HJNO Sep/Oct 2024

HEALTHCARE JOURNAL OF NEW ORLEANS I  SEP / OCT 2024 29 informatics, surgical guidance, or advanced clinical knowledge about the disease states and complications. In other words, it takes a team. And every great team needs a coach. The best physicians I know are mostly hum- ble, are not afraid of measuring and holding themselves accountable for the outcomes they co-produce with patients, and never tire of finding opportunities to improve those out- comes. The quote above by former NFL Hall of Fame defensive back, Ronnie Lott, sums it up the best. Our healthcare system would be much better if we could substitute the word “coaches” in that quote with the word “phy- sicians,” where physicians view their most im- portant role as leading and coaching a team of talented people, and where the patient is the most important member of that team. To this end, I can think of no finer “head coach” than the physician who leads the Crohn’s and Colitis Center, Casey Chapman, MD. He leads a group of assistant coaches and players that in- clude some uniquely talented individuals. They include Randee Kidder, a nurse practitioner (NP); Courtney Robert, a licensed clinical social worker (LCSW)/behavioral therapist; and Hart- man Brunt, MD, a condition-focused internal medicine physician and clinical informaticist. And I would love to give them the opportunity to tell the story of how they are collaboratively co-producing clinical excellence and differen- tiated outcomes for their patients with IBD. Casey Chapman, MD Working each day to see disease as it’s seen through the eyes of a patient can provide not only the most powerful insights but also the continued motivation needed to battle for the delivery of a personalized plan of care, ultimately leading to better quality of life and inevitably better outcomes. At the Crohn’s and Colitis Center, we focus on inflammatory bowel disease, a disease defined by two subtypes, Crohn’s disease and ulcerative colitis, and typi- cally diagnosed in the second and fourth de- cades of life only to become a lifelong disease. operational leaders at this health system who put the health of these patients ahead of pure financial performance. Having said that, these leaders would be violating their fiduciary obli- gation to their organization if they did not fig- ure out a way to make the clinic financially via- ble and sustainable. Therefore, they employed advanced financial calculus to make use of cre- ative ways of financing the clinic, utilizing gov- ernment programs, downstream revenue from colorectal surgeries, and imaging studies, in addition to traditional fee-for-service payment. The center understands that helping people attain their optimal state of health is not sim- ply a function of better prevention or greater attention to wellness principles like eating healthy and exercising more. While these prin- ciples are an important component of health, they are insufficient if they are not deeply embedded in a holistic model of care. I recall a conversation with Al Lewis, author of “Why Nobody Believes the Numbers” and “Surviv- ing Workplace Wellness.” In the distant past, Al Lewis was a proponent of workplace well- ness solutions aimed at trying to keep people healthy. He is now this industry’s biggest critic because, as he explains in his books, they fail miserably at reducing cost of care and generat- ing a return on investment for employers who invest in these programs. The specific conver- sation he and I had was about the possibility of embedded behavioral health services be- ing able to reduce the incidence of avoidable surgeries. He initially scoffed at the idea that behavioral health could reduce the need for surgery but then promptly reconsidered his opinion when offered the evidence of mental health counseling being able to reduce some of the many surgical complications of IBD. Like the cardiometabolic conditions, the very best care for IBD is not only the best care for pa- tients, but also less expensive than poor care. Achieving clinical excellence in IBD is not possible without integrated behavioral health, nutritional support counseling, attention to nursing detail, pharmacy assistance, clinical This entire series on changing the care of chronic conditions thus far has focused almost exclusively on cardiometabolic disease. We started with hypertension, diabetes, hyper- lipidemia, and then worked our way through obesity, metabolic dysfunction-associated ste- atotic liver disease, and chronic kidney disease, introducing the relatively new concept of car- diovascular-kidney-metabolic syndrome along the way. The common theme across all these conditions is that the outcomes produced by traditional mechanisms of healthcare delivery are mediocre at best. But the other common theme is that achieving differentiated clinical excellence in the management of these condi- tions is possible. To that end, the biggest bar- rier standing in the way of clinical excellence is not the traditional notion of “patient non- compliance or nonadherence,” but rather the failure of payers to offer and providers to adopt innovations in how healthcare is both financed and delivered. In situations where innovations in financing unleash the power of innovation in how healthcare is delivered, clinical excel- lence can become the normative standard. In this article, we will focus on a different dis- ease state — inflammatory bowel disease (IBD). And, although I am employed by a competing health system, in the spirit of being unbiased and out of devotion to the pursuit of clinical excellence, I would like to tell the story of the Crohn’s and Colitis Center of Baton Rouge General Medical Center. This clinic exempli- fies everything that we have written about thus far in this series of articles. They utilize a team-based approach characterized by diverse knowledge domains with integrated behavioral health, nutritional support counseling, data science, information technology expertise, ad- vanced practice nursing, and physician leader- ship. They offer patients longer appointments that nurture collaborative, trusting relation- ships. If the clinic’s financial performance was fueled only by traditional fee-for-service financ- ing offered by commercial payers, they would have failed long ago. Fortunately, there were “Great coaches lie awake at night thinking about how to make you better. They relish creating an environment where you get more out of yourself. Coaches are like great artists, getting a stroke exactly right on a painting, except they are painting relationships. Most people don’t spend a great deal of time thinking about how they are going to make someone else better, but that’s what great coaches do.” – Ronnie Lott, NFL Hall of Fame Defensive Back