//Allow shortcodes in widgets add_filter ('widget_text', 'do_shortcode'); function year_shortcode () { $year = date_i18n ('Y'); return $year; } add_shortcode ('year', 'year_shortcode'); The Future of Functional Medicine: Shifting to a Better Payment Model - Evolution of Medicine

Cheng Ruan, MD is a Functional Medicine practitioner who trains other physicians to work through insurance systems. He discusses value-based care and its current limitations, physician services that are currently billable to Medicare, insurance options which are underutilized, and how to foster a sense of empowerment with patients rather than trying to be the “hero” as a physician. Listen to the full conversation to learn about:

  • How physician entrepreneurs should be thinking about scalable growth
  • Coaching concepts for physicians
  • Statements of guidance and focusing positive energy towards collaborative health care
  • Working with conventional payment models for scalability
  • And so much more!

The Future of Functional Medicine: Shifting to a Better Payment Model | Ep 271

James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.

Hello and welcome to the podcast. This week we featured Dr. Cheng Ruan, he is the founder of the Texas Center for Lifestyle Medicine and also the Integrative Practice Builder. He is on the cutting edge of insurance, health coaching and how to deliver this coach-focused functional medicine operating system outside the walls of where we’ve been contained by mainly doing cash services. I think he’s definitely thinking outside the box, he’s got some interesting data that allows him to really understand what’s going on with his patients. We talked about how he shifted coaching from being an addendum to the central part of his practice. He talked about overcoming resentment between physicians, which I think is really powerful, especially with these meetup groups that we’ve got going on all around the country and around the world. And then he just talked about how his new model works and how the coaches and providers interact. Really powerful time, really great information. If you’re an innovator looking to build of the future of medicine, highly recommend. Check it out. So a warm welcome back to the Evomed podcast, Dr. Cheng Ruan, welcome doc.

Dr. Cheng Ruan: Hey, thanks for having me. Appreciate you, James.

James Maskell: I’m excited to have you back. I would say, over the time that we’ve connected over the last few years, my clarity of understanding of what’s possible in this transformation of medicine has been greatly aided by you, I would say. One of the things that early on in the pandemic, the vision that you shared of… I think, we were texting back and forth of this idea of decentralized community care. It’s really powerful for me and thinking about what could be possible and where functional medicine needed to go in order to be a solution for the future of care. So, thank you for all of your work and your innovation.

And I’m really excited to channel today because this is the year of growth. And ultimately I think, one thing that you’ve been able to do really well in your practice is to work out how to get the best of this relationship between physicians and coaches. And that’s something we’ve been talking about in the evolution medicine for a long time, but I think there’s a lot that the community at large can learn from your experience. So, before we get into those details, just give us the quick overview on your journey to functional medicine and how you ended up practicing, I guess, this combination of functional lifestyle medicine.

Dr. Cheng Ruan: Yeah, absolutely. So, for those of you who don’t know, my name is Cheng Ruan. I’m a board certified internal medicine physician, and I actually got into functional medicine in 2017. Actually, the first time I even heard what the word functional medicine was 2017 on a Mark Hyman podcast and really got intrigued about it because it kind of was what I was already doing. My mother is an acupuncturist and herbal specialist, so it kind of makes sense. At that time, I was experiencing quite a bit of burnout. I was making plenty of money, but it was just like 10 minute visits here and there. I was doing inpatient, outpatient, hospice, sports medicine. And my day was just like this one ball of stress. And I think what always gave me a lot of joy in practicing medicine was talking to the patients and seeing how successful they actually are just based on conversations, not based on the prescription, not based on a referral, not based on a procedure, just based on conversations. And that gave me such a huge positive boost, and it’s really part of my core values.

So, I jumped into my first institute functional medicine module, cardio metabolic, and that’s Yousef Elyaman, which maybe a lot of you know, and then he put my brain on a whole different fireball after that day in Austin. And so, a few months later, I actually decided to stop and start this prototype practice, which we now call Texas Center for Lifestyle Medicine. And at that time, it was like, let’s build it and see what would happen. A lot of it was pulling stuff out of my butt to be honest with you. But I learned a lot from that experience, and we actually started with multiple providers and health coaches and stuff like that. And I’ve always been the kind of person to just execute based on what I think is very useful and really with the patient in mind.

So, experienced a lot during that time, had huge downfalls, had huge uprises and downfalls again, hurricanes and et cetera, et cetera. So, the journey really was a very treacherous path, but the core value that I wanted to present was how do you make something like functional and integrative health… How do you make it, not just accessible, but how do you make it commonplace? I think, ultimately, the goal is to not have a term called functional medicine. Functional medicine can just be medicine. Right. And so that’s the path that I really am really passionate about.

James Maskell: Yeah. So, I guess just in terms of, as you were setting up this prototype. I know that you were not just contracted with insurance, but you were also tracking your data. And at that time were you part of an ACO and what was that? And why did you make those choices?

Dr. Cheng Ruan: Yes. So the reason I was able to do this actually is because of our accountable care organization, our ACO down here in Houston, because they actually gave us a lot of digital tools to do trackings. We have dashboards and stuff. And I think a lot of doctors and practices in the functional medicine community don’t necessarily have those tools. But I’m a data nerd. So, I like to know that if I’m doing something, is it working and does it continue to work? And then, I’m going to be innovating based on the data that’s been created rather than just what I think should happen. But, I think the data is something that’s really missing in integrative health. And even, American College of Lifestyle Medicine spends so much money on trying to get companies to aggregate this data and then publish.

And so, because of that, my obsession really came from the data. And what I didn’t know at the time is that I can actually use data and present it to the insurance companies to say, “Hey, look, how much money I saved your patients this year.” And I mean, it’s in millions of dollars, prevent hospitalizations, et cetera, et cetera. And so, they’re able to see it and say, “Oh, okay. We’ll let you keep doing whatever it is that you want to do.” So, I use it as a negotiating tactic with contracts and stuff like that. But, it’s not something I knew I wanted to do, just something that I was interested in. But it turned out to be my secret weapon for developing Texas Center for Lifestyle Medicine.

James Maskell: That’s super cool. Well, look, I think that’s… We’ve been talking about tracking outcomes and tracking data in the functional medicine space, really since the beginning of the Evolution of Medicine, because we recognize that… I mean, I worked in a clinic where I saw people reverse their chronic illness. So, I know that it’s possible. I know that it’s not happening in conventional medicine in general. And so that should be a huge tactical advantage for our network. I just feel like that sophistication that was sort of handed to you in a certain way by the ACO and obviously you did a lot of work to make sure that it was being tracked in the right way. So, with regard to coaches and groups, I featured even my second book because you were doing some innovation stuff with groups even then. But, I guess, what are some things that you tried that you weren’t sure that would work? But when you looked at the data, you were like, “Wow, this is really compelling. And I want to double down on that.”

Dr. Cheng Ruan: Yes. So absolutely. So, health coaches. In the very beginning, I treated health coaches like addendums to the practice. And that was very confusing for the patients. It was confusing for the providers. It was confusing for the medical assistants, the front desk, the back office, because it’s really hard to know when one set of values are responsible by the doctor and the next set of values are responsible by the health coaches. There’s such a huge overlap. So, it almost became very murky. And whenever you’re building a business, by the way, you want to make sure that each part of your team is doing a very specific set of values. And so, a lot of doctors are naturally very coach-y. We naturally want to nurture our patients, which is fabulous, but then that gets into what the health coaches are doing.

So, instead of just saying, “Hey, the health coaches are sort of addendums to the practice.” What if we reinvent our mindset? What if we are a health coaching practice? And that’s our core value. We think that people should really be coached through chronic disease. And a lot of people come to us because we take insurance for integrative and functional health. We get the people who spend hundreds of thousand dollars, and they ran out of money. And then they’re now relying on their insurance. So, we get stacks of paper. And so what we really quickly realized is that if we shift the mindset is that, “Hey, we may or may not know what to do, but I can guarantee you we’ll always be there for you.” Because that’s the promise to the actual patient, which means that we’re essentially a coaching practice.

And so, if the coach is at the center and then the other practitioners come along and I can add the other practitioners and the other practitioners feel the actual coaching side, that’s what turned out to be like magnificent. It took about eight months to figure that out, but that’s what turned out to be really good and attracted the patients who really wanted to be helped. And so, what happens then is that if we know that we’re a coach centric practice and our core value is coaching, then shouldn’t every patient be coached? And the answer is yes, every patient, generally, is coached coming into the practice.

And then we leverage groups because groups from the data set tend to do better. So, looking at the data, the people who go into individual coaching and the group coaching and individual coaching, group coaching. Sort of back and forth that, well… But the most surprising data that I saw in 2019 was that there’s a subset of patients that only want to do group coaching, and they actually have better outcomes than the ones that did individual coaching, which is very surprising for all of us, to be honest with you. But I think that tells you how effective the power of a group can really be if it’s done in a very structured way.

James Maskell: Yeah. Yeah. It’s interesting you say that because I think, for most people in functional medicine, they valued individualized care above all else. That was the number one thing. And the truth is, actually, you can still deliver individualized care inside a group, but you need the data. And so the data will surprise you. And so I’m glad that you’re tracking it. It’s been great to just be on a regular text thread with you and talking back and forth as we’ve started to understand this.

The story that you just told reminds me of a story. So in 2017, I think, I spoke at the PLMI conference, Jeff Bland’s conference, and Woody Merrill was up there on a panel. And Woody Merrill, for those of you don’t know, being in the functional integrated world forever and actually was the sort of head physician at the Continuum Center in New York, which was the Mount Sinai’s integrative center.

And it closed down and Woody Merrill was asked on stage at PLMI, “Hey, if you could do this again. If you could run this again and you could build the Continuum Center again, what would you do differently?” And at the moment, when he was asked that he was like, “I don’t think I’d do anything differently.” And then at the end of it, he grabbed the mic when the panel was over and he said, “Hang on a minute. There’s something I want to say.” He said, “When we built the Continuum Center, we put the doctors in the middle and the coaches on the outside. And if I could do it again, I put the coaches in the middle and the doctors on the outside.”

And it just really represents what you just said there, which is that, ultimately, what he realized is that by having the whole thing be doctor centric, there’s so many inefficiencies that just have to be because the doctors are all knowledgeable. And if the appointments take a long time and the doctors cost more than the coaches and it can’t be really done in groups, you kind of meet these fundamental economic realities that it’s very difficult to get around if you want to compete on RVUs with other parts of the hospital. And when the money men look at it, they want to just see those numbers. They don’t really feel a heart connection to integrated medicine like Woody feels or like you feel or I feel. So, I’m glad you said that because ultimately it’s the same experience that ultimately people need to go through a process where they’re going to be coached back to health. And, in your model then what is the role of the provider?

Dr. Cheng Ruan: Right. Absolutely. So, it’s not surprising that when you kind of put the doctors in the middle of the value delivery process, at first, that may seem like a smart thing to do because you can attract patients and label it either integrative or functional or lifestyle medicine, whatever it is. But, in reality, what happens is that we doctors going through medical school and residency, we’re trained to be like the heroes for the patient which is not the greatest mindset. We really should be trained to be the guides for the patient. The patient themselves should be the heroes. Well guess what’s one profession that’s trained like that? It’s the coaches, the coaches that are actually trained as guides.

And so the value that a lot of the doctors delivering value to the patient is very much of, “What can I do for you today?” And if I can’t do this for you today, I would feel bad in some way, shape or form. Whereas if you’re… So, that’s a hero’s mentality. Where you have your guide’s mentality, and if I was your guide, I’d be like, “You know what? Here’s the tools that you may need to go on your own journey, but this is still your journey, so you get to decide what step you want to take next. And I’m here for support.” And doctors aren’t trained necessarily to talk that way.

So, that’s between the provider and the patient. Now, if the doctors are in the middle of this institution and the coaches are on the periphery, there’s also miscommunication between the coaches and the doctors because they don’t know where one starts and one begins, and there could be a lot of miscommunications there. So, the idea of developing this system has to be from the ground up, and if you look at, for example, Tesla, the car was made from the ground up. That’s how Elon Musk is able to engineer in a very specific way that’s outside the original construction of gas powered cars. Same thing with integrative health.

If you designed from the ground up, from the foundation, you’re using that language of a guidance philosophy and then not being tied to the patient outcome. Patients actually have better outcomes when you don’t tie yourself self to their outcome. You’re less burnt out. Your staff is less burn out. The company culture is magnificent. And guess what? The patients know based on the language of the entire company that what your intentions are for them is absolutely valuable. And they take ownership so that they know that, “Hey, I have to do what’s best for me and doctor or coach so-and-so has told me that this is what I got to do. It’s up to me now.” And you know what? Some patients aren’t ready for you that day, but six months later they’ll come back and they’ll say, “Okay, I’m ready now.” And we see that all the time.

James Maskell: Yeah. So I guess, as you know, now we’re talking to physicians. Mainly physicians who listen to the podcast, and they’re all at different stages of reinventing their practice or working in a practice. They want to reinvent medicine and practice in a good way, in a new way. How do you sort of like… What are some simple ways to sort of evolve into this? Because I completely agree. It’s an actual reinvention. You have to start right from the ground up. But ultimately, it can be tricky to go through that kind of like cocoon to chrysalis transformation. Because there’s a point in the middle where nothing’s happening, and it kind of looks like it’s dead. And most people can’t afford to just have a dead practice for a while to only reorganize it.

And obviously, you’ve had some serious challenges that you’ve had to deal with where the clinic kind of looked dead, like Hurricane Harvey. I remember that, which is a big deal. So, maybe some opportunities to reinvent yourself in that way. Now that I know that you speak to other doctors who get it and understand it but are just trying to work out, how do I move in that direction? What are some tips that you have for doctors who see, feel what you feel, but now are trying to think about how to get there?

Dr. Cheng Ruan: Okay. I only have two tips because it really only requires two things. I want to make it as simple as possible. So, once again, I’m addressing the doctors who are kind of listening to this. And so there’s really two subsets of doctors that actually listen to us, I think. There’s one that kind of come from the conventional world. Maybe they’re starting to dabble into integrative health and functional medicine. And there’s the one that’s been in it for a while, but they have their own sets of burnouts. And both groups are actually suffering the same trauma. So, the first thing that I really want to tell the doctors is there’s no reason for resentment. And so, I see a lot of animosity between practices, especially when they’re in the same zip code. There’s no reason for that. It’s because we’re all sort of suffering the same trauma. So, a lot of people, the patients take their file to another doctor like, “Oh, this doctor doesn’t know what they’re doing.” There’s literally no reason for that to really occur.

The collaborative approach is really the key. So, the only reason why doctors like to say statements of resentment, especially when it comes to doctor-patient relationship, is that they want to play the hero card. But instead, what if you see all this stuff and the patient still feels bad, and I say this to every patient coming into the door and still to my whole staff. I was like, “You know what? This whole binder is so important because we now know what doesn’t work. And knowing what doesn’t work is more important than know what does work, and I want to thank all seven of your doctors for letting us know what doesn’t work. So, we can put this aside and work on what it looks like for the future.” So that’s called a statement of guidance. So, we also want to put that positive energy into the doctors. We want to thank the doctors. We know what doesn’t work. If you do that in your practice, the entire visit with you and the patient can be completely transformed.

The second tip that I have going on. So, the first one was basically: there’s no need for resentment. And the second tip for a lot of doctors coming in is that I feel like a lot of doctors come in, and they go into the room or they go into the telemedicine and the patients are there. And the doctors assuming that they know why the patient’s there, maybe what the medical assistant wrote down or whatever.

So, I go into the room and so do the rest of my practitioners, and we sit down and we’re like, “Okay. I think I have an idea of what you’re doing here, but I want to hear from you. What are your goals for yourself? What is a win for you? And not only that, how do you see me getting involved in your journey?” If you just say those words, first of all, the patient’s going to pause. And that’s a good thing because it really gets the patient to think that, “Oh, this is my journey. So, I’m the actual hero and you’re here for a guide.” And then they’ll actually put you, like subconsciously, they’ll put you into the guidance position. So, we’re in the guidance position, the rest of the conversation’s kind of set, which means that you basically redefine the value of you either writing a prescription or supplement or a protocol or whatever it is for the patient into just the conversations, feeling of safety.

So, really good example of doing this. I had a patient who comes in, and this patient had a specific medical condition. She had hyperthyroidism, and she comes in. And then she had all these different data sets here, and she’s like, “You know what? I want to do this fully naturally. And I don’t want any medicines. In fact, I don’t want any supplements. I just want to do it through food.” And so, one part of me is like, well, it’s really hard to do. And I don’t really suggest it, but that will be playing a hero. So, the guide comes out and is like, “You know what? I have never carried a patient in your position, doing it through just food. And perhaps there’s things that I don’t know, but someone else would know.” So, then I kind of refer this patient to like a full naturopathic doctor and stuff like that.

And so that is a really good example of you’re actually letting a patient go, but you just provide this patient a lot of value. How do I know? Because two minutes after she left, she gave us a five star review on Google having me just telling her to go see somebody else. Who does that, right? And so it has to do with the value that I provided for her was I connected with her and I wanted her to succeed. I told her, “I really want you to succeed. But guess what? You know what, someone else can do it better.” And that value is just as high as if you put them on a supplement or eating plan or protocol and stuff like that. And that’s what I really want doctors to understand.

James Maskell: That’s powerful. Well, let’s jump into coaching here for a minute because one of the conversations that I’ve really enjoyed with you over the last couple years is where you are literally like on the inside to understanding how CMS is dealing with coaching and what’s changing in that world and how they’re coming around to the value of coaching. And I know some of that starts with your data set. And I guess for you to be in the rooms that you find yourself in where you are sort of connecting, I guess, CMS and Medicare and then the National Board of Health Coaches. I guess, you are in that room because your data set is pretty critical to all of them to understand what’s really happening. That’s my guess. Right?

Dr. Cheng Ruan: Absolutely. So, the national discussions around health coaches and reimbursement. A lot of the legwork has already been done, Margaret Moore, the National Board of Health and Wellness Coaches and the Wellcoaches program. A lot of that stuff was done even before I even knew what functional medicine was, so that legwork was paved. So, our new alliance, which is myself and representatives from like Mayo Clinic, and my mommy’s hospital in New York, UCSD, et cetera, et cetera, we all kind of came together as a coalition.

And this coalition actually looks at, hey, from a federal standpoint, what are the data sets that’s really needed? Hey, what does Mayo Clinic need to put into this paragraph? What do we at Texas Center for Lifestyle Medicine need to put into this documentation to have a convincing factor that a lot of what we’re doing is not only useful, but from a dataset perspective, like millions of patient data set, not like thousands, like millions of patient data set. What does it do from a national standard? And creating the actual national standard. So, I’m very fortunate to be part of this conversation, most of which I can’t repeat right now, but just know that the health coaching movement is only moving forward. It’s really the wave of the current and future. So, and then the second thing that I really want people to understand is that 2023 is even going to be better than 2022. That’s all I can say for right now.

James Maskell: Yeah, that’s really exciting. So, I guess, I think one of the things that you’ve done is like you are a guide and yet you employ guides. So you know that you can do it, but yet you choose to have these other people do it. What do you see as the benefit of having coaching be a discreet role in the clinic? As opposed to an acupuncturist coach, a chiropractor coach, a physician coach, a dietician coach, where some other expert is also playing the coaching role.

Dr. Cheng Ruan: Well, your book is called The Community Cure, right? So part of the being in the community is that people need to have established community first. Because I think the essential tool to communicate with humans in general is to have one path forward. And I think health coaches are that voice of sort of this one path forward. And then, you can have now add-ons for acupuncture, et cetera, et cetera, as part of the main language, that’s really right there. Honestly, doctors are not great at that language. I’m trying to change that right now, but doctors are not great at that language, but the value proposition for the entire community is that no matter what, we will be here for you. It is still your journey, but we will be here for you. We may not have all the answers, but dude, we’re your support team.

And so, that is the community language that really should be established with the patients to drive forward. So, if you look at other types of non-medical stuff. If you look at religious leaders, if you look at Boy Scouts and Girl Scouts and stuff like that, these people act as guides within an actual community. We really need to change that mindset for the doctors to really adopt the same role, as well as a community leader, not just taking care of my patients, et cetera, et cetera. But like, what is the voice to the community really look like? And this is actually scalable in 2022 because now you have remote therapeutic monitoring, you have tech, you have remote bio feedback and all sorts of different gadgets that allow patients to have these tools to really utilize themselves to propel forward.

James Maskell: Yeah, that’s cool. So, you mentioned a few coding areas, and I guess I just wanted to jump into that. And I know you are actively involved in helping doctors kind of run functional medicine or coach based medicine or lifestyle medicine inside the payer system. And that’s obviously, a huge opportunity for scale and for growth of the community. And we’ve spoken about that a couple times already, so far this year on the podcast. So, where do you see the… Like if you’re a doctor really rethinking your next 20 years in practice today. I know I’ve heard you say this is the best time ever to be a physician entrepreneur.

Dr. Cheng Ruan: Ever, yeah.

James Maskell: Now, what can you tell us about how physician entrepreneurs should be thinking about what’s in front of them, and how can you set yourself up for more success?

Dr. Cheng Ruan: Well, it’s very obvious that the country is pretty lost over the last couple years since the pandemic because the main structure of the health economics in this country just went… It’s like the bridge just collapsed. Right?

James Maskell: Yeah.

Dr. Cheng Ruan: And to the government, it’s actually quite embarrassing. So if you looked at the behavior of CMS, Center for Medicare and Medicaid Services, what did they all of a sudden do that we wanted them to do forever? We wanted to make telemedicine a standard of care. They did it. We wanted to make licensure super easy for docs and not like 11 months for me. They did it. We wanted to make reimbursement a whole lot easier. They did it. We wanted to make transparency of healthcare costs transparent for the patient. January 1st, 2022: We did it. No more surprise bills from CMS or for our medical practices.

So, all the stuff that the physician population wanted CMS to do, all of a sudden, just magically happen within a span of four to five months. So, is it surprising? It’s surprising it took this long, but it’s not surprising. Even the American Medical Association, their brand new 2021 CPT and reimbursement guidelines, which is the biggest change since 1993, was proposed in 2016. It was not until the pandemic. They’re like, “Okay, we’ll do it.” Right? Now doctors can bill like lawyers, which means that if you’re spending time, not just with your patient, but away from your patient or talking to other doctors about the patient, just like lawyers bill, you’re actually getting reimbursed by all insurances. Now, how many people know this? Not many doctors know this. But even this morning, I was calling a colleague of mine, who’s a sleep medicine doctor, about a patient. Both of us can actually bill insurance for this patient with Medicare, it’s called interprofessional counseling.

So, there’s so many opportunities that doctors are really missing out on in terms of insurance billing and coding. Stuff like that did not exist before 2021, and so in 2023, by the way, I told you it was going to be better because there’s new surprises coming in, which I’m really excited. And so, from a healthcare entrepreneurial side, we really have to just reexamine what is the opportunity here for insurance in the United States or maybe a hybrid model or something like that that did not exist 2020 and before. And not only that, for the first time, there’s now clauses within reimbursable data, stating that if you collect information and data, even a questionnaire, these questionnaires can actually be billed to insurance. And guess what, if auto text is generating that questionnaire and re-utilizing it for patient behavioral change, that’s its own CPT code.

And so all of a sudden you have this massive explosion of tech that’s able to scale a practice. And for the first time ever, one doctor, instead of taking care of 900 to 1500 patients, one doctor can take care of 10,000 patients. Because this doctor can become a guide, utilize technology information to basically curate paths for the patient.

Now, this is all doctors, it’s not just integrative or lifestyle medicine, but I think the functional medicine, integrative medicine, lifestyle medicine doctors who are trained have a huge leg up because they’re already trained and obsessed, obsessed, about reversing chronic disease. And that’s the value. And I think this is really the time where integrative docs like myself can really take what’s already available and push it into the future. And I shouldn’t say the future, because we’re already doing it here at Texas Center for Lifestyle Medicine. So, push it into the current. And that’s why I created Integrative Practice Builders. So, guys who are interested go to integrativepracticebuilder.com and then… Actually, click on my blog section. I actually talk about what I just talked about far more in detail and see what’s really available for integrative practitioners within the insurance space.

James Maskell: Yeah. I guess that’s such a good point. And, I’m really grateful that you’re opening the eyes of many physicians, like physicians that bill insurance opening the eyes to lifestyle medicine coaching. And then, for doctors who have been doing lifestyle medicine and coaching on how to operate inside the payer system and make it work. Financially, I think that’s a big gaping hole that you’re filling and something that we aspire to help doctors to fill in their own gaps.

So, I guess the last thing I want to just, just touch on and get your thoughts on is… You’re inside this ACO, so you really understand what’s coming with regard to value based care. And I’ve always thought that the kind of moment where functional medicine would shine and functional medicine delivered in a different way would be when we were paid on outcomes, rather than paid on doing stuff. Because it’s easier to do a heart stent than it is to do diet counseling. But, if you can actually change someone’s diet, the outcome and the trajectory is much different and much better. So, tell me a little bit about what you’ve learned from being part of an ACO and what that means for the future of healthcare and how people are going to get paid and what skills will be most valuable moving forward.

Dr. Cheng Ruan: So, value based care is, basically, like you said, part of your reimbursement comes from the value that actually provides for the patient with specific markers. Diabetes: you monitor blood sugars, hemoglobin A1C, look at hospitalizations, admission rates, pre-admission rates to the hospital, ER visits, et cetera, et cetera. So, all the things that are really costing a lot of money for the insurance companies and Medicare to take care of a patient. So, now you have like the Medicare Advantage plans are saying that, “Hey, we’re going to reimburse you based on the value that you provide.” Now it’s not fully just value because, if that was the truth, the doctor can see six patients a day and still survive. That’s not true. It’s still volume based, and so now there’s sort of a intermixed in between.

So, being part of accountable care organizations and IPAs, which is independent physician associations. Because we have the tools to look at our data, I know if my patient gets admitted to a hospital 40 miles away. And then, so I know when they’re about to be discharged and within 24 hours, we’re either doing telemedicine with them or we’re getting them into the office to make sure they don’t bounce back. And we have tech to be able to do that as well. And so, right now, the beauty about all this is that I think integrative practitioners, because we kind of obsess about value anyways, this is sort of our wheelhouse. This is the kind of a thing that we want to track for our practice, and we’re able to validate our services because now I have score cards comparing me against 5,000 physicians. Like what percentile are we?

And so, a lot of this stuff that we did really early on in 2017, beginning of 2018, our scorecard wasn’t that great. Even though, in my head, I thought it was good, but it wasn’t that great. And then that’s when we sort of reinvented the idea of coaching in the group session, and the group session just took our value exponentially higher. And so, that’s why I think that groups will always be a thing. I think that health coaches will be the foundation of not just integrative healthcare, but just healthcare in general. And I think that from value-based care, what we’re already seeing in the Medicare Advantage market, is that these things are actually working, but we expected them to work.

Where we’re going from here on out, 2023 and even beyond, is that a lot of the value-based metrics really need to be tweaked and titrated. For example, no one’s going to be looking at if you reverse rheumatoid arthritis because in their brain they’re like, “Well, you can’t reverse rheumatoid arthritis.” In some people, that’s actually true. You find out the culprit, what’s going on. Or even memory loss, like mild cognitive impairment. And these are things that are actually reversible, we’re seeing it. So, it’s up to the integrative practitioners to redefine what the value is in value-based care from a very global perspective. And that’s what I’m looking forward to.

James Maskell: That’s great. Well, Dr. Ruan, thank you so much for being part of the Evolution of Medicine. We are super excited to see your journey and how you are looking to help other doctors now achieve what you’ve achieved in your practice. And I know that you’re just getting started. We’re excited here at the Evolution of Medicine for that. We’re also excited at your community for all of your thinking about how to make it really easy for doctors to take advantage of these changes. So, we’re super grateful for that. And yeah, if you are listening to this and you want to find out more check out Dr. Cheng Ruan, check out Integrated Practice Builder. And, I think this conversation about insurance will be something that we’ll be having all year and ongoing because, ultimately, if we really want to grow access this type of care, we have to think about new models of getting into the payer system and make it easier for people to access this care.

James Maskell: So, this has been the Evolution of Medicine podcast. This is part of our year of growth. We have a whole series on growth, and we’ve been with Dr. Cheng Ruan. Thanks so much for tuning in and we’ll see you next time.

Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.


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