Nolan Alexander (Host): Welcome to Health Dose. I'm Nolan Alexander, and with me is Dr. Sasha Savage from MyMichigan Health as we talk about family medicine, what it is, how team-based family care works, and why this approach can make a real difference for you and your family's everyday health. Dr. Savage, thank you so much for joining us today. How are you?

Sasha Savage, MD: I'm good. Excited to be here.

Host: We're certainly excited to have you on Health Dose today. And let's establish this. You know, what do we actually mean by team-based family medicine? And how is it different from the traditional model where you mainly see just one doctor?

Sasha Savage, MD: I'll start by going back to the mid-90s when I was in medical school. The model that I was taught at that time was essentially that as the physician, I was going to be responsible for practically everything. I might ask a nurse, for example, to draw a blood test or have someone obtain the vital signs. But functionally, any and everything related to the health outcomes of that individual were going to be my responsibility.

Throughout training, I thought that way, and I practiced that way. And then, when I entered the realm of being an attending physician and responsible for thousands of patients' lives, I realized that I was falling way short of being able to meet those needs.

For example, if I had people come into the office who had diabetes, and they lived in a certain area of town that didn't have access to fresh fruits or vegetables, or let's say socioeconomically, they struggled, all I could do was prescribe them medication. That was it. And I realized that we really needed more people to help those type of individuals.

So, for example, team-based care really comes out of those realizations that we needed someone, probably from the care management realm, to help identify what were the barriers in the home or some of the social barriers that they were facing in their communities that really prevented them from accessing the kind of care I assumed they were already receiving.

For example, the kind of care of access to fresh fruits and vegetables. I made those assumptions. I needed access to pharmacists who could actually follow up with patients in ways that I couldn't, and I needed a new brand of nursing engagement. Our nurses are fabulous, and they have so many skills. And we had not tapped even the smallest level of all that they could do. And so, team-based care really was born out of that recognition that while we had done our best as physicians running kind of a solo show, if you will, it was producing results that were far less than what that individual deserved. And so, the concept of team-based care really took off.

Host: That's a very interesting perspective, and I don't think I was ready for that and given the historical context of your experiences. So, you answered one of my questions, you know, what problems in healthcare is this model trying to fix? And I think scale was one of them, you answered. And with that, why are more clinics and health systems moving toward team-based family care right now?

Sasha Savage, MD: I think that the reason people are moving toward it is the recognition that, without it, we simply cannot achieve the levels of health that our individuals and our communities deserve. So, because healthcare has such a broad scale of responsibility, we realize that we need ever more partnership with people who can help us manage the elements of medicine that simply are not under the domain of a physician.

And we're also recognizing that actually without addressing those elements, we actually won't achieve the kind of care that we need in order to be economically viable as a society. You know, keeping people working, helping them live their best lives. Without this, it's just not possible.

So, I had mentioned earlier diabetes, you know, we talk about heart failure. There are some of these chronic conditions that a physician alone just simply cannot manage, because I cannot attach myself to that individual and go home with them. But a care manager can virtually attach themselves, and they can call them at home.

They can check on, "Hey, did you apply this particular dietary change Dr. Savage talked about? And economically, do you actually have access to the things that he mentioned to you?" Many times the startling reality is we don't, and I did not want to tell him. I'm embarrassed that I can't afford my medicine and I can't afford healthy food. I eat Doritos. I drink Mountain Dew. I don't think that my water is very good. So, that's why I drink so much Mountain Dew. And I just can't do the things he's asking me to do." But then, those wonderful nurses or care managers or pharmacists step into that realm. They build trust with that individual. And before you know it, those chronic diseases are better managed. So, I think healthcare systems and others have really learned this is a team-based approach. Anything other than that simply will not account for all the variables that need to be addressed.

Host: Dr. Savage, you're really spelling out the benefits of this. And you touched on this a little here, so walk me through this, of just common things. How does this team approach change the way common conditions like diabetes, high blood pressure, maybe depression or asthma are diagnosed and managed over time?

Sasha Savage, MD: Yeah, great question. I'm not sure that it changes how they're diagnosed. We know that there are medical criteria for diagnosing high blood pressure or diabetes, but how they're managed, it's radical. I alluded already to this is so much more than just a prescribe a medicine game. For example, let's say somebody comes in and they've got a body mass index of 45, which is not considered ideal for their health. They've got diabetes, and they've got kidney disease that has resulted from that, and maybe they've already started to show signs of heart disease. In times past, just me practicing solo, I would give them medications. There's no way I could address whether or not they had the money to pay for them, nor whether they lived by a grocery store, nor whether they had access to an automobile. Those were domains that I never could engage. And so, I wondered why these people just kept coming back to me every three to six months, and their diabetes was just as bad, if not worse.

Now, factor into it this multidisciplinary team. I can see them and say, "Hey, I noticed that this is going on. I want to put you on a once-a-week shot. These are those GLP medications we hear so much about right now. But I'm going to set you up with a care manager who's going to call you, once or twice every week. Here are the things she's going to be calling you about, and she's going to become your coach through how you adjust your diet the way we talked about, how you live in a low-sodium fashion so that you don't develop heart failure, what the side effects of those medicines are going to mean in real time, and how we navigate them. Got that?" They're like, "Great, so I'm expecting a phone call?" "Yes." That phone call then becomes the lifeline for that individual. And as that care manager is starting to see things, she can either funnel it back to me and say, "Hey, doc, you got to reconsider the medication. We've walked through all of the different measures to offset the side effects that it's having, and they're not working. So, I think it needs to be something different now." "Great. I wouldn't have known that before."

And if in the process of that, the care manager identifies, "Hey, Doc, I'm talking to this person. I don't see it on your problem list. But I think that they're pretty seriously depressed. Have they ever talked to you about that?" And I go, "No, they haven't." "Yeah, here's why. And I learned that they lost a loved one, and some other things have happened that you really are going to need to know about, but I think we now need to bring a behavioral therapist into this, because that is probably the biggest need right now." "Oh my goodness, fabulous."

So see, I still become kind of the quarterback of the team. But every single member of the team is so crucial to understanding the full picture of that complete individual and the environment in which they live. So, that's probably how it changes the management once we've made the diagnosis. Although I have to say, I just pointed out how sometimes diagnoses do manifest themself to me that I didn't know about because the patient has additional conversations with these other team members.

Host: Yeah, Jared Goff can't do it all himself for the Lions. You can't be the only one. He's got to have his linemen, running backs, and receivers, and tight ends too.

Sasha Savage, MD: Correct.

Host: So, this kind of leads me to think that this also helps with prevention, right? Things like screenings, lifestyle counseling, vaccines. I mean, how does this team-based approach help along those lines in prevention?

Sasha Savage, MD: Believe it or not, you just hit on one of the things that we care about the most, and it's also the most challenging. Because outside of, for example, well-health visits and well-child visits, a lot of times, we're not dealing as much with prevention of a disease state as much as we are prevention of complications resulting from poor control of that disease state.

And I would say this, there are so many voices out there in the digital world that a lot of people will come in with ideas that they have genuinely researched, but maybe they've gotten sources that, I don't know, were not the most reputable or were dispensing information that needed to be more clearly understood before it could be applied.

This team-based care builds trust with these individuals. And so, what I notice happening over time is that these individuals then before they will listen to a digital source or an internet source or a podcast source, they will call us. And many times, it's not a phone call to me. They'll call our nurse or the care manager or the pharmacist, and they'll say, "Hey, so and so, this is what I read. Does this resonate with you?" And then, that expert nurse, whoever, can say, "Actually, no, that sounds a little bit off. Let me do a little bit of looking into it myself. How about I get back to you?" The individual loves it because they feel seen, they feel heard, they feel loved. And when you build that type of trust-based relationship, what happens is the care becomes otherworldly.

I'll tell you a brief story. I have a gentleman who's been in my clinic from the time I was a brand new intern back in the late '90s. And when he would come in, there were always some challenges that made the interface with this person difficult. I liked him a lot. But he said to me, "Hey, Doc, you're maybe the one person besides my wife in this whole world who would ever say that you like me," okay? But then, I used that relationship and started to add in team members, okay, as I moved throughout my career and we became more team-based.

As we added those team members in, he began to really look forward to receiving these phone calls checking up on him. He said, "It's like more people are caring about me." And he would look at coming into our office with this lens of positivity. I remember one day about two years ago now, so mind you, I'd been his doc for 26 years at that point. He comes in and he looks at his wife and he goes, "Tell him." She goes, "I'm not telling your story. You tell him." And I said, "Okay, I don't care who tells me. Somebody tell me the story." And this man who had been a very heavy smoker, and I had talked with him about it for years, but always in a way that made him know that whether he quit or didn't, I was still going to care for him, right? I still loved the guy. And pretty heavy drinker of alcohol as well. He looks at me and he says, "I've quit doing both."

Now, I almost fell out of my chair. And I looked at him and I said, "So, 26 years I've known you. What? How did this happen?" And his response was, "Do you know that every time I come in here, you guys make me feel loved? You know my name, you know my story. Your people call me. It's like this is my family. So, who wouldn't change when you have that kind of love around you?"

And I was silent. Some emotion came over me going, "Oh my goodness, this man is reminding me that healing never comes from a prescription. Healing comes from compassion. It comes from kindness. It comes from believing in people. It comes from a place of love." So anyway, that's how we detect early things, even if a disease state is already underway, but we want to prevent some things. That's how we communicate with these folks. It really does change the landscape, and the team is what made the difference.

Host: I mean, if you're looking for a testimony, there's one right there about the benefits of how this has evolved in your career. I mean, that's so special, Doctor, and I can tell that this means something to you. Like, this isn't just a sidebar story. Like, this is authentic to who you are and what your passion is.

Sasha Savage, MD: Yeah, that's right. I think just that's developed over time. I don't know that I can take any credit for it. My patients, the wonderful people who've entrusted me to care for them and who have shared their stories with me over the years are the real heroes in the story because they're the ones that changed the system.

They would say to me, finally, when we had enough trust, "Doc, I can't do what you're asking me to do. And I'm going to tell you some stories about my life and how hard it is." And when they do that, your heart just beats for them, right? You almost can't help it. And so, then, you just want to do better for them.

So really, I look at the wonderful people that I've had the privilege of caring for over these now nearly three decades, and I credit them with the transformation of how we practice medicine in our clinic. It's them that's pushed us to be better.

Host: Well, speaking of changes, things continue to change in how we communicate, right? So, how have you seen tools like myChart, telehealth, shared electronic health records, and now even AI helping care teams communicate better and catch problems earlier?

Sasha Savage, MD: What a great day we live in. I mean... So again, I'll try to keep it as generic as possible. But just last week I was running our hospital service and I had a patient of mine who is getting very weak and toward, kind of the end of life. And I needed to get him back for a follow-up to make sure we had dotted all the I's, crossed all the T's, delivering the care we needed to deliver. And when I communicated over the portal with his wife, she said, "Doc, there's no way. We can't get him in. He's so weak." And what a blessing it was for me to be able to say, "No problem. You've got your cell phone. Let's set up a telehealth visit. We can do everything we need to do right over that from the comfort of your front living room."

The portal, the capacity to do telehealth have unlocked a world of communication with our people that I had never dreamed of before, and it has built ever greater trust. It also creates more work. There's no question about that. But that additional work really just serves as new ways to build trust with these individuals. So, I don't know. I see nothing but upsides for it. It's probably going to challenge the healthcare systems in many ways that I won't necessarily go into today, but building ever greater capacity to handle those new communications as they come in.

And since you mentioned AI, I'll finish my answer to this one by saying that AI has actually now got capacity for us to manage a lot of those questions that come in through some of that artificial intelligence assistance. So, it will enable us to handle an ever-increasing scope of messaging in ways that are unique to and individual to those patients as the artificial intelligence software and learnings begin to understand those individuals and then follow physician guidance on how to message certain answers back.

Final thing, it's brilliant because when I go into the office now, I ask permission and say, "Would you allow me to use my phone to listen to our conversation today?" I don't have to type anything now when I'm communicating with these individuals, and the entire note gets transcribed as we are just having our back and forth conversation.

What that has done is it has unburdened us as providers from so much of the click clacking, right, of typing in the room or trying to remember details later when the day is over and we've seen 22 individuals. None of those things worked really well. Nowadays, the entire note gets populated as I'm meeting with the individual. The people love it. As providers, we love it. It increases access, so we can get more people in. Like I said, it's an awesome day to be communicating.

Host: Well, Dr. Savage, you've given us so much today, and I want to leave you with this last question. If you had to sum up the biggest everyday benefits of team-based family medicine in just a few key points, what would you highlight for patients and their families?

Sasha Savage, MD: Oh gosh, that's a great question. I think I would highlight it like this. The biggest benefits for families and individuals are that you're going to get to know your team. Your trust and your confidence in them will grow. They will get to know you better. And when that magic happens, your trust in the healthcare system will increase, your capacity to remain healthy will grow, your access to good information, trustworthy information will be enhanced. And overall, your health will benefit. You will be better able to manage those chronic conditions. You might even be able to get rid of some of them as you learn the basic lifestyle things that would be most beneficial. You'll understand better how to help your family and your loved ones manage similar conditions or new ones.

So in short, I think it enhances the ability to trust people and to trust a team of individuals that will always have your best interest at heart.

Host: Well, Dr. Savage, thank you so much for spending time with us today. I certainly know way more about a team-based approach to family medicine than I ever imagined. I'm excited for it. So, thank you again for your time and insight today.

Sasha Savage, MD: Thank you very much. I appreciate it.

Host: Looking for care that puts your whole health first? Connect with a family medicine provider and experience the benefits of team-based care designed around you. Visit www.mymichigan.org/doctors.