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.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Justin Politti (00:02):
Welcome to the Reverse Mullet Podcast from BP2
Health.
We are live at ACLM Conferencein Orlando.
Ellen Brown (00:08):
Florida.
We are your hosts JustinPolitti, dave Pavlik, ellen
Brown and we are the AmericanCollege of Lifestyle Medicine.
This is day one we did have ahot one.
Justin Politti (00:18):
Is this not day two?
Ellen Brown (00:19):
Oh well, it's like the full first day.
Justin Politti (00:21):
I'm going to call this like day one.
Ellen Brown (00:23):
Okay, day one and a half, and I'm going to call
this like day one, and I'm happyto report that Justin and I
went to the HIIT class thismorning.
We did To kick it off right,and it was a HIIT, and so now we
are ready to go.
Justin Politti (00:33):
Our glutes are fire Totally.
We're like yes, I am on fire.
Ellen Brown (00:37):
So but we are here with our special guest.
Why don't you introduceyourself?
Kathleen Findlay (00:40):
Sure, I'm Kathleen Findlay.
I'm a lifestyle medicinephysician from Western Wisconsin
.
Ellen Brown (00:44):
All right, so tell us what you do.
I mean, obviously you practicelifestyle medicine, but maybe a
little bit more context, yeah.
Kathleen Findlay (00:52):
So I'm privileged to practice purely
lifestyle medicine in WesternWisconsin at a small
organization.
We have a critical accesshospital and three rural health
clinics, and it's my hometown,so I'm thrilled to be back there
after 20 years away and able tobuild a program that supports
just overall health.
Ellen Brown (01:08):
So we work with FQHCs and CHCs and all the
organizations that you'retalking about, and how did you
get lucky enough to haveLifestyle Medicine integrated
into that sort of governmentspace?
That can be very difficult andfull of friction.
Kathleen Findlay (01:24):
Yeah, so I owe that to the leadership of the
organization.
Six years ago we were gettingready to move home when my
husband retired from themilitary and I went to the
current CEO, went knocking onthe door and said would you let
me come and start an integrativemedicine practice?
She was kind enough to do that,so I was working on starting
that.
In the process I met my teammembers.
(01:45):
I helped in wellness coach Lynnwho's camp and Sherry wrote a
registered dietitian.
They were already doing thiskind of work and community work
at the facility so I knew I hadto be there and so together
we've built a program ofintensive lifestyle modification
and really been supported bythe organization.
About two years into the processI received a message from ACLM
(02:08):
saying hey, you're boarded inintegrative medicine.
There's a crosswalk to beboarded in lifestyle medicine.
That's actually where I waspracticing anyway, on that end
of the spectrum, really justtrying to make holistic
lifestyle change.
So I went to the current chiefadministrative officer at the
time and I said okay, listen, Idon't think anybody in Baldwin
Wisconsin cares if I have morealphabet soup behind my name and
(02:30):
he said yes, they do, and youneed to do this so that you can
equip the entire organization.
So we've had a change inleadership since then and
continue to have incrediblesupport for lifestyle medicine.
And it has been a challengetrying to fit this within the
confines of the Rural HealthClinic and those regulations.
What are some of thosechallenges specifically?
So there are specific codingrules.
(02:53):
There are specific rules aboutspace.
We operate in a critical accesshospital rural health clinic in
a combined setting and someparts of the facility are
critical access hospitals.
Some are rural health clinic.
I build out of the rural healthclinic so I can't use the big
conference room because it's inthe car.
So there's some unique thingsof trying to work out the
logistics.
Actually, the RHC regulationssay that you can't have group
(03:17):
visits and we practiced sharedmedical appointments but had to
go through legal to make surethat everything was legal and we
could do that.
So it's just been a challengeof trying to work through those,
understanding how we can fitthis within the confines.
Ellen Brown (03:31):
That group billing is one of the topics here at the
conference.
Are you speaking on that?
Kathleen Findlay (03:36):
I'm not speaking on that, but I'd like
to quote Dr Murski, who is kindof our lead in the area of that,
and he said the other day inone of the sessions you know,
lifestyle medicine and sharedmedical appointments are really
synonymous and I wouldabsolutely agree with him that
there is great power in thatshared medical appointment model
.
Ellen Brown (03:54):
So is it the community aspect, like where
people come, because I thinkthat's something that's really
missing, woefully missing, fromhealth care how we sort of
traditionally do it, andabsolutely in the rural setting.
Kathleen Findlay (04:06):
You know, we know that our rural residents
are more challenged with socialinteraction, and this epidemic
of social isolation is real, andit's particularly real in our
rural settings, and so thisprovides a great opportunity for
that social interaction in waysthat we never expected.
I mean, it's phenomenal.
Ellen Brown (04:25):
So you're on the pilot and demos subcommittee for
ACLM.
Are there any demos or pilotsthat done recently that you can
share?
Kathleen Findlay (04:33):
So the pilot that we've done at our facility
has been to develop a 12 sessionintensive lifestyle program
very similar to some of theother programs out there.
But then we also continue togrow that to support our
population.
Once people get into the family,as we call it, because it
really becomes like a familythey want more, and so our
(04:55):
dietician has developed aculinary medicine setting.
We don't have a culinaryteaching kitchen, but she
figured out a way to bring incutting boards and knives and
help people learn how to preparehealthy food.
We work with our fitness centerand we have some classes over
there that our patients canpartake in.
We have helped our PEDS programdevelop their own lifestyle
(05:17):
medicine approach to help kidswho are struggling with anxiety,
obesity etc.
So really continuing to justgrow the model in many ways to
just to try to support besthealth for our patients.
And then, additionally, Irecently completed a Master's of
Healthcare Delivery Sciencefrom Dartmouth and part of that
work was a group project and Iwas fortunate enough to have
(05:38):
five other individuals come onboard and support trying to
further lifestyle medicine andwe presented a novel payer
approach to the Medicaiddirector of Wisconsin with some
interest, but something we'recontinuing to try to push
forward, to try to find betterways to reimburse this kind of
care.
Ellen Brown (05:56):
So that's where we come in.
We're in, we're there to helpyou.
That is our commitment.
We have been involved inpayment transformation since the
acronym ACO was coined, evenbefore then, and we are very
passionate about paymenttransformation that can actually
reverse cardiometabolicconditions and chronic
conditions and lifestyle disease.
(06:18):
And once we stumbled in ourjourney of we don't want to
continue to watch Pete righthere we stumbled into lifestyle
medicine and now we are hugefans and really trying to raise
the voice to say, hey, if wewant to talk about
outcomes-based reimbursement, ifwe want to hit CMMI's objective
of everyone all Medicarebeneficiaries under some model
(06:39):
of value-based care by 2030, weshould be employing tools like
lifestyle medicine.
It's a simple and that's notsimple, but it is simple to
layer that in.
It just answers so many things.
Kathleen Findlay (06:51):
Absolutely.
It's just the basis of goodmedicine.
That's what my colleagues ask,like what are you doing?
That's different.
I said I get to do the thingsthat you don't have time to do
in the current model, but we allshould be doing this at the end
.
That's the end state, and intransforming healthcare we have
to find a better way.
There are not going to beenough providers to do the care
(07:11):
that we need.
We have to get back to thatpreventive care, that reversal
care, so that we can have fewerpatients.
And I do have had colleaguesthat say well, you're trying to
put us out of business.
I said absolutely I am, butwe'll never get there in our
lifetimes right?
Ellen Brown (07:25):
No, we won't Not, with 80% to 90% of people that
are not cardiometabolicallyhealthy.
Kathleen Findlay (07:30):
Never, and you know again, we'll be fortunate
to just take care of thepopulation during my lifetime,
and I think we have to findbetter ways to do that.
Ellen Brown (07:39):
And I think lifestyle.
Kathleen Findlay (07:40):
medicine is so well equipped for that.
And the other piece is thatit's across disciplines, so it's
not just the family medicinedocs.
We've got cardiologists doingthis, we have dieticians, We've
got physical therapists.
It's the basis of good medicineand we can all be doing it and
there is no group like ACLM andit is phenomenal just the
(08:01):
passion and drive that peoplehave and the scrappiness.
Ellen Brown (08:09):
So I have one last question on this is I'm just
that like I have so manyquestions, so to know that
you're doing this through thegovernment model of critical
access hospitals and in RHCs,that's just such a niche that
gets left behind, and so thefact that you've pulled it in is
just it's spectacular.
What do you think works?
Are there any components thatyou feel really help it work, or
(08:31):
where you've gotten creative?
Kathleen Findlay (08:32):
or I don't know.
I think the shared medicalappointment is fundamental and
actually my partner just help itwork or where you've gotten
creative or I don't know.
I think the shared medicalappointment is fundamental and
actually my partner justcompleted writing up kind of our
model to try to help share thiswith other RHCs that are
struggling to deliver this andtrying to figure out how do we
start this.
But really, that shared medicalappointment model, it works
within the RHC for generatingrevenue.
(08:53):
It creates the magic for thepatients to really be engaged
and be able to change theirlives.
The other thing that we didn'texpect was working with patients
so frequently.
We start to understand theirsocial determinants of health
and are able to help them startto integrate some services for
that.
So that's really cool.
Ellen Brown (09:13):
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 joiningus.
Thanks for your time.
I hope you have a great time atthe conference.
Kathleen Findlay (09:25):
Yeah, it's going to be great.
Thanks so much.
I appreciate what you're doingand appreciate this opportunity.
Welcome to the Reverse Mullet Podcast from BP2
Health.
We are live at ACLM Conferencein Orlando.
Ellen Brown (00:08):
Florida.
We are your hosts JustinPolitti, dave Pavlik, ellen
Brown and we are the AmericanCollege of Lifestyle Medicine.
This is day one we did have ahot one.
Justin Politti (00:18):
Is this not day two?
Ellen Brown (00:19):
Oh well, it's like the full first day.
Justin Politti (00:21):
I'm going to call this like day one.
Ellen Brown (00:23):
Okay, day one and a half, and I'm going to call
this like day one, and I'm happyto report that Justin and I
went to the HIIT class thismorning.
We did To kick it off right,and it was a HIIT, and so now we
are ready to go.
Justin Politti (00:33):
Our glutes are fire Totally.
We're like yes, I am on fire.
Ellen Brown (00:37):
So but we are here with our special guest.
Why don't you introduceyourself?
Kathleen Findlay (00:40):
Sure, I'm Kathleen Findlay.
I'm a lifestyle medicinephysician from Western Wisconsin
.
Ellen Brown (00:44):
All right, so tell us what you do.
I mean, obviously you practicelifestyle medicine, but maybe a
little bit more context, yeah.
Kathleen Findlay (00:52):
So I'm privileged to practice purely
lifestyle medicine in WesternWisconsin at a small
organization.
We have a critical accesshospital and three rural health
clinics, and it's my hometown,so I'm thrilled to be back there
after 20 years away and able tobuild a program that supports
just overall health.
Ellen Brown (01:08):
So we work with FQHCs and CHCs and all the
organizations that you'retalking about, and how did you
get lucky enough to haveLifestyle Medicine integrated
into that sort of governmentspace?
That can be very difficult andfull of friction.
Kathleen Findlay (01:24):
Yeah, so I owe that to the leadership of the
organization.
Six years ago we were gettingready to move home when my
husband retired from themilitary and I went to the
current CEO, went knocking onthe door and said would you let
me come and start an integrativemedicine practice?
She was kind enough to do that,so I was working on starting
that.
In the process I met my teammembers.
(01:45):
I helped in wellness coach Lynnwho's camp and Sherry wrote a
registered dietitian.
They were already doing thiskind of work and community work
at the facility so I knew I hadto be there and so together
we've built a program ofintensive lifestyle modification
and really been supported bythe organization.
About two years into the processI received a message from ACLM
(02:08):
saying hey, you're boarded inintegrative medicine.
There's a crosswalk to beboarded in lifestyle medicine.
That's actually where I waspracticing anyway, on that end
of the spectrum, really justtrying to make holistic
lifestyle change.
So I went to the current chiefadministrative officer at the
time and I said okay, listen, Idon't think anybody in Baldwin
Wisconsin cares if I have morealphabet soup behind my name and
(02:30):
he said yes, they do, and youneed to do this so that you can
equip the entire organization.
So we've had a change inleadership since then and
continue to have incrediblesupport for lifestyle medicine.
And it has been a challengetrying to fit this within the
confines of the Rural HealthClinic and those regulations.
What are some of thosechallenges specifically?
So there are specific codingrules.
(02:53):
There are specific rules aboutspace.
We operate in a critical accesshospital rural health clinic in
a combined setting and someparts of the facility are
critical access hospitals.
Some are rural health clinic.
I build out of the rural healthclinic so I can't use the big
conference room because it's inthe car.
So there's some unique thingsof trying to work out the
logistics.
Actually, the RHC regulationssay that you can't have group
(03:17):
visits and we practiced sharedmedical appointments but had to
go through legal to make surethat everything was legal and we
could do that.
So it's just been a challengeof trying to work through those,
understanding how we can fitthis within the confines.
Ellen Brown (03:31):
That group billing is one of the topics here at the
conference.
Are you speaking on that?
Kathleen Findlay (03:36):
I'm not speaking on that, but I'd like
to quote Dr Murski, who is kindof our lead in the area of that,
and he said the other day inone of the sessions you know,
lifestyle medicine and sharedmedical appointments are really
synonymous and I wouldabsolutely agree with him that
there is great power in thatshared medical appointment model
.
Ellen Brown (03:54):
So is it the community aspect, like where
people come, because I thinkthat's something that's really
missing, woefully missing, fromhealth care how we sort of
traditionally do it, andabsolutely in the rural setting.
Kathleen Findlay (04:06):
You know, we know that our rural residents
are more challenged with socialinteraction, and this epidemic
of social isolation is real, andit's particularly real in our
rural settings, and so thisprovides a great opportunity for
that social interaction in waysthat we never expected.
I mean, it's phenomenal.
Ellen Brown (04:25):
So you're on the pilot and demos subcommittee for
ACLM.
Are there any demos or pilotsthat done recently that you can
share?
Kathleen Findlay (04:33):
So the pilot that we've done at our facility
has been to develop a 12 sessionintensive lifestyle program
very similar to some of theother programs out there.
But then we also continue togrow that to support our
population.
Once people get into the family,as we call it, because it
really becomes like a familythey want more, and so our
(04:55):
dietician has developed aculinary medicine setting.
We don't have a culinaryteaching kitchen, but she
figured out a way to bring incutting boards and knives and
help people learn how to preparehealthy food.
We work with our fitness centerand we have some classes over
there that our patients canpartake in.
We have helped our PEDS programdevelop their own lifestyle
(05:17):
medicine approach to help kidswho are struggling with anxiety,
obesity etc.
So really continuing to justgrow the model in many ways to
just to try to support besthealth for our patients.
And then, additionally, Irecently completed a Master's of
Healthcare Delivery Sciencefrom Dartmouth and part of that
work was a group project and Iwas fortunate enough to have
(05:38):
five other individuals come onboard and support trying to
further lifestyle medicine andwe presented a novel payer
approach to the Medicaiddirector of Wisconsin with some
interest, but something we'recontinuing to try to push
forward, to try to find betterways to reimburse this kind of
care.
Ellen Brown (05:56):
So that's where we come in.
We're in, we're there to helpyou.
That is our commitment.
We have been involved inpayment transformation since the
acronym ACO was coined, evenbefore then, and we are very
passionate about paymenttransformation that can actually
reverse cardiometabolicconditions and chronic
conditions and lifestyle disease.
(06:18):
And once we stumbled in ourjourney of we don't want to
continue to watch Pete righthere we stumbled into lifestyle
medicine and now we are hugefans and really trying to raise
the voice to say, hey, if wewant to talk about
outcomes-based reimbursement, ifwe want to hit CMMI's objective
of everyone all Medicarebeneficiaries under some model
(06:39):
of value-based care by 2030, weshould be employing tools like
lifestyle medicine.
It's a simple and that's notsimple, but it is simple to
layer that in.
It just answers so many things.
Kathleen Findlay (06:51):
Absolutely.
It's just the basis of goodmedicine.
That's what my colleagues ask,like what are you doing?
That's different.
I said I get to do the thingsthat you don't have time to do
in the current model, but we allshould be doing this at the end
.
That's the end state, and intransforming healthcare we have
to find a better way.
There are not going to beenough providers to do the care
(07:11):
that we need.
We have to get back to thatpreventive care, that reversal
care, so that we can have fewerpatients.
And I do have had colleaguesthat say well, you're trying to
put us out of business.
I said absolutely I am, butwe'll never get there in our
lifetimes right?
Ellen Brown (07:25):
No, we won't Not, with 80% to 90% of people that
are not cardiometabolicallyhealthy.
Kathleen Findlay (07:30):
Never, and you know again, we'll be fortunate
to just take care of thepopulation during my lifetime,
and I think we have to findbetter ways to do that.
Ellen Brown (07:39):
And I think lifestyle.
Kathleen Findlay (07:40):
medicine is so well equipped for that.
And the other piece is thatit's across disciplines, so it's
not just the family medicinedocs.
We've got cardiologists doingthis, we have dieticians, We've
got physical therapists.
It's the basis of good medicineand we can all be doing it and
there is no group like ACLM andit is phenomenal just the
(08:01):
passion and drive that peoplehave and the scrappiness.
Ellen Brown (08:09):
So I have one last question on this is I'm just
that like I have so manyquestions, so to know that
you're doing this through thegovernment model of critical
access hospitals and in RHCs,that's just such a niche that
gets left behind, and so thefact that you've pulled it in is
just it's spectacular.
What do you think works?
Are there any components thatyou feel really help it work, or
(08:31):
where you've gotten creative?
Kathleen Findlay (08:32):
or I don't know.
I think the shared medicalappointment is fundamental and
actually my partner just help itwork or where you've gotten
creative or I don't know.
I think the shared medicalappointment is fundamental and
actually my partner justcompleted writing up kind of our
model to try to help share thiswith other RHCs that are
struggling to deliver this andtrying to figure out how do we
start this.
But really, that shared medicalappointment model, it works
within the RHC for generatingrevenue.
(08:53):
It creates the magic for thepatients to really be engaged
and be able to change theirlives.
The other thing that we didn'texpect was working with patients
so frequently.
We start to understand theirsocial determinants of health
and are able to help them startto integrate some services for
that.
So that's really cool.
Ellen Brown (09:13):
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 joiningus.
Thanks for your time.
I hope you have a great time atthe conference.
Kathleen Findlay (09:25):
Yeah, it's going to be great.
Thanks so much.
I appreciate what you're doingand appreciate this opportunity.
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