plm institute - the functional medicine operating...

The Functional Medicine Operating System Texas Center for Lifestyle Medicine

Cheng Ruan, MD

July 2017

1 month later...

What to do?

Well that sucks...

Hurricane Harvey Emergent Pivoting OperationsBusiness Pivoting

- Fixed costs

- Marketing

- Financial projections

- Patient care

- Employee layoffs

- Employee reassignments

- Lawyer fees

- TELEMEDICINE

- GROUP VISITS

Personal pivoting

- Remediate house

- Personal expenditures

- Managing the kiddos

- Flood insurance

- SBA loan

- Personal finances

- Move in with parents (AGAIN)

- Remediate parent’s house

- MINDSET SHIFT

COVID-19The Straw That Broke The Camel’s Back.

How the response to COVID-19 revealed the ugly truth

about global healthcare systems.

The Classic Medical Model

Patient Doctors

Insurance

Other Doctors

Rift Between Patients and Doctors (Traditional)Patient’s Experience

- Expensive

- Limited Accessibility

- Waiting times

- Confusing insurance coverage

- Confusing prescription coverage

- Overpromised, Under-delivered

- Avoidance of doctors

Doctor’s Experience

- Frowning waiting rooms

- “Difficult” Patients

- Uneducated in billing codes

- High liability = Defensive Med

- Insurance Denied Claims

- High Fixed Costs

- Burnout

Text COVID to 773-770-4377: 2020 CPT Code Updates

Text COVID to 773-770-4377 to get free PDF

Rift Between Patients and Doctors (Cash)Patient’s Experience

- Expensive

- Limited Accessibility

- Waiting times

- Resentment of Having Insurance

- Confusing and complicated

- Overpromised, Under-delivered

- Doctor shopping

Doctor’s Experience

- “Difficult” Patients

- Question explosion

- Uneducated in marketing

- Complexity inhibits progress

- High demand from patients

- High expectations

- High Fixed Costs

- Burnout


Rift Between Patients and Insurance CompaniesPatient’s Experience

- Expensive

- Confusing

- Co-pays, Deductibles, 80/20

- “It SHOULD be covered”

- Resentment

- Scared of NOT being covered

- Filing appeals

- Filing superbills

Insurance’s Experience

- Expensive

- Confusing EOBs

- Appeal delays

- Lots of phone calls

- Denial of benefits

- Increasing premiums

- Coverage gap (ie: the doughnut

hole)

- Promote generic Rx

Text 773-770-4377: 2020 CPT Code Updates

Rift Between Doctors and Insurance CompaniesDoctor’s Experience

- Denied claims

- Billing contractual obligations

- High fixed cost

- In-network contracts difficult

- Rely on ACO

- Inaccessibility

- Coding complexity

- Square peg into round hole

- Peer to peer reviews

Insurance’s Experience

- In-network contracts

- Delays in reimbursements

- Denials and appeals lower cost

- Changes in fee schedules without

notice

- Authorization for generic Rx

coverage

- EOB layout: “You may owe”


Doctors Transitioning to Cash and Hybrid Practices- No marketing experience

- Guilt of “leaving behind” patients

- Tends to promise a higher level of care

- Complexity is the enemy of progress

- High demand patients

- One foot in, one foot out

- Resentment from other doctors, patients, and public

- Lack of understanding of finances


The Classic Model

1:1 in-person visit

- Perfect for personalized prescriptions

- “I’ll see you in 3/6/9/12 months”

- Power is in the prescription

- Transfer of value is unidirectional


Creating a Bidirectional Interface

Current Healthcare CrisisCurrent challenges in medical care:

- Lack of motivation

- Impaired communication

- Limited community resources

- SOCIAL ISOLATION

- Lack of COMMUNITY

- Lack of RESPONSIBILITY

- Lack of RESOURCES

- Disease identification rather than Individualized approach.


Group VisitsPros to enjoy

- Build Your Tribe

- Better outcomes

- Improved Compliance

- Maximize time for provider

- Health Coaches can lead

- Patient Satisfaction

- Improved referrals

Challenges to overcome

- Difficult to set up

- Hard to market

- Patient buy-in

- HIPAA Concerns

- Documentation complexity

- Hard to hit CPT codes

- Hard to document ICD-10 codes


Group Visits


Telemedicine Visits


Remote Patient Monitoring


Remote Patient Monitoring- Digital monitoring defined by CMS

- Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose

monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the

physician or other qualified healthcare professional, qualified by education, training,

licensure/regulation

- Providing patients with ongoing communication with lifestyle medicine

and allied health specialists- Life and Health coaches

- Lifestyle medicine providers

- Medical Assistants

- Mental health specialists


Track it to hack it:- Encourage communication between patients and providers.

- Encourage interprovider communication.

- Track vitals, habits, and outcomes.

- Deliver performance data to the patients’ providers

- Provide encouragement and support for patients.

- Ensure compliance with diet, lifestyle, medication compliance.

- Ensure compliance with preventative health services (annual wellness,

colonoscopy, bone density, etc).

- Create a community by sharing struggles as well as success.


Texting is the Best Form of Messaging

Emergency Notifications


Injecting Functional Medicine Into Current ModelsFunctional Medicine points of entry:

- Remote Patient Monitoring

- Telemedicine

- Primary care and specialist referral source.

- Advocate for patient outcomes

- Tech development for data API

- Hospice care

- Nursing Home, Assisted Living, Senior Communities

- Insurance Based Programs (DSMES from ADA, DPP from CDC)


The 4 love languagesWords of Affirmation?

Quality time?

Receiving Gifts?

Acts of Service?

Physical Touch?


Questions?

Email: [email protected]

Facebook: Cheng Ruan, MD

Instagram: cheng_ruan_md

Twitter: @theruanway


mailto:[email protected]

plm institute - the functional medicine operating...

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