethe past 100 years at least,
we've been skipping that firststep and jumping two hoops and
going to the third or fourthstep?
(03:59):
Yeah, going to jumping thosethree hoops and just going down
there.
So what ACLM and LifestyleMedicine does is they're just
going back to the basics andjust basically just following
the guidelines.
Speaker 1 (04:08):
Yeah, Somebody said.
One of our guests said theother day we think maybe it's
too simple.
Speaker 2 (04:12):
It sounds too simple, yeah, so how could it be
effective?
Speaker 1 (04:15):
So effective?
Yeah, you got any questionsdown there, sunglasses.
Speaker 2 (04:19):
Wait, what were you calling him in high-five Marbles
, hide behind marbles, becausehe said he had marbles yesterday
.
But that was because he waslike done in the afternoon but
like he's fresh now I am.
Speaker 1 (04:32):
Went out and did a big walk oh he's like.
I did like 10 000 steps.
He's fresh.
Yep, I did, I did the 5k twicein your sleep.
Speaker 2 (04:35):
There's a lot of rural areas in oklahoma like
explain to us, or explain to ourlisteners, how lifestyle
medicine can help solve that,address those issues.
Yeah, so how about I give anexample of one of my patients?
Speaker 1 (04:46):
Yes, please, that'll set the example.
That's kind of set the, andwhen you do that, can you tell
us kind of your program?
I love your program, yeah.
Speaker 2 (04:53):
So what our program is?
It consists of two parts.
We have a dedicated lifestylemedicine clinic where we see
patients in all shapes andcolors and referrals and all
kinds of shades of life.
Speaker 1 (05:03):
So share I actually.
I think it's a really importantdifferentiation.
When I talk about your programto people, one of the things
that really sticks out is howyou utilize referrals Right, so
can you speak to that a little?
Speaker 2 (05:15):
So every specialty has a pain point which lifestyle
medicine addresses.
For example, gi has pain pointaminamine.
Pain point amine, a medicalcondition that they're trying to
address and they don't have amechanism to address that.
As an example, fatty liver.
Right, let's take an examplefor fatty liver.
Fatty liver is almost purely ametabolic condition,
cardiometabolic condition, whereyou don't have any medications
(05:39):
for that.
So if a GI doctor sees fattyliver, basically what they tell
them is to go home and eathealthy and live a healthy
lifestyle.
But how is that patient goingto do it?
How is he going to get there?
So that's for GI.
For OBGYN, there's preterm labor.
70% of preterm labor is fromlifestyle conditions.
You have pcos, which is a,which is again a lifestyle
related condition.
You have mild cognitiveimpairment, as you've all seen
(06:01):
from the owner study that youknow that.
You know there's a, there's abig way where you can
potentially reverse it.
Uh, I mean, the list is long,right, cancer survivor should be
.
You name pediatric obesity.
So each specialty has a painpoint which lifestyle medicine
medicine can address.
So our clinic model isbasically you know what?
Just give us your pain points,just give us all your, all your
specialties, just give us yourpain points and let us act as a
(06:23):
bomb for you, for those, thosepatients where you have no
option.
You are telling them to go homeand eat healthy, and we'll do
that.
As for primary cares, you knowprimary care see 20 patients and
they have 15 things to do inthat 20 minute encounter.
Expecting primary cares to takeanother 20 minutes to practice
lifestyle medicine in that 20minute encounter, it's just not
logical.
So what we reach lifestylemedicine to primary care is that
(06:44):
we know you want to do this.
We know you want to talk toyour patients about lifestyle
medicine and all these advices,but you don't have the time.
So just outsource that piece tous, so we're going to take care
of that aspect so that we canhelp you get better outcomes.
So that's the model of ourclinic, where everything funnels
into this and then, based oneach patient's individualized
needs, we formulate a plan forthem.
(07:04):
That could be either followingup in our clinic every three
months, seeing a dietician inbetween, or, if they choose, to
go really gung-ho about it.
We have a teaching kitchen, anintensive lifestyle medicine
program which consists of fiveshared medical appointments
spread over eight weeks.
It's done in our health zone,our health facility.
You get teaching, kitchenclasses run by a chef, dietitian
(07:24):
visits, stress managementsessions.
You get exercise training witha trained exercise physiologist.
You get two months of freemembership to the gym.
So it's a much more hands-on,much more dedicated, more
intensive program.
So those are the two approachesthat we've had and we've seen
some phenomenal results.
Yeah, there it goes again withthe shared medical.
That's the best way to dopractice lifestyle medicine, no
question about it.
Speaker 1 (07:44):
Well, and the way that they've figured out which I
think is really smart forlisteners that are on the
technical side of this is if youdo it right and you pair it
with an actual physician visitassociated with that group visit
, you can bill it at an E&M codelevel and not just the group
billing code, and so it's a muchmore robust revenue
(08:05):
reimbursement.
Obviously, outcomes, sharedsavings is the way to go, but if
you're in that fee-for-serviceservice line model so kind of
going back to Justin's point,tell us how your model works
with those that are kind ofrural.
Is there an element that helpsthere?
Speaker 2 (08:20):
I think for the first , we are trained.
We're all human beings, we allhave our biases.
We tend to think that you knowwhat the folks in rural areas
are not going to make, thechanges that we expect them to
make.
I'll give you a story of agentleman in rural Oklahoma,
came in with a attack, had to doa stent on him, and this is a
rancher.
He's a rancher, he's lived onmeat and potatoes all his 60, 70
(08:42):
years.
And that was a moment for himand he said you know what I'm
going to.
You tell me what I need to do.
I'm going to do it Right.
So he went back home and he haschanged his lifestyle for
himself.
And the beauty of lifestylemedicine is is that it's not
just that index patient right,it's the ripple effect that
happens.
He changes his lifestyle of hiswife, his kids, his friends,
(09:02):
his family.
I mean, that's the beauty oflifestyle medicine.
So he has been a champion oflifestyle medicine in his own
small town.
So, that's the beauty oflifestyle medicine.
Speaker 1 (09:12):
Yeah, no, it's amazing.
We talked yesterday about kindof that tipping point, like when
you have that moment in yourlife that you're willing to make
a change.
So, unfortunately, I think whatwe have to we're like on a
tight schedule today.
We're back to back today and Iwant to be respectful of your
time but, we most definitelywill be bringing you for a full
episode, because you're such agood case study of how to do
(09:34):
this.
Speaker 2 (09:34):
So yeah, because you're such a good case study of
how to do this.
Thank you.
Thank you so much.
Have a great day.
Speaker 1 (09:37):
Thank you All right, thank you Bye.
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