Join us for an enlightening conversation with Dr. Robert Groves, Executive Vice President and Chief Medical Officer at Banner|Aetna. We'll explore their innovative partnership with Virta Health, which has led to remarkable outcomes in Type 2 diabetes reversal and sustainable weight loss. Dr. Groves will share insights on how this personalized, nutrition-first approach is transforming lives, reducing medication dependence, and setting new standards in diabetes care.
Robert Groves, MD, CMO EVP, Banner Aetna
Megan Antonelli, Chief Executive Officer, HealthIMPACT
Welcome 0:01 Welcome to Digital Health talks. Each week we meet with healthcare leaders making an immeasurable difference in equity, access and quality. Hear about what tech is worth investing in and what isn't. As we focus on the innovations that deliver. Join Megan Antonelli, Janae sharp and Shahid Shah for a weekly no BS, deep dive on what's really making an impact in healthcare.
Megan Antonelli 0:30 Hi. Welcome to Digital Health talks, where we explore the cutting edge of healthcare innovation. I'm your host, Megan Antonelli, and I'm here today with Dr Robert groves. Dr groves has been on the show before, and we're excited to have him back. He is the Executive Vice President and Chief Medical Officer at banner. Banner. Aetna, Hi, Dr gross, how are you? Hi, Megan. It's good to be back. Good to see you. Yeah. So we are here to talk about a topic, you know, that is really on everybody's minds. And I know I recently saw an article around, you know it, have we seen the peak of obesity? Because I think the numbers, and we're seeing actual for the first time in a very long time, obesity numbers are going down in this country. So, and you've done a lot of work at at banner Aetna around this. So tell us a little bit about one your role and the work there, but, but mostly about that program.
Robert Groves 1:29 Yeah. So I hope that we have reached the peak of the obesity epidemic. It is certainly as high as anyone in their right mind would want to ever see it get and if you talk about metabolic disease, which includes, of course, the metabolic syndrome, which is associated with truncal obesity, high triglycerides, hypertension, you talk about pre diabetes, which is that stage of hyperinsulinemia before The onset of full blown diabetes, it's basically a continuum of metabolic dysfunction. So pre diabetes is not normal. Then you can talk about diabetes, of course, and then obesity, all of those are metabolic dysfunctions that affect half of the population. So one hopes that it has peaked, and there have been a number of efforts ongoing over the last several years. It's been in the news. We've been talking about this. We've implemented programs to address this, like at bantarena, for example, Virta, the Eco which includes the banner, Etna kitchen. We have all of these programs to try to address this. And then, of course, the advent of GLP ones, and what that means. And so it may be that this combination of things has started to impact the population overall. There's one more thing that we're seeing increasingly, and that is the food industry, in very small ways, beginning to respond, to understand that Americans are starting to look at all the additives in their foods, and they're starting to ask questions about what we're being fed, if you will, by by the food industry. So perhaps all of those things are starting to have an impact. That would be wonderful. I think it's too early to claim victory, and as long as we have that many people suffering from these metabolic derangements, which lead to heart disease, kidney disease, Alzheimer's disease, all of the chronic diseases that we're struggling to pay for, many of them have their roots in these metabolic derangements. So I hope we've reached the peak, but I think we've got a lot more work to do to see a bright future.
Megan Antonelli 3:45 Yeah, no doubt. It's really, it has been interesting to see. And I think, you know, with GOP ones, and, you know, just the, you know, everybody's talking about it, right? It is in the news. There is a lot of awareness, but that awareness has taken obesity from what was sort of a personal choice problem to a metabolic disease, and I think that that's, you know, a shift in the dialog that is an important one. You know, what are your thoughts and in terms of, you know, kind of people's awareness and acceptance of some of these treatments. Yeah,
Robert Groves 4:24 well, you know, there are two sort of counter regulatory for lack of a better term influences going on. One is the and I think the good effort to not stigmatize obesity, to not discriminate against folks who are challenged with metabolic derangements and and not categorize them as something less than and that's been, I think, a positive thing for those who struggle with this. And part of that has been recognizing that there are. External factors and genetic factors that predispose folks to encounter metabolic disease in their lifetimes, and that it's not it's not just a function of willpower. You know. It's not like, you know, if someone is obese, it's there. They're not as good a person as I am because I'm skinny. That's just not the case. There are external influences. There are genetic factors. This is, in fact, a disease, and the fact that it now affects half the population is remarkable. I myself have pre diabetes now. I have the advantage of it not showing right. Obesity is apparent to everyone. Pre diabetes, and often diabetes is not visible to the external world, so we tend to suffer less of that stigma, if you will. So I think while it has been positive to say you should not stigmatize, I think we still need to recognize that for most people, you know, a BMI of 30 or above isn't healthy, and it comes with a variety of health risks. And so our our goal is, just like we would address somebody with heart failure, we want to get them on the right meds, the right programs, the right lifestyle strategies to address that physical problem. The other thing that I'll say that I've said over and over again, our everyday habits are far more powerful than any drug now. GLP ones are a phenomenal breakthrough, don't get me wrong, and I think they have a place, a big place, in our armamentarium to fight this epidemic of metabolic disease. But we need to remember that each time in the past that we have relied on a magic bullet to solve our problems, we've been disappointed. And so if you're thinking that GOP ones are going to solve the obesity epidemic, I would suggest that that's not the case, and used inappropriately without a change in the daily habits and healthy strategies that we know work, I think we're going to be very disappointed in the outcomes. So I'm delighted that these drugs exist. I wish they were much cheaper. I think they can be. But overall, we've got to continue to address the underlying behaviors and habits that drive metabolic dysfunction. And part of that, by the way, is what does the food industry make available to us? How easy is it to eat healthy? How convenient? How inexpensive, etc, is it to eat healthy? And we need to address that too in a big way.
Megan Antonelli 7:39 Yeah. I mean the food, the food is medicine and food, you know, that movement and the importance of that can't be understated, you know. And I think the moving of the needle, I you know, when I think about what you said in terms of, you know, the food industry actually playing, playing a role in this, you know. And over the years, it has gotten better, right? I mean, particularly if you think of accessibility to good foods in in places that they haven't always been, you know that that that has gotten better and and, yes, I mean, I you know some of the fast food even getting better, and that being more available to people and offering healthy choices to at least create awareness. But tell us a little bit about some of the other programs, like the Virta health program that that you mentioned. What? What does that, you know? What makes that unique? Tell us about, you know, banners journey with that.
Robert Groves 8:37 Yeah, you know, the Virta premise is, is pretty simple, but remarkably powerful. And their premise is this, if, if carbohydrate intolerance is one of the primary markers of metabolic disease and the primary drivers of metabolic disease, are there ways to eat a healthy diet with much less carbohydrates. And by the way, carbohydrates are not intrinsically bad, but once you get to the point that you have pre diabetes or diabetes or one of these metabolic diseases, they fuel the fire of worsening disease. So and you know, we don't understand all of the mechanisms that got us here. We know that food additives have something to do with it. We know that the massive amounts of sugar that we consume have something to do with it. But Virtus premise was very simple. Is there a well formulated low carbohydrate diet and lifestyle strategy that can address this. And by the way, they've been out there for 10 plus years. And one of the things I liked about them was, from the very start, they started with the science. They started by doing a study and saying, Let's study this in real people. And it was, I think, sponsored the University of Indiana. They had some very. Very well credentialed physicians that were part of this, and what they discovered was, yes, it can work and and simply by changing the diet, they were able to reverse that inexorable progression of diabetes that I was taught about in medical school. You know, I was taught that diabetics are going to get worse over time, you're going to have to increase their medication. This will end up in stage at some point, there's really nothing you can do except tell them to eat better and exercise. And we see how that worked. It didn't and so Virta has a very hands on approach, and it's interesting to speak about a fully technologically enabled company that's remote and virtual as hands on, but they use a process that I think the term Sami Incan and coined was continuous remote care. And what that means is, I did the program for pre diabetes. And what that meant for me was, first of all, I had a comprehensive intake with a physician who tried to understand my motivations so they could help me stay on track. They tried to understand if there were any contraindications. They tried to understand my commitment. And then when they let me into the program, they assigned a coach specifically for me, and I have contacts with that coach on a you know, for the first part of the program, it was literally a couple of times a day because questions come up in real life. They often are forgotten. When you're in the physician's office for that 15 minutes, you're not going to see them again for three months. Things get lost. So the ability to have contact with my care team every day of the week and ask those simple questions like, oh gosh, I'm stuck on the road. All I've got is McDonald's and Wendy's. What do I do? And there are strategies that you know you don't want to make that part of your regular diet, but there are strategies to keep on track in terms of that low carbohydrate strategy, even when you're on the road and don't have a lot of good options, and having that support from the beginning was key. The other thing that I think they do very, very well is they have a community. There are there are videos that I can access to educate myself on the science behind a low carbohydrate strategy. There's a community of users that share tips and tricks and recipes and so forth. So there's this feeling that I'm not in it alone. I've got continuous access to an expert to help me navigate this trouble, and ultimately, what it led to was my ability to stay connected to the team and on the diet over the long haul, and it dramatic, you know, it eliminated evidence of prediabetes. I think if I went back to my old habits, you'd see it come back. But I've got a strategy that works for me now. And we've had hundreds, literally, of patients who give us the same testimonial. And there's published literature showing that up to 60% of diabetics, all comers from all walks of life, that engage with this program for a year. 60% of them come off of all anti diabetic medications, and these are full blown diabetics, not pre diabetics. The only exception of that is Metformin, because Metformin is used for a variety of other purposes, but that is a remarkable accomplishment. They also demonstrated that meaningful weight loss is part of the program without counting calories or doing anything special, just changing the diet, changed the hunger level, if you will, in these patients. And so they lost, you know, 1112, 13, 15% of body weight over a year's time, and finally, it decreases the cost. I mean, if you eliminate the cost of those medications, you've done a real favor for those individuals. They might have to buy a new wardrobe because their clothes won't fit anymore, but usually they're not too upset by that, because they have the money from what they're not spending on these expensive medications.
Megan Antonelli 14:04 So tell us, what is that, in terms of the coaching program, what does that look like? Is it, you know, team, or is it a community? What is what does it look like? Yeah, yeah.
Robert Groves 14:17 So I had an individual Coach assigned to my particular case. And first of all, they're available to me anytime. I can text message them. There's an app, and so I can text message them and say, Hey, I got a question. I can set up an appointment with the physician if I have something more complex that I want to talk about. And by the way, if I'm not in contact, they'll reach out to me and say, Hey, is everything going okay? Want to make sure you're all right, you know. And and then on the app, as I mentioned earlier, there's a whole community, so I can reach out to other users if they have recipes that I want to look at. And there's a tremendous amount of education, you know, when people. And verta doesn't like to call it this, but it's a ketogenic diet. That's what it is. And people have, you know, they think, Oh, that's a fad, or they think that's impossible to stay on. They think nobody can do that. And what verta has shown that is that that's not true. A well formulated ketogenic diet is both healthy over the long term, and by the way, they tracked cardiovascular risk factors over the long term and did not see an increased risk in cardiovascular events. They did not see an increased risk in cardiovascular risk factors. In fact, the opposite is true. They saw a decrease. There are exceptions to that. It's not for everyone. There are some that are hyper responders, that can have a spike in their LDL. It's not clear what that spike means, because we're getting more sophisticated about understanding the role of LDL and whether it's dense LDL or not dense LDL. I don't want to get into all of that, but the bottom line is, there's no increased risk of cardiovascular disease in the peer reviewed, published studies that they've done so far, and then they also discovered that it can have profound impacts on lots of other aspects of mental function, of sleep apnea, all of these things that go along with a reduction in obesity and a reduction in metabolic derangements, has a profound impact on the risk of multiple chronic conditions long term. And so that coach was my coach. And what surprised me most about the program is how flexible it is. I always thought, oh my gosh, I'm on a ketogenic diet. I gotta eat bacon, eggs and steak every day. And that's not the case at all. There are lots of options out there now for different cuisines, even, you know, Asian, Mexican, you can find strategies that are customized to the individual, that make the diet palatable and sustainable long term. And that's what I found, is it was customized to my needs in real time, and with that constant availability of advice and support when I needed it to stay focused? Yeah, absolutely.
Megan Antonelli 17:08 And that's so important in terms of like, so you say there's customization. Like, how does that personalization of the approach work? So if it's predominantly diet, how is it bearing between patient to patient?
Robert Groves 17:23 Well, you know, I'll give you a couple of examples. When I started it, it, you know, I wanted to be pretty strict, because I wanted to get the benefit of the diet pretty quickly. And so I was strict in staying and, you know, measuring my ketones religiously and and understanding what foods kicked me out and which ones didn't, and that varies from person to person, and it varies by age. Carbohydrate tolerances vary over time with activity and age, and so you have to factor that in and and measuring that over time and sharing those measurements with my coach allowed us to understand what works and what doesn't work for me. And so, you know, I can eat yogurt, I can eat avocados, I can eat onions, I can eat tomatoes. Not everybody can. I didn't eat them initially because I wanted again to establish that effectiveness. But I've learned over time that I can expand my palate significantly without kicking myself out of the beneficial effects of the diet. And so that takes time, and but if you stick with it, then you can find a place to settle that doesn't require you to eliminate those things you love. For example, there are strategies for rice that allow me to have rice like food that I've begun to enjoy now, it's rice cauliflower, and it's amazing how effective that is in substituting for white rice, which is a tough one for folks who are carbohydrate and tolerant. The bottom line is too much carbohydrates, especially those simple carbohydrates are toxic for folks who have already crossed that line into pre diabetes and diabetes. And I, you know, how we got there is a whole nother matter. But once you get there, you know, excess carbohydrates, excess simple carbohydrates, you got to avoid them. And I found strategies for every now and then having ice cream, you know, and every now and then having pizza, you know, I didn't have to sign up for life to never, ever eating the foods that I love again. And I'll tell you something else that fascinated me and surprised me. My tastes have changed so much over time. I am absolutely averse to foods that are too sweet now it they don't taste good to me anymore, and that was a shock to me. That was a surprise, because I've loved my chocolate milkshakes for as long as I can remember, and now I have no desire to do that anymore. And so that was a not only surprising, but gratifying. That over time, my body adjusted its desires to a much healthier strategy. And by the way, I don't want to exclude exercise here, because when I started to feel better, I started to feel like exercising more. And we know that exercise is one of the most important strategies for reducing the risk long term of chronic disease for improving insulin sensitivity, so that you don't, you know, you know, if you exercise a bunch, you can tolerate a lot more carbohydrates. I'll put it that way. So, you know, it's a two prong strategy, and the coach helped with that as well. You know, there are, there are experts on her team that are in exercise physiology. So there's a variety of support that you can get from that team that add to that overall strategy of I'm going to change my habits to make it possible for me to expand, to expand both my health span and my lifespan, right?
Megan Antonelli 20:58 Amazing. We've talked a little bit about this in the past, in fact, but in terms of how, how does it work? For Members, is there a co pay? Is it all members get it? What's the
Robert Groves 21:12 Yeah, no. For for diabetes, which is where we started, because that's where the the clear data are. That's where the ROI is initially. So for diabetes, where we started, it's free to members, so all they have to do is sign up for it, and we pay it like a medical claim, without a co pay. And, you know, they become part of the medical team and coordinate what they're seeing and the labs that they're seeing with the patient's primary care physician, so that information is shared. Everybody's on the same page. And so it's like, it is much like having a specialist in low carbohydrate diets that you're referred to to manage that problem for you and for for members of beta retina, that's free,
Megan Antonelli 22:03 amazing. Yeah, that's great. I mean, I think, you know, in terms of, you know, sort of managing that behavioral change and having that, that 24 hour coach, accessibility, that's so important, no matter whether it's just diet alone, diet and medication. I mean, I imagine it works all in concert.
Robert Groves 22:22 Oh, yeah, absolutely. And in fact, verta is now well on their way to a strategy that allows them to manage GLP one medications. And by the way, there is no entity out there that has more experience with GLP ones and weaning people off of GLP ones while maintaining the gains than Virta, because they've been doing it for diabetics for years. So they have the knowledge and the insight necessary to manage this and they understand the responsible prescribing of GLP ones. You know, one of my buddies, Al Lewis, has a company called quizify. I don't know if you've met Al before. Interesting, yeah. Interesting guy, contrarian. But what he's found is, when he uses a quiz that educates patients before they take GLP ones on what the parameters are, et cetera, about a third of them choose not to do it. And so we've got to make sure that people understand what they're getting into, what the side effects are, what the consequences are if they decide to stop them. Because you know, the data we have is that most of the weight comes back if you stop them, and and so the benefit that you might get short term is lost if all of that comes back and you're back to square one. And by the way, the GLP ones were approved only in concert with a lifestyle management program, they are not approved as a magic bullet to cure all your ills, and you can continue to, you know, slam milkshakes, like I was doing, and expect that everything's going to turn out okay. They are linked to diet and lifestyle, so that's really important. I think they are transformational drugs, but I think they have to be used responsibly and appropriately, and we'll see more of them coming out. I mean, you'd be amazed how many are in the pipeline now, from a variety of angles, and not just GLP ones, but now adding other hormones in to manage the side effects, etc. So I think they'll be with us, but I think we have to understand that there's no magic bullet, that no matter what you do, GLP ones might be able to give you a head start, but changing the way you manage your daily habits and activities has the most profound impact on health span, how healthy you live, and lifespan, how long you live
Megan Antonelli 24:48 right now. There's no question about it. And I think I mean what they're seeing in terms of GLP ones making that behavioral change maybe easier for some who really have that sensitivity. But I do think, at least in my experience, going on a ketogenic or low carb diet, also, you know that it is a self sustaining change, because when you don't eat the sugars, your body doesn't respond to, then spike, then, then overdo it, and what have you so it, you know, in concert, I can only imagine that these two things would be better when it comes to, you know, how you're looking at, how the mar the, you know, sort of payers and hospitals and providers can get into this, you know, like when we think about nutrition based intervention, behavioral interventions, and just even just the food is medicine movement, right? I mean, I the whole idea of it. I love it. I want it to take hold. I still have trouble thinking about, how does it take hold as part of the healthcare, you know, infrastructure that exists, right? Yeah. Well, when you think about that, how to what, you know? What? Where do you see? The promise?
Robert Groves 26:02 Yeah, let me tell you another, another program that we've recently implemented at banner retina, and it's called the banner retina kitchen, and I'll talk about how that's evolved into the banner retina eco, which is a community of services and people that are trying to live more healthy lives. So the banner out in the kitchen was a concept that our population health manager Philip Randall came up with. And the way it works is we take high risk diabetics, we reach out to them and say, Hey, are you interested in this program? And this program is a cooking show like experience, where we bring them together on a weekly basis with a chef and a dietitian cook stations. So they're not just watching it. It's not just didactic. They're actually cooking a meal with fresh, good ingredients and with, you know, with a strategy for a healthy meal without a bunch of additives or massive amounts of carbohydrates, and so they cook that meal with other members. And so we're creating community. We're getting people back together and out after the isolation of the pandemic. People are starving for that interaction. And so with this program, they have that cook show like experience, and then they take those ingredients home with them. They take that back and cook it for their families. So they not only have the chance to cook in real time at the show, but they take those ingredients home and cook it for their families. Now what's cool about this is this what you know the educational community would call this experiential learning, and we know that compared to didactic learning. In other words, I'll give you a lecture on what you ought to eat and you know, or a slideshow on what you ought to eat. We retain maybe 10% of that. We can retain up to 90% of experiential learning. So we're not just creating healthy Members, we're creating teachers. They're going to talk about this with their families. They're going to talk about this with, you know, their friends, and they're going to show them how to do it. And what that means is that we're creating communities of people that it's an old fashioned viral spread, person to person. We're not talking about electronic here. We're talking about real encounters with real people and learning how to live a healthy life. It has been wildly popular. We've actually had business clients come up to us and say, can you create a custom program just for our employees? That's how popular it's been. And we're seeing we haven't been rigorous in our studies, yet we're we're putting that into place shortly, but we're seeing drops in hemoglobin, a 1c as you might imagine, marker for diabetes. We're seeing drops in weight, as you might imagine, reported blood pressures are going down, the things that you expect to happen when people change to a healthy strategy. So the banner at the kitchen. Then led to other programs that we started to include banner at active. And this is a program that gets people back out into the community. They might visit a museum, they might visit a health club or a gym you know, or a park in you know, when the weather cools off in Phoenix, and all of these things are ways to get people both active and engaged, and it's amazing how much that means to people. I mean, we have many participants in the program who volunteer to stay on and help out with the program for free, because they enjoy the community. They enjoy meeting people. They enjoy living healthier lives. So we're starting to flip the script a little bit and and include a high touch program in addition to high tech programs. Now we've toyed with, should we create an app for these communities? Should we put it online and create and that probably is something worthwhile, worth doing. Long term. We're in the fairly early stages of this. We know that the kitchen works. We also have a know your numbers event on a regular basis where we cater healthy food and have people come in and they haven't had a hemoglobin, haven't had a hemoglobin, a 1c or they haven't had their blood pressure checked. We can help them do that to discover how they're doing metabolically and all of these programs we call the banner Aetna eco. So we're excited about that program too. So it's not a one, you know, Virta is an amazing program, you know, we, we were the first to bring it in to the region, and we're very proud of that. But we're looking at other ways to not only improve metabolic health, but create community and address the epidemic of loneliness. You know, people want to get together, and here's an excuse to do that in support of your own health. And we think it has legs.
Megan Antonelli 30:52 No pun intended. No. I mean, you know, but it's so you know, of course, it seems so logical, right? I mean, it's common sense, right? That a health plan, and, you know, your health home would would sort of help with kitchen choices and food choices and all that. But it's cut, you know, it's a big leap. It seems to be happening more, and it's great to see that success, but it is. It's amazing that it's taken as long as it has to get here, you know, and then to actually get people engaged. I do wonder. I mean, I think about it also when I look at my kids, right? I mean, there's a certain awareness about health that they have that I certainly didn't have in the 70s, you know, and and their willingness to be helped around health and you know, whether it's through and out or through, you know that, you know that gives a bit more opportunity for organizations like banner at Yeah,
Robert Groves 31:57 yeah. You know Megan as you were talking, one other thought occurred to me. I think that as a population, we're a little bit confused as to what the health care system is. You know, you hear the comparisons all the time that we are the number one spend in the world, but at, you know, towards the bottom of the pack in terms of health span and lifespan. And really, what the health system has been historically is rescue medicine. You know, it's after the horse is out of the barn that we're chasing it to corral it again, and that's how the system was designed. And the the the outcomes of health span and lifespan, those are far more dependent on those habits, individual habits that I was talking about, they're dependent on zip code, as many people have talked about, what opportunities are available, and how much stress is there day to day, and you know, and what kind of culture that I grow up in, what are the habits of those cultures? Those things have a much more intense impact on health span and lifespan. So and what does that mean? Well, really, what we need to do is rejuvenate what we think of as public health in this country, because those are really public health issues. They're not rescue medicine issues. Rescue medicine, what we spend $4.5 trillion on now, what we refer to as our health system only has about a 10 to 15% influence on health span and lifespan, and it's not, you know, not everything do we have control over, but we have control over about 40% of that through lifestyle habits, culture, availability of options, low stress, which means economic security. You know, there's a lot we can do in public health that will have a far greater impact on health span and lifespan than trying to tweak and honestly, what we're doing is we're doing the job that ought to be done by somebody else, frankly, but if no one else is doing it, guess what? We have to because it's the dollars that are being spent on this that we have to mitigate or it will be unaffordable for everyone. And that's close to where we are now, frankly,
Megan Antonelli 34:20 right? Well, and, and in some ways, it's the system that we built right in. You know, I mean by by allowing the sort of for profit, private medicine system to be as large as it is, we've diminished the public health system to such a degree that there isn't the money there to do the preventative care. So it is the onus is on that side of the system until we fix it the other way, which is not going to happen, not in my lifetime, at least. But. You know, but it speaks to, I mean, I've been, you know, my background was in public health and what, and didn't really went into it without an understanding of what the healthcare system was, but then realizing, Oh, that is the healthcare system that we have so but I think that that is, that is, the answer is, you know, finding the, you know, motivation to take preventative medicine on that side of on that side of the the system. So, yeah,
Robert Groves 35:34 by the way, it's not all doom and gloom. I mean, we have made tremendous advances in healthcare over my career just astounding. I remember when I was in training when someone had a heart attack, we put them in the intensive care unit and looked at them, you know, and basically said, well, we'll give you a little beta blocker. We'll see what happens here. You know, we had no way to intervene the way that interventions are accomplished today, in real time, immediately, and our rescue medicine system is the best in the world. If you get hit by a truck or you get cancer or you have a heart attack, I would there's no country I'd rather be in than the good old US of A we do great at rescue, but it's not addressing the problem of population health that we need to address. And so, you know, insurance companies are starting to address that, because they are the ones who are trying to keep costs down year to year. Delivery systems are starting to address that. And I do think the trend towards value based care will help, because those profits that those companies have will be put to good use on on population health and and that's a form of public health. I mean, we still haven't talked about all the folks who don't have insurance or underinsured because of high deductibles. So that's a separate problem that's got to be addressed. But there is hope. And as you mentioned, kids, you know, the new generation of physicians are not just eating what they're being fed by the old establishment. They're starting to ask real hard questions and say, hmm, I don't think I'm okay with that. Shouldn't we be doing this instead? So I think there's plenty of hope. We're at a transition stage right now that's going to be very difficult. We've got to solve the fragmentation problem that you mentioned earlier. We've got to solve the access problem. I don't know if you've engaged with the healthcare system recently, but it's nearly impossible to get an appointment at the last minute for anything, and that's when people think about it. It's like, wow, I'm sick. I need an appointment, and it's almost impossible to get or you go to urgent care where you're going to wait for two hours and see somebody for five minutes. You know, it's a system that's not working well for us now. So there's a lot of work to do. Yeah,
Megan Antonelli 37:53 well, I could talk to you all about this all day, and we could solve all of the problems. I'm sure of it, but I really appreciate your time. And I think that, you know, it's always, it's always so good to have this, you know, I think this conversation, and obviously metabolic disease, frames the conversation of both the intersection of the private health care system, the public health care system, yes, regular regulatory and then the food industry and all of that, you know, all of that, it's going to take the collaboration of all of them to solve that problem, you know, for the for us and for, you know, even globally. So it is, it said, but to have moved the needle and to see the solutions coming down the pike is exciting,
Robert Groves 38:37 yes. And thank you, Megan, for making people more aware by doing what you do. It is really a service to our entire population, for people to understand this so that they know what to do and what kind of pressures to put on government agencies, the healthcare system, etc. So thank you for what you do.
Megan Antonelli 38:56 Oh, well, thank you, Dr groves, it's always a pleasure. And to our listeners, thanks for tuning in. And you know, Dr groves is available. He's on LinkedIn. Reach out. He's a great resource. And thanks again. And this is Megan Antonelli, and this is digital health talks health impact.
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