Regenerative by Design

Jon, hello, everyone. You are
listening to the regenerative by

design podcast where we will be
getting to the root of health,

climate, economics and food. I
am your host. Joni kinware. Join

me on this journey as we explore
the stories of individuals and

organizations who are working to
realign our food system with

both human health and the health
of our planet. All right, hello,

everybody.

I'm Joni kimalmore, your host of
the regenerative by design

podcast. And I am so thrilled to
have Ellen brown on this, on the

on our session today. This is
absolutely fantastic. Welcome

Ellen,

thank you. I'm I'm super
excited. We were talking right

before we hopped on, right about
how we feel like we know each

other, but we don't know each
other.

So Exactly, yeah, it's like the
modern digital friendship, where

you get to know somebody via a
chat or a social platform, and

then you realize you've actually
never even been on camera, so

you didn't actually know what
they look like. It's always kind

of fun when that happens other
than

other than your your profile,
right? Yeah, your profile shot?

Yeah, I took the one where I'm
laughing because the formal ones

just still seemed a little bit
too exactly

when we're delving into topics
like we both work in, which is

the nexus point of where
healthcare and food and

nutrition and medicine and even
economics all intersect. It is

such a hot topic right now, and
I know Ellen, you are like a

lifelong, passionate systems
thinker when it comes to

healthcare and delivery of true
health to people. So I'm excited

because we have not taken enough
of a dive into this topic on the

show. As our listeners know,
regenerative by design is really

just digging into the principles
of regeneration, and it really

starts at the food system level
and nature. I mean, we're a

reflection of the health of our
environment and the health of

our food, but we cannot talk
about regeneration without

really taking on conversations
around healthcare, healthcare

delivery, food is medicine and
the economic impacts of what an

alien population that is like
suffering from diet related

disease means for us as a
country. Like, as a former

nurse, I can't tell you how
passionate I am about this

topic, and you are an expert, so
I am so excited for you to just

share your life experience.
Like, how did you get to this

point? Like, I bet our audience
is like, who is Ellen, and what

does she do? And I'm a
regenerative farmer, and I don't

hear about people in healthcare,
so take it away. Let us know how

you came to be doing the work
you're doing today. Well,

I'd like to have a perfect
answer for you, but I kind of

feel like the universe honored
me, not particular woo, woo

person. But I I say to people
today, I feel like the this is

all happening. It's sort of like
a higher frequency, if that's

what you want to say. And I'm
just lucky enough to be pulled

in for the ride, and I'm all in.
I'm like, 100% I love it. So,

yeah, so I mean quickly, my
background and sort of how I

ended up here, I suppose, right,
you used to say like, I don't

sound like I intended to end up
in the space that I'm in,

necessarily, but in all
seriousness, so I've been in

healthcare on the business side
for 30 plus years, and I started

out actually as an underwriter
and on the actuarial side of

things, Which is totally geeky
financial. And I stumbled there

because I couldn't cut it in I
wanted to be a physician, and I

just could not cut it in college
chemistry like I admit it. It

was not my it's not my jam. And
so I came home and I was like my

mom, and I had a full ride
scholarship at the time, but I

was on academic formation after
my lackluster performance in Kim

and my mom, and I'm like, a dog
with a bones. I'm like, Well, I

will be taking that over again.
I am. I'm in. My mom was like,

you know, and this kind of goes
back to that universe thing,

which is, like, you I think when
doors close too hard, you have

to pay attention to that. And so
she's like, Wait a minute. But

you took economics as an
elective, and you loved it. So

maybe there's like, maybe you
could consider business, and

this was in the early 90s when
the business you could not get a

job at in business to save your
life. I mean, you were like, a

marketing assistant, and, you
know, it was a really difficult

time. And I was like, I am not
going into business. Going to be

a physician. And she's like, how
about you just take accounting

this summer? I was like, Okay,
so, so I did, and the rest is

history, because i Because, you
know, accounting is sort of like

chemistry for a business like
that. Some people say, right?

So,

yeah, there's so many parallels.
And as someone who did pre med

as well, I understand the focus
that it like chemistry is the

hurdle of hurdles for pre med,
for all the premies, yeah, if

you can't, if you can't, cut the
first two years, like, you know,

physical and then, okay, that's
like, the litmus test, you're

dying. And it's so frustrating,
because, in retrospect. Act. Is

it really as important as we
think, or is it just a rite of

passage? Because honestly, the
thinking that does make somebody

good at accounting or economics.
Economics and accounting are

literally very similar to
chemistry. When you think about

it, it's all about interactions
and properties and how they fit

together. It is.

It's very much a systems thing
and so. And actually, I mean,

I'll say this, and then I'll
just kind of quick finish my

background more. I won't make it
this long, don't worry. I just

think it's an interesting piece
to this story, how I ended up

part of the puzzle. Yeah, it is.
It is. And so I'll just try to

hit on a couple of the important
pieces that brought me to this

point. Not so much just my
background, but what's

interesting about that is I have
had a lot of recent

conversations, and I am a little
bit controversial in this, but I

I shared. I choose not to have a
really strong voice, because I

don't feel like it's important,
and I don't want to muddy things

up. But when I look at how care
really should be delivered in

the future, I think that AI,
whether we like it or not, it

does give physicians a
tremendous amount of information

that they don't normally have
access to, that we can't

possibly expect them to memorize
and know. And I think med

school, I think our whole
construct around education is is

very misaligned now with it's
very antiquated. When you look

at what is accessible, and I
think we miss a lot of really

talented people that should be
in clinical care delivery, but

they can't. They can't cut it
right in in organic chemistry.

And so when you think

about like the selection process
by personality type and aptitude

level that has now come to
dominate our medical provider

environment. You can see the
culture shift that has happened.

And not to be rude, but there's
a lack of EQ often. I mean, I

worked in ICU. I worked in
cardio cardiothoracic surgery,

like recovery, so it's like,
you're working with like that

cut, and they're amazing at what
they do. I mean, they're like

incredible technicians, but the
EQ and the soft skills and the

communication part is where it
often falls short, and

unfortunately, that's the divide
where we lose a lot of success

metrics in healthcare, because
it's not just about the

procedure, it's about the
holistic experience of healing

and the interface of the patient
with the system,

and it's also about behavior,
right? Is, is we have to change,

we have to change people's
behavior around lifestyle. And

if you don't have EQ, you're not
going to do them. You're not

even going to want to do that,
right? So it's a really

interesting time to your point
in medicine. So, so that's kind

of an interesting nugget in my
background. So I I basically was

desperate to get to Maryland
because my husband was there,

and I just wanted to be with
him. He was going to law school,

and his dad had a locker and
stuff. So I was lucky. I had a

professor who got me a really
great paid internship that was

at a health plan while I was in
college. And so I was like,

Well, I'm going to run with
this. So I landed an underwriter

job, which was unheard of, to be
able to jump right into

underwriting, yeah, which was,
which was fantastic, and kind of

the rest was history on the
payer side. But what's

interesting about it was, what I
really wanted was to do strategy

and product development, things
like that. And so I at one

point, had a little stint, which
is an important piece of my

background of back in the late
90s when Medicare did the this

was called Medicare plus choice,
and they had about a one year

blip, really, where suddenly
providers could take financial

risk. It was, I think it was
1997 and I 96 and so I happened

to have an opportunity to go
work for provide organizations

that want to take full risk and
start a Medicare Advantage plan

back then, though, there weren't
the analytics tools to do that,

and so pretty much every every
clinical delivery system that

jumped in then failed, there's
only a handful that really

survived that time, and It
unfortunately left some real

deep scars in the healthcare
industry for That's why, I think

that's one of the big barriers a
lot of people don't realize to

organizations taking downside
risk in moving towards out based

outcomes, based care, because
they still have legacy folks

that were involved in that.
Yeah, the scar tissue is real.

It is. And so then what
happened, though, was it showed

me. I was like, we have to do
this. We have to move towards

outcomes based care. So then I
went back to the I got

recruited. I really wanted to do
product development, but I was

quote, unquote, too young. So
then I got recruited back

through a recruiter that said,
Hey, will you come back and do

product development? I was like,
Yes, that's what I wanted to do

in the first place, but you guys
told me I was too young. So I

came back in. And what's funny
is I didn't even remember this

until I was talking to Aaron
Martin the other day, which is

to get promoted to a director
job. I ended up doing a demo on

alternative medicine to the
leadership team as part of my

like, why you should hire me as
the director, as opposed to, you

know, my other co workers and I.
Brought in an acupuncturist and

and I brought in some other,
some other, quote, unquote,

alternative medicine. And so
what I realized is, I've been

after this for since I kind of
came out of the sense too,

probably, yeah, and so then, but
then I just went deep. I was

like, okay, payment reform is
where it's at. So I'm going to

make a difference in that if we
can get health systems and

provide organizations to either
start health plans or take, you

know, get into value based care,
not just by dipping their toes

in the water, start ACOs, align
themselves with outcomes based

care delivery. I was like, this
is making a difference. I know

it doesn't seem like it, but
it's down. It's in the

underpinnings, right? Like, if
we can change that foundational

economic framework.

That's a design feature like
when you shift the target of

what the outcomes and everything
that is approvable starts to

align behind these outcome
metrics, that actually starts to

shift the whole system in a
significant way. Yeah, and you

know, the other thing that
happened during your career that

I experienced firsthand as a
nurse, like when I came in, it

was paper charting and maybe
early digital charting. And, you

know, 15 years later, it's all
digitized. We have huge data

sets to learn from. Evidence
Based Practice became the

mantra. And again, it's that
more outcomes focused of like,

okay, we're, you know, we're
starting to understand trends.

And importantly, I always talk
about this, and for you guys on

the insurance side, this is
really important. We started to

realize a lot of the habits that
we had in healthcare were

contributing to poor patient
outcomes. We just didn't realize

it until we had large enough
disparate data sets from

different geographical areas
different patient demographics,

where we can suddenly go, Oh, we
didn't realize we're actually,

like, killing our patients. And
we didn't realize it like, you

know, and because you know,
like, that's the beauty of like

AI, like you mentioned as well.
I feel like AI is going to help

us move these preconceived
notions, these like inabilities,

to take risk or think in an
innovative way because of being

burned in the past, or it seems
too expensive, or it seems like

a barrier to adoption from a
learning perspective. But when

you have that data, and AI can
help us see data that we might

not be able to see on our own, I
think that's where we're going

to really start making these
leaps. The fact that you are on

the insurance side gives you an
incredible vantage point that

very few people in the industry
see

absolutely yeah and so. So what
happened was I had I spent 10

years as a payer. I ultimately
ended it was a multi billion

dollar blues plan. I was really
lucky where I was able to watch

an attempted transaction. I was
on the ground floor. I was

working for the CEO, and because
I ran strategy for the

organization, I sat on the C
suite floor. So literally, one

door into my office was into the
boardroom. One door went into

the chief medical officers, and
the other door went into the

CEOs. Like, I'm not kidding you.
So it was, it was a, it was,

it was firehose.

That is an understatement. And I
was, I wasn't even 30 yet, and

so maybe I was 30. I mean, I was
really young, but it was

amazing, because I it really
taught me so, so very much. Um,

but then I left, and this is the
fun fact. Is my husband, I took

a year and a half to go on an RV
trip, yeah, to see if we really

wanted to be grown ups in the
corporate world. And come to

find out we did. So we resumed
our careers, but I did it as a

consultant so I could still stay
in Colorado. We fell in love

with it when our on our trip and
but I came back in to really

work on payment transformation.
So that was really my jam. So,

so, you know, the last 20 years,
I've been working with big

health systems, big payers in
that payment transformation

space. So, you know, like I
said, starting Medicare

Advantage plans, starting ACOs,
creating ventures together,

doing white label things, create
a clinically integrated network,

show all

the things that we've done. Can
you define ACOs? Oh, yeah,

sorry.

So so on the I'll just kind of
back up for a second. So when I

talk about payment
transformation, that's the whole

notion of moving from what the
majority of payments in the

healthcare system are today,
which is a which is fee for

service, which means you go to
the doctor, right, and then that

doctor gets paid for that one
specific service. If that doctor

provides a couple of different
things while you're there, there

will be a bill that gets sent to
your insurance company that will

show like three services, for
example, and they all go back to

a code. I mean, you you know
this very well as well, but, and

that is what everybody talks
about with this fee for service

hamster wheel, because, again,
the doctor is incented

financially to perform more
services, not to keep. Too

healthy. If you don't come in,
the doctor doesn't get paid,

right?

So it's such an important piece,
and I'm sorry to interrupt, but

because I don't think people
fully understand that. And they

get it, like, when they get a
bill from the ER, and they're

like, how did that cost $17,000
that's usually people's very

first experience with the fee
for service framework for

compensation within the medical
system, and considering that the

United States has the most
expensive healthcare system in

the world with some of the
poorer outcomes associated to

spend this piece, is such a
critical part of that puzzle,

absolutely is I just had to have
you stop and like, make a like,

make some, yeah, you know some.
Like, real, solid concept around

that for our listeners, because
our listeners are a lot of

people on the farming side and
the Ag side and the food system

side, very few are have deep
knowledge and insurance and how

our healthcare system operates.
And when we appreciate that

fact, a lot of it starts to make
sense of how we fix it

absolutely the same, exactly,
exactly. And I didn't mean to

derail you, Ellen, but I'm

so didn't derail me at all. I
totally and I would, I think

there's an opportunity here that
you know, maybe you and I do

another episode where we kind of
do a deep dive on just the

health insurance and healthcare
fundamentals, so people can, you

know, for people that want to
learn that, and I don't have to

junk up your podcast, we can do
it over on the reverse mallet if

you want. Definitely do both.

No, but this is so good because
our farmers are locked in a

similar system, where they have,
like, the insurance they have,

they have, you know, crop
insurance, but they also have

local regulatory things and and
when we start to see that the

systems in parallel have a lot
of similar barriers to

innovation and barriers to
prioritizing and realigning,

realigning the way they work
with human health outcomes and

climate resiliency, we start to
understand that we can borrow a

lot from the medical framework
or from the Ag Food System

framework. There's a lot of
energy, interesting synergies

there so totally

are they're totally but I think
what's important for people

understand and why you're making
such a point to stop here, and I

will stop here too, to reinforce
that, is that when we are when

healthcare is delivered under
the current construct, which

I'll add another element that
people should understand, which

really has, has is the reason
that our healthcare system is

designed the way it is, is there
are two main forces here, right?

How you get your health
insurance is typically through

your employer, because your
employer gets a really good tax

advantage to offer you that
health insurance and those

health insurance benefits are
not your choice. They're your

employer's choice, right? And so
we have been, as people, we have

been completely removed from our
health care in terms of the

decision making process, we're
handed a network that the

insurance company will let you
see. So it's like, here are the

physicians you're allowed to
see. You don't have full choice,

and this is how much you have to
pay to go see them. And

unfortunately, this fee for
service payment system

underlying it, it re it's a it's
a hamster wheel, because it just

reinforces that. In order you
have to have volume, right? And

the same, when you talk about
farming, it's not quantity over

quality, right? It's quantity
over quality. And so healthcare

is quantity over quality, still
in that fee for service. And so

when I talk about payment
transformation. What I'm talking

about is there has been a
tremendous effort in the last

decade after Obamacare. A lot of
people look at Obamacare really

negatively. I have a completely
different opinion of Obamacare.

I believe that people need to
understand it is why we all have

security of knowing we can get
health insurance. It did away

with medical underwriting for
people that are within small

employers, or that are
individuals, you used to not be

able to just get health
insurance that you could pay for

if you were sick. And I think
people need to understand it's a

really big deal. And the other,
really, another really important

aspect of Obamacare is that it
put into account the Affordable

Care Act, and with that, they
created what's called CMMI,

which is basically the
government CMS, which is the

Centers for Medicare and
Medicaid Services. So they have,

they have created an innovation
center, which is CMMI, and in

that it is focused almost solely
on payment transformation of

creating programs to move into a
an outcomes based payment. Them.

So instead of it, the sicker
people are, the more money

physicians make. It's the better
the care is, the higher the

quality, more efficient, right?
Then the better that goes. And

so in that, they created a
number of different things

outside of just health
insurance. One of them is called

the accountable care
organization. They created that

through CMMI, and that is what
an ACO is, is an accountable

care organization. And so it
allows physicians to say, we're

going to come together as a
group, right, and we're going to

deliver better care, and in
exchange, we're going to get

paid a portion of whatever
savings we generate from the

government by having this
Accountable Care Organization.

I'm making it. This is like,
I'm, you know, it's a very I'm

making this very basic. This

is a fantastic explanation. I
feel like we should just cut

this explanation out and put it
on YouTube for people to

understand, because this is so
critical, and this is one of the

reasons I was so excited to have
you on the show, because I talk

a lot about incentives and
creating systems that

incentivize the outcomes that
you'd like to see that benefit

people and planet, and how we
shift the equation back to being

balanced between efficiency and
effectiveness, because in the

last 50 years, all of our
systems have gone to dominate a

very narrow slice of what
efficiency is, and it's been at

the expense of effectiveness,
which is health outcomes. And

you know, planetary outcomes as
well, like balance with nature

and our planet. And also, if you
look at True Cost Accounting,

it's actually less efficient
than it would be if we looked at

a balanced a balanced picture
between effectiveness and

efficiency, because the
inefficiencies are coming home

to roost in externalities, which
is reflected in our health care

spending, which is literally a
burden to our GDP, it's a burden

to the success and happiness in
the American people. You cannot

talk about health care without
getting real about that part.

So so then take this notion of
outcomes based payment right the

Accountable Care Organization
was created for the Medicare

segment. So because the
government so the other really

important piece, and I won't
spend too much time on this,

because this gets complicated,
but I'm going to try to keep it

I think this is a super
important element that I want

people to understand, is we have
to acknowledge there's something

called insurance risk, and
people love to point fingers at

health plans and say, the
payers, the insurance companies,

the whatever right we all and
they're the big bad guys because

they don't want to authorize our
care. They this or the right

they are, actually, when you
look at the list of quote,

unquote, insurance companies,
they hold actually not the

majority of the insurance risk
in this country for people, it's

a way more complicated system.
So when I talk about insurance

risk, I'm talking about the
money that's being paid on my

behalf to cover my health care
expense. That healthcare

expense, somebody's signing up
to cover it. I'm not, right? So

whoever I send my check to,
well, if I'm over 65 and I don't

sign up with a health plan, say
I just have a supplemental plan,

right? I take like Plan F or
plan A, or one of those plans,

and then I pay Mutual of Omaha
to cover my deductibles and

such. The government is still
insuring me. They're still

paying for my health care.
There's no insurance. There's no

big, bad insurance company
that's covering it. If I'm

Medicaid eligible, unless I'm in
a state that's mandating that a

Medicare, I mean, a Medicaid
organization, health

organization, HMO, kind of thing
is covering the care again, the

state's paying for it. They're
holding my insurance risk. So

the government said, Hey, half
of the people that we pay for we

were bankrupting the trustees
fund, right? So we've got to

figure out a way to manage this
other half that isn't with an

insurance company, and so that's
where they created these

accountable care organizations.
And so the important thing is,

when we talk about outcomes
based care, there's you have to

also comes with that is the
insurance risk. So if I'm a

provider and I'm saying, Hey,
I'm going to, I'm going to

become an accountable care
organization. I'm going to

create one. We're going to have
primary care physicians and and

I won't go into all the nuts and
bolts of it, but I'm in essence

saying to the government, hey, I
think that I can deliver the

care to the people that see me
as my primary care like I

believe that I do it well, I
have a model of care that's

going to cost less. And 1000
bucks a month. So I want to, and

I want to get some of that
money, because then I, instead

of worrying about somebody being
like, just getting as many sick

people in the door, I'm incented
to actually make people healthy.

Okay, so that's super important
to keep

them out of this system. It's
like a reverse economic thing.

So here's the last part of my
story, Joanie, I've done that

now for the whole decade that
CMS has been doing it. And more

I've that that is, I have been
deep in the trenches of doing

that, sitting in hospital
boardrooms, sitting in health

plan boardrooms, at the top,
with the middle, the whole thing

doing great. But about a year
and a half ago, what I realized

was, well, two things. One,
about eight years ago, I had my

own health kind of derailment,
and during that process, I

realized just how broken our
food system was, and I realized

that my own health, I healed
myself through food entirely.

There was no medicine that was
going to bait me better. I had a

toxic exposure, I had chronic
stress. I had it. It all came to

a head. And I thought I had MS,
and I thought I had thyroid

cancer. It was, it was a
horrific time. I went down the

diagnostic rabbit holes, and
what ultimately pulled me back

into health was I had a
tremendous amount of

inflammation. It was in my
brain. It was horrible, but what

I learned was eating clean. So
when we talk about regenerative

I learned that that's what I I
needed, I and then suddenly I

went really deep into food. And
so for the last eight years,

I've had this, literally, like
this kind of bipolar

relationship of my passion for
food and health and my work in

healthcare, and I thought, if I
just keep focused on laying the

underpinnings of as many clients
as I can that will take outcomes

based care and implement it
right, like many that'll that'll

put more and more lives and will
make but what I finally realized

a year and a half ago is we
don't actually deliver care in a

manner even when it's outcomes
based. We don't have a care

delivery model that actually
reverses anything or makes

anybody better. We basically
treat sick people. And so I I

almost walked away from the
industry, because I was like,

I'm tired of this and so. But I
stopped and said, No, I need it.

I need to just broaden my
horizon. Maybe, maybe food is

medicine. Because, you know,
last year, food is medicine was

getting a lot of traction. Maybe
food is medicine will yield

some, some, like, I don't know,
some fruit for me, right? And

get and I gotta tell you, it
kind of went from there. I met

Carter, I met Aaron. I And and
Carter Williams has, you know,

he has. He really showed me that
there is a huge underbelly. It's

not a bad underbelly. It's like
the good part of people, of

farmers that are like, Hey, we
have to fix this. We can't have

a broken food system. And I was
like, okay, so everybody doesn't

think like Zach Bush, there's
hope yet, right? Not that Zach

doesn't have hope, but you get
what I'm saying. And I was like,

okay, maybe I don't have to give
up here. And and so then what I

realized is, we need translators
like me that can say, hey,

health system, CEO, if you
reverse lifestyle disease on

these lives that you hold that
insurance risk, we can take 40

to 60 to 80% of the cost of care
of a big chunk of Your

population. Oh, by having them
eat healthy and teaching them

and changing behaviors and all
of that. So that's my story. It

was very long.

It's an amazing story. I'm so
glad because we, you know,

really, it weaves in this whole
experience of, like, really the

big picture design, redesign
process that we're all up

against. And, you know, having
the understanding and the deep,

deep understanding of how these
systems work, like insurance, is

critical to how we think through
the the design for the future

that we want to see, because we
cannot ignore the pieces of the

puzzle that actually drive the
system, like like financial

systems, like banks, insurance
systems, they they have so much

to do with, like, how society
operates and how the systems

work, and when you're dealing
with incentivization, um,

incentivization is the engine
that will drive change, and so,

like, it's all the moving parts
coming together. How do we

rethink the model? And I love
that you're passionate and

experienced and knowledgeable
about healthcare insurance,

because I think it is actually
one of the most intimidating,

complex topics on the planet.
Like I would take almost

anything all day long. But if
you hand me like an insurance

manual, like my eyes cross and
you'd think that I like, I. You

know, kind of reading problem
like I literally had the hardest

time getting through it and
making any sense of it at all.

So I'm appreciative that you
have this expertise. It's

fantastic.

And the other thing is, I don't
there nobody's at fault here.

And unfortunately, I think in
the healthcare industry and then

in society, people want to point
fingers at the healthcare system

and say, you're greedy. You're
broken because, oh, this CEO

makes this many millions of
dollars, and, you know,

whatever, I'm like, But what
about all the other CEOs in

every other industry in the in
the world? You're not yelling at

them for making that much money.
You know, it's like, it's a

private industry. We haven't
created healthcare for all. We

don't have socialized medicine.
And so, quite frankly, when you

become sick, you want the best
care

and and you you want the best
talent in leadership. And guess

what? They're business leaders,
and they will go to other

industries if there's not
competitive compensation exactly

at the leadership level. So
yeah, that's just the reality,

right? As a nurse, I've heard a
lot of grumbling about this. I

have done my fair share of
grumbling because I've worked

with, I have worked, I have
worked with some of the most

fantastic, forward thinking CEOs
of healthcare systems and or

hospitals, especially in rural
hospitals, that were just

absolutely fantastic. And then
I've worked for some that really

do epitomize just the kind of
transactionality mindset, like

it's just the transactions. This
is just a business and, you

know, and it's clear that they
don't spend time at the bedside

when people are suffering, you
know. And absolutely they don't

see that full effect. But then
they really don't see the full

effect of like, how do we keep
people out of here in the first

place? Because they know that's
their business models. The more

they come, the more they make.
And that's where that whole it's

so incredibly difficult to wrap
your head around where to even

start with changing it and
bringing in diet and

foundational things like
farming, seed, genetics,

agronomy, processing
infrastructure, like, that's

where I spend most of my time
now, is like that little piece

of the puzzle, because you can't
have high quality food if you

don't have connected networks
of, you know, people at the crop

production level, or, you know,
whatever The product is. It can

be animal or whatever, but and
then going into those first and

second tiers of processing, that
is like a divide that is so hard

to manage and navigate in our
country, and it's one of the

things that dictates the
dominance of so many of these

big processed food giants in
like literally making or

breaking what we can buy on the
shelves today. So it's like,

Yeah, huge system pieces.

And so I mean, a couple of
interesting things with what you

just said. So I mean, first of
all, I've chosen, as you know,

which is how we met. I've chosen
to go deep on food, which

doesn't really try to understand
the food system itself. And I

think it's really important that
if you, if we want to, we want

to bring food and health back
together again, then if you're

on the food side, I think it's
important to understand where

health care is coming from. And
if you're on the health care

aside. You have to understand
where the food is coming from,

and then try and think about
those disruptive, unexpected and

disruptive is hard for me
because that sort of implies

this, like, I'm just gonna come
in and spinning around and like,

do it the way I want, and I
don't know I destruction can

be dangerous. It actually can
create some negative

consequences. And with
healthcare, we can't afford to

have a dangerous disruption
event like we just can't afford

for that to happen. We need to
figure out a stable transition

and a realignment of the
priorities, and then the systems

need to be built to support that
reprioritization, which is

wellness, and the understanding
that that wellness starts on the

plate,

it does and but what I think a
lot of people miss in this whole

situation and you or this whole
story, and you'll see this with

me, is I don't talk about
wellness and prevention, and

that's very purposeful, because
insurance is Insurance. It's

there to cover you when bad
things happen, my homeowner's

insurance does not cover my roof
being maintained right, my

health insurance, my homeowner's
insurance, right does not come

that i i caulk around the
corners of my house so that I

don't have leaks, right and and
so, but, but right it. And so

there's a I think a lot of
people can't separate. Uh,

insurance from health, right?
And so Harvard and I've actually

spent a fair bit of time
recently kind of talking about

this is we really need to, I
spend a lot of time talking

about a new healthcare model
that is a care delivery model

that is based on health, as
opposed to based on sickness,

sick care needs to stay. We
still have a need to have a

network of sick care facilities,
sick right? Sick care physician

really good at sick care. I
mean, a former er and I see you

are in like, oh my gosh, like I
if I am in a car accident, I

want to go to our ers. I want to
go to arc ICUs, but I want them

where the staff is focused on
trauma, where the reality is, is

any ICU in America, like half,
half of it or more, is full of

chronic, renal chronic, you
know, complications of diet

related disease, and that's what
sucks the resources away from

delivery of trauma and emergent
interventions, the sick care

gets diluted by the needs of the
chronic care, because that's the

top 5% right? So the sickest of
the sick consume. They're only

5% of the people, but they
consume 90% you know, 80%

resources, right? Yeah, and and
so, but it's, it's not quite

that bad, but it's, it's, it's
pretty grossly big, like that,

um, disproportionate that way,
however, um, there's a, there's

a huge amount of money to be
saved in the lifestyle bucket of

that, and in the lifestyle
disease. And so I right now, I

think it's super important. Is
it we really should just be

focusing, like, let's just stay
focused on the first step, if,

if we can get a system in place
where, economically, there's

money in the system to pay to
reverse lifestyle disease. It is

a condition for which we are
paying for. It is a sick

condition, and so I'll use my
mom as an example. She went into

the ER, year and a half ago with
inseptic shock from a kidney

infection that was a she had no
idea she had. That was a

complication from uncontrolled
diabetes that had been going on

for years that unfortunately,
she had the belief she was pre

diabetic. Now, when I got to the
ER in the ICU, actually not the

ER, when I got to the ICU, they
were giving her insulin, and I

asked, I said, What's What is
this? Because my dad's like,

she's not diabetic. And the
nurse said, was her a 1c was 9.5

and I was like, Okay, papa,
She's diabetic. That's an that's

a 30 day marker. I'm like,
That's not that didn't happen

because she ate chocolate two
days ago, like, and so, but, but

here's the interesting I learned
from this experience, because

when she came out of it, she
wanted to get healthy. She

didn't want to be sick anymore,
and what I realized is there was

no avenue for her. Her
Transition of Care back to home

was about keeping her from
getting back in the hospital. It

was keeping her from being
acutely sick. There was no care

plan for her to engage with to
become healthy, to reverse the

disease that took her into the
hospital. I'm not talking about

metastatic metastatic cancer
that is likely not going to be

reversed, right? I'm talking
about the millions and millions

of people that have lifestyle
disease that could reverse their

chronic conditions, and it's as
simple as food and and also

having physicians that are
trained to deliver care in a

manner that focuses on their
lifestyle and educates them and

engages them, we have given up
on people. There is this. I had

given up on people like, oh,
people are just lazy, people.

People just want to eat. What
they want to eat, right?

Whatever they are overwhelmed.
They and somebody really, this

guy, Eric hiker, who's a
branding person, who's really

into health, he said to me, we
need to give people permission

to be healthy. It's not. They
don't think they have permission

anymore. They feel like they're
not invited, right? Yeah, yeah.

And that's to me, Joanie, that's
like, at the core of all this.

And so I go back to and say,
Hey, okay, so let's take the

economics of healthcare. There
are trillions of dollars being

spent, and insurance companies
are taking that revenue, and all

of the middleman in the middle,
and all the people that are

holding the insurance risk,
right? Those are employers,

their health plans, their
intermediaries that people don't

even realize that are out there
that are holding that financial

risk. And those are the people
to say, hey, let's create a

program for 100 of your
diabetics or 500 of your

adiabetics. To start, let's take
board certified. A lifestyle

medicine physicians, or take
your primary care physicians and

and get them board certified in
lifestyle medicine. Let's

connect use a program like Aaron
Martin's created with with

regenerative farmed food
delivered to the person, with

actual booking demonstrations
and engagement. It's a care

model. It's a food based care
model. See it as such, right?

And change the behavior and and
then, because you're, I'm, I'm

saying, let's focus on people
that have financial incentive to

do this. If they are holding
insurance risk, they have a

financial incentive. Start with
them, and when they see, oh my

gosh, I just had 50% of the
people in this program drop

their a 1c into pre diabetic
range. They've come off of their

medicines. They they don't have
their blood pressure has come

down. They feel good. They're
engaged with their health. Let

them be on the glyphs. Let them
be on on GLP ones, it's totally

fine, but put the food with it,
and put the lifestyle with it

and help people move back to
being healthy. There are

millions, if not trillions, of
dollars to be put back in the

pockets of the right people,
including farmers like what I

want to see is programs where
you have an insurance company

that says, Let's do this. Let's
have some docs that are focused

on lifestyle disease reversal,
and we have people that want to

reverse lifestyle disease
themselves and are engaged. We

engage local farmers to grow
regenerative, nutritionally

dense food provided to those
people, teach them how to eat

it. They become addicted to it.
We all there are right there.

You know this?

Yeah, when you eat good food,
and then you don't for a few

days, if you're used to it like,
you're like, oh my gosh, I feel

awful, right? I can't wait to
get home and just eat normal

again. That's your baseline. If
you eat if you eat garbage all

the time, you don't know what it
feels like to feel good.

You just don't the I told the
Agricultural Commissioner for

Kentucky when I was down at Air
H recently, my dream is to write

a check to a farmer for the
health care savings of the

person that's eating his how
powerful would that be? And it's

feasible.

It is we have the frameworks in
place like you know, and you

even look at just how that would
drive regeneration at the field

and farm level. Because if we're
now incentivizing eating more

diverse diets, more crop
rotations, growing things that

are actually grown for quality,
not for quantity, and suddenly

your farmers are like, this is
fantastic, because I've been

wanting to grow these critical
crops. They're super healthy,

they're super foods, they're
whatever. But we need a market

incentive to plant them and get
them through the value chain,

like, get them into processing
and get them into human form.

Because, you know, often they
need to be clean, they need to

be dried, they need to be boxed.
Even if it's like produce, they

need to be cleaned and boxed
grains. You know all that,

although everything has a
different process through the

value chain to get to the
customer. And you know, if we

can figure out how to link and
incentivize consumption

patterns, we suddenly now have a
feedback loop between field and

farm and and market that is
aligned with the interest of

health and climate resiliency,
that alone, once that hamster

will starts turning, that'll fix
so many things, just the ripple

effect from that realignment and
that closed loop feedback system

exactly.

And I think that that's an
incremental step that that

economically aligns to disparate
systems and allows for you could

call it disruption, but it's
also innovation and market, I

think demand. So then what
happens is, then people that

aren't sick are like, wait, I
want to be able to get the

regenerative food. I want to be
able to be part of this program,

right? And then you can say,
hey, insurance only covers that

for if you're if you're truly
sick, right? But by being part

of this plan, you can still
participate in the program, so

you can get your produce from
produce from here instead of

this other place, right? It's
also looking at it at the

grocery level, it's saying, can
we partner at the at the larger

distribution channels to say you
drive healthcare? So how do we

bring you in as a, as a, you
know, as a gateway drug to

healthcare, as Carter sometimes
says, There's big opportunities

there. And then ultimately we
do. We are going to have to

address the actual insurance
structure. So we're going to

have to start to, I think
ultimately we have to break

apart. We've kind of talked
about, like three or four

buckets where you have true
lifetime disease, catastrophic

health. Bridge, which is
somebody who's born with the

genetic and the government like,
that's where you say, You know

what? The government really just
needs to have a fund that pays

for that. I'm not trying to put
more burden on the government,

but I think that is where some
of our pressure is coming from.

Is that that right? So you move
that over, and then you start to

get employers to focus more on
providing catastrophic

insurance. And then you have a
new emerging, what I will call,

sort of like a middle maybe it's
a supplemental policy. It's a

kind of like an Aflac where, but
it's but it's different in that

it includes things like, you
know, an aura ring or your Apple

Watch and food and some of the
things that we want to invest in

to help us, you know, but take,
but again, not locking $1,200 a

month on my behalf into a sick
care insurance policy, if I'm

willing to invest a portion of
that into my health instead,

you know what I'm saying do,
because that's the spend that

could be invested into doing the
things that you need to support

good health, like exercise,
investing in gyms, access to

exercise, access to good quality
Food, if you're paying out of

pocket that you know, which we
all are in, that in that role,

even as nurses working for a
health care institution, our

monthly spend on health care
insurance from a family of five

was out. It was just insane
budget for all the other stuff,

exactly, yeah, and

it's so it's cheaper to be sick,
and so that's the other really

important piece, is that we have
to address that in the insurance

benefits world. But what I've
realized is there's this

starting point, there's now
that, and I think this gets back

to the inflection point that you
and I talked about, which is

we're at this really interesting
time that all of us have been in

this industry for so long, and
now all of a sudden, we're

talking to each other, and it's
like, oh my gosh, there's like,

momentum. We met in this
Whatsapp group of people that

are coming together around food,
is health. There's a momentum

now. And I and so I feel like
that's the important piece. Is

like, don't just say it's
broken. Don't just say you're

going to blow it up. The money
is here, let's figure out how

to, how to redistribute that
money into the right places,

change behaviors, right try and,
you know, start at some points.

I mean, we could talk for hours.

That is a that's a design
process like because we can do

it. It can be done. But it's
like, you need to have that

express to understand the
complexities of the system, so

that collaboratively, a group of
people with diverse perspectives

but aligned around a central
goal can go, Okay, if we, if we

move this lever and we change
this incentive, and we make this

available, and we bring these
people together, suddenly, you

can do these small proofs of
concept that have powerful data,

takeaways that prove that it can
be done. Now it's a matter of

scale and replication, like what
Aaron has done. And we had Aaron

on the show. We actually had
Carter on the show this summer

as well. I and so we're like,
really trying to weave in this

concept where we pull through
the whole system and all the

pieces of the puzzle working
together in unison to to

actually show that this is a
viable model. Because once we

prove in several places that it
can be done, it is viable, it's

creating the outcomes we want to
see, and it has the economic

ROI, that's when it becomes
undeniable that, like that. It's

that it's a unicorns and rainbow
dream, like, it's like, we

disprove that whole unicorns and
rainbow thing. It's like, No, we

have the proof that this works.
This is not just a dream. This

is actually the reality. We just
need to get it in place. So I

love this, Ellen, we are going
to have to do a follow up

anytime. So much to unpack here.
I'm happy to join you on your

podcast as well. Yeah, that
would be super fun, because

it's, again, the reason I even
got into food systems was

because of being in healthcare
and just seeing like, where we

were at. It was so urgent and so
pressing to me that, you know,

like I could spend the rest of
my life in the ICU, which I

love. It's a it's a wonderful
place. I love delivering

healthcare, but I was never
going to make the change that I

wanted to see, and
unfortunately, would be leaving

my kids the same system, which
is a finite system. So I love

the work you're doing. Thank you
for being so passionate about

it. And for our listeners, I bet
there's going to be a lot of

people that want to learn a lot
more about this. How did they

learn more? How do they follow
you? Where do they find you?

Yeah. So

I guess my voice is getting
broader now so they can find our

firm is BP two health.com you
know, B is in boy, if he isn't

Paul at the number two
health.com that is our actual

firm. But we have a podcast
called the reverse mullet

healthcare podcast. It's. I
think it would probably be the

reverse of yours, literally,
where we're much more healthcare

centric. But we did, we actually
will just, we are going to be

releasing an episode with Clint
from Greenfield. Yes, any day

now. Oh, I went on

the show too. He was going to be
on Season One, and now we're in

season two.

Okay, well, he we did him, and
we have had Carter on. We're

gonna have Aaron on. We actually
work with with Aaron to help

her. We had a just had a great
conversation with a payer like,

it's very exciting. I won't go
down that thing. And then the

other place you can find me is
actually Carter Williams, Katie

stevins And I just started a
podcast called and and Carter's

really fancy, so we have, like,
a sub stack channel and

everything, but it's called the
right now, it's called the food

is health revolution, and we are
really committed there. We're

really trying to get even, you
know, Silicon Valley, to

understand what's happening here
and and help push this whole

thing forward. So, yeah, so any
of those places you can find, I

love it on LinkedIn, I have a
big voice on LinkedIn, as you

know you

do, so I'll make sure that we
have those links in the in the

show notes for people who want
to learn more and want to get

involved. And I'm just seeing
this year like we have a

conference in my own backyard
here that I'm very involved with

year after year at the Spokane
Conservation District. We have

our Food Food and Farm summit
every year, and we have great

speakers. This year is totally
focused on food, is health, and

it's an ag conference. It's ag
conference. So we're putting

together panels, and we're
bringing in speakers to really

address this topic, which is
fantastic. So it's happening.

I'll have

to talk more about that, because
I have some opinions on the food

is medicine versus food is
health. I think both are great.

But I think it's really
important to try and get people

to think broader than just food

as medicine. So, yes, exactly.
And you know, with this one,

it's, it's, it's fascinating,
because we're really talking

about, like, linking
agricultural practices with food

quality and then how that
affects health outcomes. And

it's great because it is largely
an all, like 80% of the people

there are farm and ag. And so I
gave a presentation last year on

the linkage between health
outcomes and food outcomes and

agricultural practices and
outcomes. And it was, like,

kicked off of, you know, kind of
a momentum in that community of

like, okay, we really do need to
think about what we're doing as

farmers through the lens of how
that affects human health, which

is, that's the dream, that's
where it's happening. So I just,

I'm so happy you took time out
of your day to join us. And wow,

lots to unpack. And I can't wait
for the next one. Thanks. Joni,

yeah. If you love the show,
share it with your friends. Give

it a reading on whatever
platform you have and just let's

get the word out. And thanks so
much for joining thanks. Joni,

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