Hi, this is Nick Webb and welcome to another episode of the Healthcare Cure podcast. You know, one thing is for sure is that if we’re going to fix healthcare, we need to take a look at the core causality of cost. And when you look at that, it’s pretty clear that one of the major causes of the cost of health care is self inflicted chronic disease, yet the dialogue that tends to go on is the we need more access to healthcare. But I really think there’s a more interesting argument and I think that argument is, shouldn’t we be asking for more access to health over healthcare? You know, 60, 70, 80%, depending on the numbers, and the studies you look at of all the costs associated with healthcare are directly associated with lifestyle disease. And this new concept of lifestyle disease is driven by primarily obesity, but also drinking, smoking and even setting. Sedentary lifestyle is a big part of how we attribute to the problems associated with lifestyle disease.

Today, I have a tremendous guest who I’ve had the opportunity to learn from, and really get to know in our relationship as a board member at Western University of Health Sciences where I serve as the Chief Innovation Officer. And also I’ve learned from him in the work that he’s doing and and the enthusiasm that he has around the area of wellness and prevention and really changing the dialogue from the automatic trigger mechanism of allopathic care. And again, we all believe in traditional health care. Chances are everybody listening to this podcast has been saved through an antibiotic or a vaccine. But we also need to realize that the opportunity to fix healthcare is rooted in our ability to make the big shift the big shift from anticipatory healthcare to one of prevention and one of wellness over the automatic intervention trigger mechanism. So I have with me today, Gene Barduson. Gene, can you tell us a little more about your background? And then I’m going to hit you with a lot of great questions.

Well, thanks, Nick. It’s great to be here. Thanks for, thanks for having me. I’ve been, I’ve been in the computer oriented business for a long, long time since actually since the 60s with IBM and the last three decades or so in the health information technology business. And after leaving that in about 2009 I started a wellness business called the La Jolla Wellness Studio. And and subsequently have been on the board as you mentioned, at Western, and also at Scripps, I’ve been honored to be on the board at Scripps health in a large integrated health system here in Southern California.

Terrific, thanks for that Gene. So let me ask you about so many questions I, well, first of all, I love the fact that every time we talk, your the conversation always goes to Nick, let’s talk about the way in which and the incredible opportunities to innovate around prevention and wellness we have all these great drug companies and all these great device companies and hospitals and clinics that are populated by true innovators but it feels like our focus has been sort of reactive rather than proactive. Tell me about your philosophy about the importance and your own experience with it with your own center on how this has really changed lives.

Well, the prevention wellness model is is very exciting to look at when you look at the long-term results. And what was sort of prevented us from prevented us from getting to prevention here in the past is it’s not immediate. It’s not like taking a drug. It’s not like having a procedure done. Remove your appendix. It takes commitment, it takes time. And it takes behavioral change. And so when you introduce those those concepts, you need to be innovative, and you need to be dedicated to the long term in order to have success. And all those play with each other. And what I’ve observed is getting at the stress management piece is probably an important first step in almost everyone’s case. Once you get into prevention and wellness, you almost automatically bump up against behavioral health. And once you get there the whole idea of how you approach whether it’s nutrition, exercise, any of the lifestyle modalities requires that behavioral change.

Yeah, absolutely. You know, it’s interesting I in in filming Fixing Healthcare, I began to realize like, wait a minute, Nick, you’re talking about the importance of being in an optimal weight. But as near as I can tell, you’re 22 pounds overweight. So I begin to think, wait a minute, I need to really read you know, and so about three months ago, I started my own and I’ve always been a vegetarian all my life. I exercise every day. And so I figured that was good enough. But you know, when you’re overweight, you’re overweight. You’re at risk of hypertension and all the other chronic diseases. So what I realized were three things it’s just me personally, I realized that number one, I had to get to a mental state because your point is so well taken, I had to get to a mental state number one, this has to change, right. And that’s where a lot of people don’t, they never get to that point there, because of depression or apathy. They don’t get to the point where they really and truly say to themselves, this has to change. Because without that you can’t transition into the next two phases. The next phase was, it can change, you have to realize that you actually can do this. It’s hard to believe that you can get to an optimal health, but you can. And then the last scary part of this awakening, is that you have to realize that you have to make it happen. So to transition through, this has got to change. It can change, but I got to change it. That’s a really, really tough transition for most people, including myself. The good news is I’ve lost now 25 pounds, and I feel great and there’s zero chance of them ever going to allow myself to slowly gain weight like that again. But doesn’t that seem to be the transition that most people struggle with, Gene?

Yeah, I think so. I think that’s, first of all, the first step course is the recognition and acceptance of that, and I guess getting out of denial, and that’s the first step. And that’s a big step. And as you look at scaling, wellness and prevention, that is the step we need to take if you take almost any population, if you’re going to deal with the population as opposed to the individuals, you need to figure out how to scale that. That self-confession if you will. Now, a good friend of mine, Dr. Jean, last name sip of mine, she called it the working wounded. The working wounded are those that are showing up every day with depression, for example, at their job. And so it gets in the way of whether you’re in your office, whether you’re teaching, whether you’re traveling, whatever it is you’re doing in your work. If you’re in a state of not optimal health, that is some kind of depression, it’s going to affect you and all those around you.

So how do you do it? How do you scale that? How do you get to the point where you can identify these nuances across behavioral health, and hardwire those insights into a prescription for change?

Well, many things have been tried. One of the models that we’re working with now is Viva which is the insurance company for the San Diego union teachers. And they have initiated a wellness program across that population. It’s about 10,000 teachers, if you include the rest of the staff and their families, it becomes a population of about 100,000. They have put in place an app that has about a dozen different modalities which you can participate in. And they vary from social workers, psychiatrists, acupuncture, yoga, strength training metrics, which is something was dear to me because it was our health studio and on and on, and so, oh and cooking classes, nutrition classes and so on. So it gives the population an opportunity to enter at a point which is most interesting to them to begin to get to the point that they want to do something as you did.

Yyeah you know, I had the great honor of touring your health studio in La Jolla, and I was sort of, I was impressed with sort of the handcrafted nature of being able to develop those relationships with the patients and to really understand their journey and for them to get together and collaborate around a better, better state. You certainly must have some great case examples of how that model that you created has changed lives.

Well, we had, we had the opportunity to work with hundreds of folks over a half a dozen years, and it was a great observation laboratory if you will. Our studio focused on nutrition, fitness, and stress management. And so, as as the clients came through there, and it was only 20 – 25 minutes for them, we use some pretty interesting technologies. But it became, it became very apparent to us that the, the catch was not weight loss as we expected coming in, but was the viral nature, if you will, of the stress management modality.

Wow. How did you how did you approach that? How did you approach stress management?

Well, we had a technology called whole body sound vibration, and the stress management is essentially inherent in that bottle.

I see. And so, you know, I would in the time that we have I want to make sure I get in a couple of things here. You know, you work on as you serve on the Board of Trustees for Western University of Health Sciences, which is an amazing institution and as an osteopathic college, you know, we have our sense is towards prevention and wellness and getting the body to a to a state of homeopathic stasis. What do you think in the future, we’re working right now at the University on this, the concept around training the physician of the future? What is the emphasis of prevention and wellness? And what what do we do to train these, these amazing people as they go into this new world as it relates to prevention and wellness?

Well, it’s a it’s almost a tug of war, isn’t it? Because there are so many new things to teach our physicians as they’re coming out. It’s innumerable, the devices and the procedures and what have you, and how do you squeeze wellness and prevention into that curriculum is always a magical. But we’re making great progress at Western in getting the acceptance of wellness and prevention as a, a key part of the education and being integrated into all of the other pieces that that are in the curriculum. We have some as you know, some separate wellness and prevention stuffs, but it has to be in the mind and spirit of the, the institution and the deans and the faculty and, and, and emanates them through the students as as they go through that curriculum.

Yeah, that’s a good point. And we’ve talked to several other people that we, you know, we have to sort of change the conversation and really change the focus because, you know, historically in traditional allopathic education, there isn’t a lot of discussion about prevention, and there’s not a lot of bandwidth that are that’s attributed to it. One of the things that we’ve seen from our research is that if you really want to fix healthcare, you first of all have to re-establish the relationship with the caregiver and the patient. You know, I happen to see a naturopathic physician as my primary care caregiver. And she’ll spend 45 minutes with me. And we’ll talk about stressors, we’ll talk about diet, we’ll talk about fitness, we’ll talk about all of those things. And, and so I think that, you know, we’ve got to get more time. When I see those, those students graduate, I’m thinking, gee, you’re going to go out into into practice today, and you’re going to have not enough time with your patient. And you’re not going to have really enough data. They’re getting, you know, fractional data during a traditional office visit, which is, by some people’s accounts, resulting in a wrong diagnosis 50% of the time in a primary care setting. So I think that one thing that we have to do for doctors is to give them new economic incentives and models that allow them to have the time they need with the patients. We also have feels like we need to give them a lot better data. We’ll definitely get there, and we’re going to get there through continuous patient monitoring that’s already well underway. I think the other thing that we’ll have to do is we’re going to have to change the economic incentives of the healthcare industrial complex to allow patients and doctors to have a more connected and more thoughtful relationship that includes time, there’s no way to make up for time and in my work as a management consultant, it’s amazing to me to see how many consultants are traveling around the country right now. Working on patient throughput, optimization, yikes. You know, they’re using technologies that they’ve taken from the fast food industry to try to get more patients through the system. And then they’re surprised to find out that they’re seeing that that patient again in seven or eight days, and it’s short term gain for long term pain, you know, we have to really reimagine that. And do you see that I know that with Scripps, one of my favorite health systems, we’re in fact we have the great honor of featuring them in the upcoming film. I know that they have a very big commitment towards not just delivering exquisite and safe and efficacious care but also to deliver a wide range of new patient experiences. What what I know you’re not a spokesperson for Scripps, but I think you share my reverence for them. What’s your take on where they’re heading in this direction?

Well, um, a couple of things. First of all, in a specific manner, we had we at Scripps had had about 200 tele-health visits until February one and now we’re doing 30 to 40,000 a month, fine. So, it is yet to be ascertained whether or not that frees up the doctor for more time to spend on on other things such as wellness, but it certainly has the potential to go in that direction. And and the the single most important pillar at Scripps is the patient experience, patient experience is the focal point of whether it’s a financial or a technology or, or clinical, whatever it is, it is centered around the patient experience. And so that’s the direction we’re going.

For sure. You know, I love that.

And and that that changes the culture that changes the culture. And one thing that’s always been sort of my high high on my list is wellness and prevention is not a separate part of healthcare. It’s a part of every part of healthcare. every disease state has a lifestyle component. Every one and and some are more severe, some are more behavioral somewhere, but they’re all have a lifestyle component. So, we should be lifestyle people, lifestyle physicians, lifestyle healthcare workers, because it is part of the patient experience.

Right and if we want to fix healthcare, we have to change the economic models to substrate. I mean, I started my career as a medical technologist developing medical technologies four decades ago. And every day I would wake up and I would take a look at reimbursement data to find out where we targeted innovation. We didn’t targeted target innovation based on patient need we targeted as a medical device company innovations based on third party reimbursement. In other words, we created things we got paid for. And unfortunately in modern medicine, we continued to scale and scale and scale and we have a punitive situation where caregivers and hospitals and clinics are not rewarded for focusing on patient care related to wellness and prevention. They’re there in the intervention business. And that’s how the that’s how the healthcare machinery is set up. And I don’t think we can change the focus on lifestyle until we change the economic substrate that supports, you know, gratuitous intervention.

Well, population health ACLs were supposed to be the answer to that. And they’re the movement in the right direction. value based care is certainly a movement in the right direction. We’re making progress. We’re making it slowly. I would, I would love to see a, a way to accelerate that. Because as you look at a population, then wellness comes to the top of the heap because you’re asking the health system to keep people out of hospital right? As opposed to bring them in, and it changes the the way they’re looked at. And it changes the the reimbursement. So we’re making some progress there, Nick. I don’t expect it to be accelerated anytime really soon. But as Scripps, for example, more and more risk contracts are being put in every year, to the point where we have now, you know, some 300,000 people involved in a risk situation with us. And those risk situations automatically bring health to the fore.

Yeah. Yeah, that’s a good point. And I think that, you know, hopefully the film will will change the conversation when Dr. Power and I decided to, to, to put this film out into into make a commitment to change the conversation we wanted. We wanted to at least say, you know, when you look at value based health healthcare, I mean in many ways, it’s just a way to create a gauge associated with with intervention. And although that’s good to be able to show you know, a direct corollary between intervention and value benefits, but we I think we really need to have a, a C changed in terms of how we look at the way in which we, I mean, if 70 to 80% of the cost associated with healthcare are lifestyle disease, it’s amazing to me that we don’t have a robust and thoughtful system in place to start there because we always start at intervention. And you know, somebody presents that they’re 35 – 40 pounds overweight, they got a few minutes with the doctor and they’re going to get medicine for they’re going to get a stabbed in probably a hypertension, medicine and out the door they go. When if if the system was set up to be able to spend time with them to take a look at the the behavioral issues the environmental issues, life situations, and to really get them on a on a path towards health rather than intervention. The cost savings to the system is unbelievable. I mean, I think the other thing that you pointed out, I just liked as we run out of time here, I would like to comment on what you’d said about the experience. You know, I wrote a number one best selling book called, What Customers Crave, two years ago on the impact of consumerization and not least of which was in healthcare. And unfortunately, what happened is there was a bunch of consultants that started climbing around the country doing patient experience consulting, and that my my criticism towards that is that I think that hospitals and clinics that are going to do this right, they have to have the maturity to be able to call patients consumers because patients you know, consumers don’t wait for 45 minutes to see to buy a pizza. They don’t wait for 45 minutes to buy a pair of shoes at Nordstrom. They also don’t have to fill out forms 30 times, right? And so a lot of people look at the consumerization of healthcare as a superficial thing. I mean, after all, we’re saving lives here. But we can, we can actually directly show that improving customer experiences can help us do a better job of understanding patients at an ethnographic level at a behavioral health level. It can also help us drive compliance and avoid a lot of problems associated with compliance. The benefits are very, very big and they go beyond what most people think, is the superficiality of customer experience. And consumers are taking over I mean, you take a look at orthodontists I don’t know if they’re a thing anymore because Smile Direct Club is replacing them quickly. You look at optometry is optometry a thing not according to Opternative, right. So we’re creating all of these consumerized solutions that patients like they’re inexpensive, their value is transparent. And I’m optimistic that that will continue but I think the biggest problem with healthcare is unlike Scripps, a lot of hospitals are making patient experience nothing more than a bumper sticker.

Well, it’s always been important, but now with the new generation coming into the, into the patients, it’s mandatory.

I think that’s right. You know, and also in a time of, of hyper influential communities, we’ve got health grades and Yelp and all kinds of they’ve got Google rating. There’s nowhere to hide even. Even Glassdoor, you know, we see now that you know, before a nurse or a caregiver will even apply at a hospital they want to find out you know, what’s that internal culture light? How do you treat your employees and how do you treat your patients? Well, Gene, what would you, you know we’re out of time, now I’d like what what’s your final message about your sense of the impact and the future of taking more of a proactive rather than just a reactive approach in healthcare?

Well, maybe I can sum it up this way. As you know, there’s a lot being done in symptom reversal for chronic care for chronic diseases. And it is very clear in that research, the earlier you catch the disease, the easier it is to reverse it. And so the earlier you get to prevention and wellness, the easier it’s going to be to reverse those symptoms and have a healthy and happy life. So I think that that, that research can can really show us the path we need to take to prevention and wellness.

That’s a great point. Well, Gene, I it’s been an honor to be able to work with you over the years at Western looking forward to continuing our great collaboration at the university level. We’re so pleased to have you in our film, Fixing Healthcare, and you know, hopefully, through the work of of this film and the discussions we have with insightful people like yourself, we’ll be able to at least maybe move the needle, maybe change the conversation to where we can have some true impact. Gene, thanks so much for your time today. I really appreciate it.

Thanks, Nick. Keep it up. Okay.


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