Taking Healthcare by Storm: Industry Insights with Dr. Jorge Otañez

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Jorge Otañez, MD, DipABLM, Associate Chief Medical Officer of TrueCare.

Dr. Otañez shares his expertise on various health topics, emphasizing the significance of preventative measures and the importance of community health initiatives. He also highlights the role of innovative treatment methods and patient education in improving health outcomes.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-091925-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical Director of Quality Insights, and today I am very excited to be joined by Dr. Jorge Otañez. He is a board certified family physician and lifestyle medicine. Expert who serves as Associate Chief Medical Officer at TrueCare, a federally qualified health center, committed to providing care for all regardless of ZIP code.

He was born and raised in Tijuana, Mexico. Dr. Otañez has witnessed firsthand how healthcare disparities can devastate families and communities. That experience became the driving force. Behind his mission to serve vulnerable populations. After earning his medical degree from the autonomous University of Baja, California and completing his residency at uc, San Diego, where he served as chief resident, he spent over a decade practicing and leading in community.

Settings across California. We are gonna be talking about how Dr. Otañez integrates the pillars of lifestyle medicine into family practice, how the COVID pandemic reshaped chronic disease care, and how he empowers patients to take control of their health. Journeys. We're also gonna explore how his cultural background shapes his perspective and what the future holds for lifestyle medicine and chronic disease prevention.

Dr.  Otañez, thank you very much for joining us today. Thank you very much for having me. I'm very happy to be here and they're ready to engage in a meaningful conversation. Great. So your journey spans from practicing medicine in Tijuana to leading clinical teams in the United States. I'm sure they're very different uh, experiences.

So what originally inspired you to become a physician, and how did that path lead you to lifestyle medicine? Yes. Well, you know, I was born and raised in Tijuana. I did my entire education from kindergarten all the way up to medical school there. I practiced medicine there for a while. I initially thought I wanted to be a pediatrician, actually was accepted and started a pediatrics residency in Mexico.

And very quickly I realized that I did not want to practice medicine there. Not that I didn't know before, but. Just thought I'd give it a shot.  There was a lack of resources and health disparities and I felt that I, could do more on this side of the border, understanding just the way that a lot of the patients that I was seeing on the Mexico side of the border.

Some of them lived in California and then sought their medical care in Tijuana and the other way around. So I had that opportunity to  start looking into how I can become  licensed in California and in the United States and eventually practice in California. So I started looking into that, but to take a few steps  back, I just was inspired to become a physician after just witnessing everything.

Just health disparities, lack of access to quality care and underserved communities in Tijuana. But then the reason I actually became a physician was because of my parents. I, both of them passed away when I was young. My mother when I was eight, my dad when I was 18, don't always talk a lot about the details, but it was related to just differences in practicing styles and medical care and things that I wish I would've you know, known at the time so I could counsel them to make better decisions, which is why I essentially led me into go into family medicine and lifestyle medicine.

Some things they  experienced could have been prevented by implementing some of the things that now I, I put into practice with my patients. I think it's so very interesting when people have challenging experiences in their youth as they're young and then they bring those challenges to help others, and that sounds like exactly what you are doing now, so that's amazing.

As a family medicine doctor working in community health, what do you see as the most pressing chronic health issues affecting your patients today? I think a lot of us, it doesn't matter where you are in this country, other countries, like there's a high prevalence of  diabetes, hypertension, obesity, hyperlipidemia, just metabolic syndrome in general.

But not, just that, the fact that all of those chronic diseases are intertwined with mental health challenges and social drivers of health such as food insecurity, unstable housing. It's just that burning of the chronic disease in the communities that I serve is  I see it as both preventable and reversible.

At TrueCare, the way we screen for SDOH  we have focus on preventive care, primary care and we wanna make sure that what we're doing is meaningful and that we actually have a. Sort of a solution for that. In fact,  we're screening for things that we can provide our patients with answers and connect them with those resources.

'cause there's, I'm sure you know, there's a lot of questions you can ask, but, it doesn't make any good that we're just asking questions just to collect data if we cannot actually do something about it. So it's just that combination with mental health  and all those chronic diseases that  I feel is.

It's becoming more and more challenging by the minute. Yeah. And you have to look at the whole person, and that includes where they live the food that they're eating, the water that they're drinking, what their household income is. Yes. But all holistic view  of individuals. So I know I'm gonna talk about something that probably nobody wants to talk about anymore.

How do you feel that the COVID pandemic changed the landscape of chronic disease management in your practice? And what long-term effects are you still seeing now? Yeah, that's, that. I think it exposed and deepened existing health disparities. Many patients, as you are aware, delayed care  the access to healthy foods and exercise spaces and just, it, it was just an added stress and grief to everything that they were dealing with, their loved ones and, not being able to do things that.

You know, you were you had to shift very quickly to telehealth practices and then telling patients to like, eat healthy and, exercise and all those things that we continue to tell them. And yet  they didn't have the access to those things at the time. Something that I saw that is still, it's getting even worse now.

 The. Decreased trust in the medical field. Not just a pandemic, but something that a lot of people referenced as an info demic. There's a lot of misinformation that was going on and that it's currently is still going on. And just. Seeing that all of those chronic conditions were worsened, more advanced diseases at younger ages  accelerated the need for innovative and patient-centered medical care models.

With this telehealth  we have to shift very quickly. All of a sudden it's like, patients are not coming. You need to do telehealth. So you have to get very creative. So as of today, I continue to see that trust in the medical field  the misinformation that's being put out there  continues to be a problem.

 We have a very difficult job to do in, in community health centers, caring for, the vulnerable populations and that those kind of things  don't make our job easier at all. Yeah, misinformation is tough and it seems to get worse by the day. So you are practicing lifestyle medicine  the pillars of lifestyle medicine and what you do, and it emphasizes empowering patients to take control of their health.

So what strategies do you personally use to help patients feel confident and capable of making lasting changes for their health? I, and I've always practiced this even when I was practicing medicine in Mexico.  I started with listening and truly listening and understanding where each patient is on their journey.

 I wanna make sure that I can help them identify their small but achievable goals. So I always you know, smart goals, I always put that into practice and make sure that I partner with them. I use motivational interviewing a lot. Cultural humility.  I build, help them build on their strengths. Just ensuring that I can partner with them.

I don't like being prescriptive, although practice in medicine in both countries, in Latin American countries a lot oftentimes patients are like, you're the doctor. I'll do whatever you tell me. You tell me what to do. Like you're and that's something that. Those same patients when they're getting their care here in the United States, they don't always understand and they're expecting me to tell them what to do, and that is not my job.

 Right? As you are aware, like we need to have  shared decision making and we need to present them with options, and we need to really truly partner with them. So when I'm working with patients and I tell them like, here are your options. Like, What can you do? Then  they're oftentimes surprised because  they're expecting me to just tell them what to do, and things don't, work like that.

So the active listening, understanding and just partnering with them is something that has. Work very well throughout my career. Yeah  I would agree. And, And I'm just gonna build on that a little bit because we all know behavior change is so incredibly difficult  just for us as physicians, so obviously for patients as well.

So how do you approach patient motivation in populations that are dealing with multiple stressors or health disparities, which seem to be becoming worse currently? So how do you approach those  patient populations first? I recognize that the motivation can look different for everyone, especially when sometimes.

Survival takes precedence over wellness.   I can't say eat healthy exercise when they don't have the money to purchase healthy foods or to purchase food, you know, altogether.  It is just that understanding. I meet patients where they are always, and  I acknowledge their challenges.

also make sure that I can celebrate any progress as small as it is, like I, just a couple weeks ago with patients that  Hey, last time you were here, you lost four pounds, two pounds. Something's like, oh, I wish I would've lost more. It doesn't matter, right? Sometimes I joke with them, it's like, Hey, if I had a gold star, like I would  you would leave with the gold star on your forehead so people can ask you about it and say  Hey, my doctor gave me this gold star because I lost two pounds, because I exercised, because I'm not eating more.

Fruits and vegetables. So it's just celebrating those small wins helps a lot. And I also focus on the why they want to change. I'm always partnering with them and asking them like, what is it that's motivating them to change? And then we create those plans together, ensuring that they're realistic and then culturally appropriate.

'cause  that is also something that I've seen where a lot of people in general just in healthcare get frustrated and say like, they're just gonna eat whatever they eat. They're not gonna. Do the things that I'm recommending. So I think overall empowerment not judgment is key to be able to partner better with patients and just help them  make better choices ultimately.

And in the end  they are gonna make the choices that they think are going to be best for them.  But I considered my job to give them the information and that is evidence-based information. I really love that idea of small wins,  so like people really want like the whole big shebang. Like I wanna be 40 pounds lighter.

But yeah, I think small wins are definitely the way to go. So you grew up in Mexico and you saw firsthand how healthcare inequities can devastate communities. How has that experience shaped your approach to chronic disease prevention and care today? Growing up on the other side of the border where I am here in California gave me a deep understanding of how just poverty, lack of access, systemic neglect  I saw that firsthand.  Not even that some patients had access to care. There. There's a lot of like different, the healthcare system allows you to even have access to private practice. And like sometimes,  there's pharmacies as an example where you can go and get your care for five, $6 and you'll have access to a fully licensed physician, however.

 I think the issue of having the right information from the right sources and going back to the misinformation of where those physicians and the people providing the care are getting their information from, or the patients would come to you and say like, Hey, I read this online, social media and all those things you know about, and it's sometimes difficult to change.

What they think. So those perspectives of, looking at everything the way I grew up, the way I access healthcare as well, and my family  was able to drive my commitment to just like this concept of health equity, right? So I know there, there's a lot to say about that.  But just with an emphasis on the prevention.

I think the fact that I was able to experience that and I I'm able to, I still volunteer on the other side, right? So I go to Mexico, I volunteer, I see patients. There as well.  Those perspectives actually help me now in my current practice to design programs that can be accessible, that can be culturally grounded because I know what's at, stake for those who are not, don't have the access.

Again, it's not, you can have the greatest access. In the world, however, like what are we telling patients?  how are we saying things is what I think it matters the most.  a lot of healthcare happens outside of the four walls, right? It's just like that 20% that we get here.

And that other 80%, as we alluded to earlier with the SDOH happens outside of our clinics and hospitals and other healthcare settings. Yeah, I mean I, so what you just said resonated with me so much. What we say matters so much.  Like going back to like the two pounds, like you're saying, you lost two pounds, it's great.

Another physician might say You only lost two pounds.  And the way you say that is gonna make such a difference in that patient's life. So  I think that message really needs to be stressed. Like I wish we'd say it in medical school, like how you say things really matters. So  I really appreciate that view.

Just shifting a little bit in talking about leadership and, 'cause you've held several leadership positions in federally qualified health centers or FQHCs. From a systems level view, how can clinics and organizations better integrate lifestyle medicine into primary care?  According to the current administration, we're supposed to be making America healthy again, and lifestyle medicine is here for it, right?

So how can we integrate that in a systems level? I think first we need to shift our mindset a little bit from. Although we do a lot of preventive care when it comes to cancer screenings and labs and infectious disease and many other things, and we you know, we do check for A one Cs and like to screen for all those things, but we need to be  a little bit more, a little bit less reactive and not necessarily driven by those things that are gonna.

Bring money back.  So sure,  you need to keep the lights on. You need to be able to be here for patients, especially in clinics like us, that will see any patient regardless of their ability to pay. However this push for strengthening the preventive care.

Means that we need to invest in team-based approach and just leverage also like the community and community health workers  and community partnerships and just tying the lifestyle and interventions to also a value-based care model, right? So I found a way here  at True Care where we have, we're working on a value-based care roadmap, right?

So things are gonna shift in the future and how we get paid and how we do things and all of that. And then I started you know, looking into lifestyle medicine, how we're always in the room with patients, telling them they should do all the great things in the world of eating healthy and exercise or clicking boxes.

We're saying like, oh, I counsel the patient, however, that isn't enough. So I started looking into that and as, a clinician and as an administrative person as well it is just tying everything together, right? Looking at the system wide and saying, okay  we're gonna look into valley based care.

Let's start doing some group medical visits, right? So like how we can look at alternative ways of delivering care and doing like lifestyle medicine. Sure. Medical appointments as an example.  So we're also looking into integrating culinary medicine, medically tailored meals and, just a lot of I started with this idea like, I want to create this one program.

Now we have on a roadmap upwards of 18, 19 programs that we're gonna start  delivering within the next two or three years. And we started already with a couple of those. So it's just the way you're looking at things from the system view at large and ensure that I think this value-based care is where there's a lot.

Of strength in making sure that everything that you're talking of, you're talking numbers. If you're being, it's not just talking about being productive and seeing more patients, it's just working smarter. And that's something that we did here. And it certain, it resonates with everyone. So a lot of people here truly understand and our clinicians, right?

So there's not only the patients that benefit from this, our clinicians as well, because we're giving them more tools so they're not feeling. Powerless when they're in the room with a patient saying like, oh, you know, it's very difficult to affect change and adult and all that. And feeling frustrated.

 Guess what? Now we have this set of programs where you can say like, Hey, here's this exercise program, here's this walk with the doc chapter that we started. Like you can invite your patient, you can lead a walk, your patient can come and exercise with you.  So I ask myself this question like, am I just gonna give up because it's difficult to affect change, or are we gonna continue to push through and find ways and programs are sustainable and enhance our preventive care model as well?

I wanna be a patient in this, in your clinic. I mean, I love this Walk with a doc and the, and you said cooking classes just really innovative but not innovative, really basic and simple. And it  not only affects change with patients, but it sounds like it's very meaningful for your  providers as well.

 Very two very important things and making a healthy atmosphere for everybody. In your experience, how does being bilingual and bicultural enhance your ability to connect with patients and deliver care that resonates across diverse communities? It's helped me a lot. It allows me to build trust faster.

Understand  unspoken cultural values that affect health physicians? I think it's not just about translating words, having someone in the rooms. 'cause I felt that way when I, I only speak Spanish and English, right? There's many other languages that I clearly do not speak. And I have those patients that when you have.

A phone translator. You have a device, you have a person, a third person in the room, a family member. It's not the same. And, and I think a lot of us have experienced this, so being able to. To care for the population in the, in their same language. I think it's just beyond  it makes me feel so, so great.

And then  I walk into the rooms and the patients, I start speaking Spanish because I see that's their preferred language on our EMR. And then I have so many stories and so many times where like the patients like, you see their eyes, light up, they're like, oh my God, you speak Spanish. And they just like, and then all of a sudden they start.

 Talking and talking, which I know we only have certain amount of time, right? So sometimes I do have to say like, well, let's put a pin on that. We'll come back to that. In fact, there's the first time that I'm seeing you, I want to focus on this, on that. It just makes patients feel seen, heard, respected.

Not that you can't do this when you have translators and all that. It's just the ability to be able to do that. And I see that with my colleagues that also speak other languages that I do not speak. It certainly helps build that trust and the foundation for more effective and lasting care. I've been able to create great partnerships with patients just by.

Understanding and having conversations. I'm, I joke with everyone, but like, I kid you, not every single patient that has diabetes and we're having a conversation about nutrition, what they eat, like almost every single time, either I bring it up or they bring it up, but we're having a conversation about how many tortillas do they eat, not just in a day with each meal.

My goodness. Just two, three weeks ago, I had  a conversation with the patient where. I was like, okay, so how many tortillas do you eat a day? And they're like, yeah you know, about 10, 12. And I ask in a day, and they go, no, with each meal. So they were eating upwards of 30 tortillas. And again, this does not surprise me.

I grew up like this. I know this. Like now I can ask different questions and try to understand. Okay. And then we start partnering, right? So making those smart goals, and I'm, I gonna say stop eating tortillas altogether like. that's not how you do things, right? So it's okay, what do you think you can do?

Let's maybe cut it like in half, or let's do this, lets do the other. So. they just open up. And in my current position, I only see patients once a week. The rest of the time is administrative work that I do, creating programs and doing many other things. I from, not to toot my own horn, but multiple times, those patients who speak Spanish, they like, can I be on your panel?

Can you be my doctor? And I say, you're gonna get frustrated because I'm only here once a week and there's not enough appointments for you. But guess what? I'm also in charge of hiring doctors so we can hire other doctors that speak Spanish or understand you and all that, and then I'll recommend others to, to be seen with them.

I think it's really powerful and very, very helpful. Yeah  I would agree. Looking ahead, what do you see as the future of chronic disease management, particularly in underserved or high risk populations? And I'll add to this, if you had a magic wand  what would you want to see?

 I think the future lies  in prevention and personalization.   We have to stop adopting models that. Just you, again, like going back to my comment of like just telling patients the same thing over and over and, counseling them and clicking boxes and saying that you told them what to do when, we need to teach them.

You need to go out with them and exercise. You need to bring them, you need to give them the spaces and the tools so they can. Make those choices, I think we need to move away again from that one size fits all care and address  the actual root cause, right? So with lifestyle medicine, with the changes that we're hearing from this administration  and things that could potentially happen just the support that we can give patients, we need to embrace technology.

There's a lot of things that are out there that can help us and to ensure that we can bring lifestyle. Based innovative approaches to our patients to help us with that. For the underserved populations, it means that we need to integrate those services. I'll give you an example.

Nutrition, right? So we don't have enough nutrition is  we have a couple of them for our entire organization and we care for over 70,000 patients. And it's only as an organization, we get paid for their services for specific programs and with ps, or, and then  women's health, but a patient who can greatly benefit a diabetic patient, a patient who has hyperlipidemia or hypertension, a lot of those things that can be improved in nutrition.

We do not get paid for the services of a dietician, right? So I think we need to find ways that creative with the shared medical appointments, with the  teaching, cooking kitchens and activity, physical activity programs and things like that. Where you do this whole person care, which is what we're doing with our programs here  in this chronic disease management, which is, it has to become a community center and equity driven approach.

 Part of what we're doing here  is a community of care ecosystem. We recognize that we're not the experts in exercise and nutrition and all of those things. So we're partnering with the community and  forming those links so we can say Hey we know healthcare you know, physical activity and fitness.

Let's do this together. You have a kitchen, let's do this together. So that's what I think the future should look like. That's what the future's gonna look like for us. As far as the magic wand  I don't have a great answer for that right now.  There are days where I  I feel like, gosh  I wish I had more ways to just give food to our patients, helping nutritious foods,  forget about like. there are medications and all the other things they have  and there are days where I'm like, I wish I had, you had access to a nutritionist, you had access to mental health. Like it just depends on the day. So it's a tough question to answer.  . So last question. What excites you most about the future of lifestyle medicine and what message would you share with other physicians considering certification or bringing this approach into their own practice? What excites me the most is this, although you know, you, you went to medical school and, and they teach you how.

preventive medicine to some extent, depending on where you went and how long ago you went to school. And  you're talking about hypertension. It is like, yeah, you can exercise, you can eat healthy, dash diet, this and that, but here's a list of a hundred medications you can prescribe and here's all the doses and all those things.

So I, lately, in the last five years or so, I've been seeing a lot more of this. Push to try to do more preventive care. It was one of the reasons that I became certified last year because I felt that I have even more tools to be able to transform the patient's lives and not just, that's when I'm seeing patients one-on-one, but in my current role, to bring programs that can transform communities.

For physicians. It's just not too, I don't see this as another credential. I think this movement towards a, it's more meaningful and impactful care. I recently made a comment to someone. I was like  I don't know, like I need to, I started looking into this because I wanted something else that would brighten my day.

I wanted other additional tools instead of just doing the same thing over and over. So I think it's been.  Not that I was feeling burnt out, but I was ju I just wanted to find a new meaning in what I was doing and lifestyle medicine truly gave me that, the ability  to reconnect with why I went into medicine.

Coming back to the first question, what I wanted to do, this completely helped me with that  and I think. To some extent contagious, because I've had other clinicians here. Now a couple of them  they're on their way to get certified and I'm going to pursue my culinary medicine certification next, and  I will bring others along as well who want to do this too.

So I think it just help me to reconnect with why I went into medicine, the purpose, and I can continue to do a lot more for my patients. I feel more empowered. To empower them to make better and healthier choices. Yeah, that makes total sense.  That's inspiring. So  Dr. Jorge Otañez, if people wanna hear learn more about you, I think they can.

Is the website www dot true care, T-R-U-E-C-A-R e.org, can they go to the website to learn more about you and your practice? Yes, that is correct. Awesome.  Thank you so very much for joining us today. I learned a lot. I've been inspired, and I hope everyone out there has been inspired as well. So thank you.

Thank you so much for having me. Appreciate it.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.