Medicine, disrupted

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 issue.

Our system is siloed, fragmented, patriarchal, impersonal, episodic and completely disconnected. A sick care system. The turbulent forces of 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 Netflix, on demand, anytime, anywhere. What we desperately need is a new “operating system” for healthcare. One that is predictive, preventive, personalized and participatory (P4 Medicine).

Enter Functional Medicine 2.0 — a centuries old method of root cause medicine now with a fresh, 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 articulates the need to shift from a symptoms/disease centered focus of medical practice to a systems oriented, patient centered approach. And shouldn’t we all be thinking of humans as holistic beings with complex ecological systems, rather than just focusing on a collection of organs?

Maskell brilliantly couples the need to solve the problem of chronic disease with a viable economic practice model that positively impacts 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 creation 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, the functional medicine framework is “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, movement 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.