By Dr. Shaiv Kapadia, Chief Medical Officer and Co-Founder, Iggbo
The United States has the best and worst healthcare system in the world. Let me explain. If you are having a heart attack or stroke or a victim of an accident, there is no better integrated system of acute care delivery on the planet. Chronic disease, however, is a completely different story. [EDITOR: The medical industrial complex spends twice as much on political lobbying as the military industrial complex, to avoid disrupting healthcare as they know it. That’s because cutting costs to match what other advanced nations pay per capita would mean losing over $1.5 trillion/year in profits – profits that today mostly come from treating symptoms.]
America’s healthcare system is siloed, fragmented, patriarchal, impersonal, episodic and completely disconnected. A sick care system. The turbulent forces of an aging population, surging demand, inadequate provider supply and access, high cost with low value are creating the perfect storm for disruption.
Contrast this with positive forces — the rise of medical consumerism and the accelerated discovery and development of molecular diagnostics and genomics with costs falling mirroring Moore’s Law. Couple this with the dawn of the Information Age — mobile, connectivity, and Big Data analytics, and a new paradigm of creating health is upon us.
Healthcare is inexorably shifting from a Blockbuster’s bricks and mortar model to a Netflix on demand, anytime, anywhere model. What we desperately need is a new “operating system” for healthcare. One that is predictive, preventive, personalized and participatory (P4 Medicine video testimony).
Reason for Optimism
Enter Functional Medicine 2.0 — a centuries old method of root cause medicine, now with a fresh and invigorated model of care delivery. James Maskell, in his new book, Evolution of Medicine — Join the Movement to Solve Chronic Disease and Fall Back in Love with Medicine, eloquently and passionately describes the need to shift the practice of medicine from a symptoms/disease centered focus to a systems oriented, patient centered approach. After all, shouldn’t we all be thinking of humans as holistic beings with complex ecological systems, rather than just seeing them as a collection of organs?
Maskell brilliantly couples the need to solve the chronic disease problem with an economic model that improves upstream care. The P4 Medicine paradigm “[demonstrates a] new way to engage patients, to treat people individually, and to motivate them to …make behavior and lifestyle changes that will lead to better health outcomes…”. The way I see it, patient engagement will be the “blockbuster” drug of the twenty-first century.
Functional medicine focuses on health improvement by uncovering predisposing risk factors, triggers and mediators of a patient’s chronic health problem, leveraging cutting edge lab diagnostics, and deploying a team based approach to care. Maskell argues, quite convincingly, that the functional medicine framework is a “systematic, scientific and reproducible way to understand a patient”
The emerging science around genomics, epigenetics, and the gut microbiome on the micro level is incredibly compelling, all influenced, quite significantly, by lifestyle, environmental and psychosocial factors. Integrating all of these complex variables and creating a personalized care plan is the daily bread for a trained functional medicine provider. After all, who would refute the notion that the foundation of health creation is nutrition, sleep hygiene, exercise, and mindfulness?
Being a physician myself, I am gratified by James Maskell’s discussion of not only the patient experience but also the provider experience. Physician burnout is a real phenomenon in conventional medicine, likely related to the pressure of declining reimbursements, high patient volume, administrative headaches and the uncertainty of a changing healthcare reform landscape. Maskell makes a compelling case for a new method of practice — the low overhead, technology-enabled micro-practice. He describes cash pay only models — purely transactional/per click, membership and package models, at price points with flexibility that don’t have to segment the market. Imagine not having to deal with insurance companies and eliminating the infrastructure required to collect these monies!
Creating efficiencies in this new model of practice is critical to accelerate growth. Maskell discusses group office visits, creating provider teams and leveraging technology. One example is Iggbo, an on-demand technology platform, that delivers phlebotomy specialists to collect diagnostics, anywhere, anytime. The benefit is to create more access and convenience in the healthcare experience for patients and to streamline provider workflow.
Clearly, the Functional Medicine movement is accelerating at a rapid pace in the US and around the world. The opportunity at hand is to integrate all of these systems of care without creating further fragmentation in our healthcare ecosystem; to disrupt without being disruptive. In the not too distant future I would like to see the term “functional” disappear, replaced by an integrated ecosystem of practitioners focused on high value health creation at a lower cost.
About the Author
Dr. Shaival J. Kapadia is an invasive, non-interventional cardiologist with a focus on early detection/prevention of coronary artery disease and heart failure. Studying first at Johns Hopkins University and receiving a BA in Behavioral Biology, Dr. Kapadia then went on to the University of Virginia’s School of Medicine to obtain his MD degree. After attending Medical College of Virginia for his internal medicine residency, Dr. Kapadia completed a Fellowship in Cardiology at Brown University in Providence, Rhode Island.
. . . His newest venture is Iggbo, an on demand healthcare labor platform that provides more access and convenience in the healthcare experience. Today Iggbo is focused on diagnostics, often likened to the “Uber of phlebotomy”. At the core Iggbo is a technology platform delivering quality, efficiency and compliance. Iggbo is up and running in 130 markets with over 100 laboratories and a network of > 6000 phlebotomists.
mHealthTalk Editor Perspective
I too believe that disrupting healthcare must go beyond just how we pay for it or deliver care. We must stress functional medicine and business models that focus on health, wellness and prevention. Public health officials know that what Benjamin Franklin said two centuries ago is true today, that “An ounce of prevention is worth a pound of cure.” Most physicians instinctively know this too, but our fee-for-service compensation system incentivizes sick care, and medical schools still train new docs to diagnose and treat symptoms, with relatively little attention given to the pillars of health (exercise, nutrition and sleep).
Disruptive change has met intense political lobbying from within the healthcare industry, which makes perverse profits from illness and injury – over $3 trillion/year. That suggests that true reforms will likely come slower than they should, but Dr. Kapadia points to positive forces, including medical consumerism, that will make disrupting medicine an economic imperative. The public and their elected representatives need to understand that the biggest healthcare cost savings by far will come from wellness. Besides the obvious healthcare cost benefits, wellness will provide the biggest productivity benefits and translate directly into improved corporate productivity, GDP growth, and global competitiveness.
Top 10 Related Articles
Modern Health Talk has posted well over 100 articles on healthcare public policy over the last 4 years. Here are some that relate closely to today’s article by Dr. Kapadia.
- Is American Health Care the Best?
- Transforming Our Flawed Healthcare System
- The Unbreak Campaign – a Declaration Of Independence
- The Big Heist, a satirical, follow-the-money documentary-in-process about America’s healthcare status quo and efforts to fix our broken system.
- Health Care Reform – Progress and Next Steps, by President Barack Obama
- Let the Health Care Reform Debates Begin, Again
- The Future of Healthcare? It’s In The Past
- Why Medicare-for-All is Not Enough
- Chipping Away at Healthcare Special Interests Yet?
- Precision Medicine vs Prevention & Wellness