In this episode of Enabling Health Value, Dr. Julia Flax, Chief Population Health Officer at CoxHealth, shares her insights on integrating advanced primary care, the Quintuple Aim, and Lifestyle Medicine to achieve whole-person health. With over 23 years of experience in family medicine and value-based care, Dr. Flax discusses the evolution of CoxHealth’s approach to patient care, emphasizing the importance of comprehensive, patient-centered models that go beyond traditional disease management.
This interview highlights the impact of Lifestyle Medicine on patient care, the importance of motivational interviewing and building trusting relationships, and how CoxHealth is leveraging its advanced primary care model to transform patient outcomes and reduce costs. Dr. Flax also shares insights on overcoming healthcare challenges, the role of community collaboration in addressing social drivers of health, and the importance of physician wellness. Join us for an inspiring conversation on how these synergies are shaping the future of care delivery at CoxHealth, a leading exemplar in value transformation!
Podcast Transcript (Bookmarks)
01:15 Introduction to Julia Flax, MD, DABFM, FAAFP (Chief Population Health Officer, CoxHealth)
03:30 Dr. Cox has been practicing family medicine at CoxHealth for over 23 years and become their first CPHO in 2020.
05:00 A passion for family medicine and the trust involved in physician-patient relationship.
05:45 Value-based care expands a physician’s medical purview beyond the 1:1 exam room encounter to the entire population.
06:00 Family medicine physicians are the cornerstone of transformed health system (and their voice needs to be heard!)
08:00 Overcoming political division to find fundamental truths and achieve the truest aims of healthcare reform.
08:30 Population health as being integral to the pursuit of happiness.
09:30 The Quintuple Aim as a Rosetta Stone to crack the code in VBC transformation.
10:00 The reactive biomedical model taught in medical school doesn’t prepare physicians to be leaders in transformation.
11:00 We don’t really have a “health care” system in this country. (It is a disease management system.)
11:45 How Lifestyle Medicine (LM) transformed the way Dr. Flax cares for and listens to patients.
12:30 AAFP’s Whole Person Health Champion Project aligns efforts across LM, public health, community, health equity, and whole person health.
12:45 An example from Dr. Flax’s practice of how the whole-person health model is addressing food insecurity in an underserved population.
15:00 How LM is gaining traction for its effectiveness in the prevention, treatment, and reversal of chronic disease.
16:00 LM can empower self-actualization by creating a therapeutic environment that fosters both healing and personal growth.
17:00 The convergence of Lifestyle Medicine and Western Medicine (whole-person care vs. medical reductionism)
17:30 The clinical method of motivational interviewing (MI) evolved from the person-centered approach of Carl Rogers.
18:00 “Quality metrics are important, but we also need to focus on health goals that are most important to the patient.”
18:30 The importance of social connection and how Blue Zones should inspire us to a higher standard of health.
18:45 “The Japanese term for “purpose of life” is Ikigai. We need to capture this with our patients.” (How Ikigai Can Help Us Live Longer)
19:30 How Dr. Flax’s training in LM inspired the redesign of primary care into a value-based model at CoxHealth.
20:00 The effectiveness of motivational interviewing in improving patient care.
20:45 Rejuvenating the love for primary care through Lifestyle Medicine! (Highly recommend resources at ACLM and AAFP)
21:30 Access to advanced primary care = better health, timelier diagnoses, more prompt treatment, fewer ED visits.
22:45 The U.S. spends only 5-7% of its healthcare dollars on primary care — less than half of the 14% average in Western European countries.
24:30 “There are no RVUs for compassion and taking the time to develop trusting relationships that are so important for health outcomes.”
25:00 Accessing capital to build an infrastructure for advanced primary care and population health management.
25:15 Dr. Flax discusses the Chronic Care Management (CCM) and Transitional Care Management (TCM) programs at CoxHealth.
26:00 Advanced Illness Care Management – the importance of palliative care and Advanced Directives at the end of life.
27:00 Population Health Department – how the work it does decreases administrative burden and improves quality performance.
28:00 The success of pharmacy integration as a part of CoxHealth’s advanced primary care model.
29:00 Committing resources for behavioral health as part of its overall population health focus.
30:00 “Our population health team is basically an advanced primary care model.”
30:30 CoxHealth has improved patient health outcomes, lowered costs/utilization, and driven physician satisfaction through VBC.
31:30 An overview of CoxHealth’s value journey since 2014.
34:00 Adopting VBC as a strategic pillar for the health system, participating in the Next Generation ACO program, etc.
35:00 Capturing data on social drivers of health through Z-codes.
35:30 How longstanding, successive wins in population health ultimately changed the mindset of the physician network.
36:00 Navigating population health management during the pandemic.
37:00 Evaluating participation in new CMMI models and how to explain “Population Health” to others.
38:30 How do you measure health? Patient stories are just as important as Qualitative/Quantitative results.
40:30 Physician burnout – how it is affecting over half of all physicians in practice and contributing to depression and suicides.
43:00 “Never showing weakness as a physician didn’t serve me well over the years.”
43:45 How physicians are averse to seek counseling for fears that they will lose their medical license.
44:00 The need to be open and vulnerable with your physician colleagues.
44:30 How CoxHealth supports physician wellness throughout the health system.
45:00 Getting past the unrealistic expectations that physicians must be resilient above all else.
46:00 Importance of Self Care: “If we are not functioning at our fullest, we are not there for our families, friends, and definitely not our patients.”
47:00 The synergistic connection between VBC, advanced primary care, Quintuple Aim, LM, whole person health.
48:00 The dispersion of clinical leadership in an interdisciplinary, team-based care delivery model.
50:00 How collaboration within teams and between health systems and communities drives whole person health.
51:30 Collaboration with CBOs and public health organizations.
52:30 Collaboration in data sharing.
52:45 Collaboration with other health systems and school systems in the community.
54:00 The end results of merging health care and public health (e.g. community health and equity, accountability, physician wellness)
55:45 Parting thoughts and an optimistic vision for the future!