By Sameer Berry, MD, Chief Medical Officer at Oshi Health
As the popular saying goes, the most direct way to a person’s heart is through their stomach. Unfortunately, new research and evidence across the healthcare community is showing that our stomachs are suffering like never before.
One in four adults of working age are coping with a chronic digestive health issue. One of the most prevalent gastrointestinal (GI) disorders, irritable bowel syndrome (IBS) ranks as the second leading cause of absenteeism in the workplace, only trailing the common cold, and goes undiagnosed all too often and for far too long.
Yet recent evidence and innovations offer hope. New diagnostic pathways, therapeutic interventions, and digitally-enabled care models have the opportunity to help millions of Americans reclaim their lives from these painful, debilitating, and stigmatized conditions.
Digital health first
The pandemic demonstrated that a significant amount of GI care is conducive to a virtual interaction. In many cases, a virtual-first approach is more optimal than in-person care since it allows for numerous touch points with the patient and on-demand access to care.
As provider shortages drive unprecedented wait times to be seen in-person, digital health also goes a long way in supplementing face-to-face care – with the ability to triage which care can be handled virtually, while coordinating cases that require in-person expertise.
Dietary interventions are especially well-suited to digital health, where people can have more frequent check-ins with a registered dietitian and share analytics on food and symptom tracking that is very cumbersome to do in an analog format.
Anyone who’s tried to change their diet knows how hard it can be. And for people with digestive health issues, diets can be incredibly restrictive and difficult to implement and maintain. One common dietary intervention used in gastroenterology is the low FODMAP diet, which eliminates a broad category of foods likely to cause GI symptoms and can be a difficult diet to pursue alone. Working with a registered dietician allows patients to quickly identify triggers and shift gears to different therapies if this particular diet doesn’t work.
Working the gut-brain axis
Most people don’t realize that there is a separate nervous system that exists in our gut – the enteric nervous system. These “gut nerves” respond to the same environmental stressors that cause us to feel anxious or depressed, but instead cause GI symptoms. When the signaling between the gut and the brain is dysregulated, the best approach is to utilize therapies proven to help hypersensitive nerves. Unfortunately, many patients continue to receive medications and procedures that target only the digestive organs, but ignore this enteric nervous system which is the root-cause of their symptoms.
Specialized GI psychologists (yes, these people exist!) will draw from a broad, evidenced-based clinical toolkit to help rewire the gut-brain axis to control GI symptoms. These include specialized cognitive behavioral therapy, gut-directed hypnotherapy, and diaphragmatic breathing.
Bringing it all together
There is growing consensus in the medical community that the future of multidisciplinary GI care relies on an integrated approach. An integrated care model brings together all the specialists required to address the patient’s needs, working collaboratively for the same organization. In gastroenterology, this may include the gastroenterologist, nurse practitioner, GI dietitian, GI psychologist, and health coach – all working together on the same iterative care plan.
A critical component of integrated care is a specialized focus on only one condition area. In integrated care, dietitians, psychologists and health coaches spend all day treating only GI symptoms and therefore develop an expertise and deep understanding in how to address the unique needs of these patients. This level of clinician specialization is nearly impossible to find in traditional care; even when patients have access to dietitians and psychologists, these providers rarely focus just on gastroenterology.
Integrated care also enables patients to “parallel process” and benefit from the combination of medical, dietary, and behavioral interventions simultaneously. This is in stark contrast to traditional care models which typically layer these interventions one after the other in a sequential manner. The growing raft of digital health tools emerging to help support patients will finally enable a convenient patient experience while also broadening access and allowing physicians to practice at the top of their license.
Payment models need to adapt
Despite their clinical effectiveness, both dietary and behavioral interventions are underutilized in our healthcare system due to lack of access and antiquated payment models. Today’s payment models were designed when we had a very limited understanding of digestive disease and have not kept up-to-date with the latest evidence of effective gastrointestinal treatments. It is absolutely mission-critical that we think creatively to develop new and innovative reimbursement models in gastroenterology. Patients are ultimately the ones who suffer while we fail to unshackle ourselves from today’s nonsensical payment structures.
The current system provides coverage and reimbursement for dietary and behavioral interventions for certain indications like diabetes and depression, but not for GI-related indications. While we wait for the long anticipated shift to shared savings, shared risk, subcapitation, bundled payments, or some other type of value-based payment – we must work within today’s time-based payment models to enable coverage for dietary and behavioral services in GI.
Virtual care providers focused on gastroenterology are working with forward-thinking health plans and self-insured employers to expand coverage and develop innovative payment models to help more patients. But this is not happening fast enough, despite overwhelming evidence that providing these services provides a net ROI, improves healthcare outcomes, and reduces unnecessary cost.
Innovation proliferating in GI
The pandemic necessitated an acceleration in digital transformation across healthcare. In gastroenterology specifically, we are seeing the rapid emergence of more robust, AI-powered mobile symptom trackers, FDA-approved digital therapeutics, and at-home diagnostics. Speciality-specific virtual care companies have purpose-built technology to provide high-touch care, connecting patients to a truly integrated GI care team from the comfort of their home. These digital health tools are being designed from the ground-up to improve access to the latest evidence in GI-specialized care with a focus on convenience at significantly reduced cost to patients.
New options are meeting an eager audience: People are increasingly open about their health issues – from mental health to infertility. High-deductible plans are driving educated consumerism in healthcare. There is growing awareness of food as medicine. Most importantly, people are tired of feeling unwell and not getting answers.
For the millions of Americans struggling with their digestive health, this rising tide of innovations is exciting. As physicians and healthcare leaders, it is our responsibility to seize this opportunity and radically transform the way we care for our patients and our communities.
In addition to his role redesigning gastrointestinal care delivery as Chief Medical Officer at Oshi Health, Dr. Sameer Berry is a gastroenterology & hepatology fellow at the University of Michigan and co-host of Healio’s Gut Talk podcast with Dr. Bill Chey. He is active on Twitter @sameerkberry.
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