Dr. Jeff Gladd is a brilliant Fx/integrative physician who is PASSIONATE about all things Fx business.
If there is ONE area I get more requests on, it’s business: setting up a practice, platform building, building a reputation, finding one’s focus and passion. Extra-clinic revenue streams.
And mentorship: finding your tribe, building your collegial connection, moving off the island of medicine and into your tribe. With that in mind, Jeff – who is the CMO at Fullscript – and I have a tour-de-force convo on all of these topics. Learn about FS’s integrated EMR, our Clinic Immersion and Fx Residency programs, with top tips for building your brand. And so much more.
Check out the shownotes for loads of links, references, downloads and more, and be sure to leave a review wherever you listen to New Frontiers! As always, thank you for listening! ~DrKF
As doctors and other healthcare practitioners move into functional medicine, one of their top questions is: How do I run a thriving functional medicine business? In this episode of New Frontiers, Dr. Fitzgerald talks with Dr. Jeff Gladd, who has started several successful functional medicine businesses. He shares his insights on starting a functional medicine practice, marketing and promoting a practice, and increasing revenue.
Dr. Fitzgerald shares details about her groundbreaking practice, including the clinic immersion program and the nutrition residency program for fellow practitioners. The New Frontiers episode is full of pearls on building a successful functional medicine practice.
In this episode of New Frontiers in FxMed, you’ll learn about:
- Dr. Gladd’s personal functional medicine journey
- How Dr. Gladd succeeded in opening an insurance-billed integrative medicine clinic within a hospital system
- How Dr. Gladd transitioned from running an in-hospital, insurance-billed clinic to launching a separate, direct-pay practice
- How Dr. Gladd leveraged the hospital’s marketing department to promote his integrative clinic
- Tiered pricing for working with different practitioners in an integrative practice, including nurse practitioners and health coaches
- How to leverage telemedicine and remote platforms to increase revenue and grow your business
- How to talk with patients about the financial aspect of direct-pay services
- The pros and cons of charging by the hour versus offering packages
- How to structure billing and scheduling to encourage patients not to cancel follow-up visits
- Building a practice around your particular passion within functional medicine
- Pros and cons of different EMR systems, online pharmacy providers, and patient communication systems
- Medical transcription services
- Creating multiple in-clinic revenue streams
Dr. Jeff Gladd, MD graduated from Indiana University School of Medicine in 2001 and is board certified in family medicine. While running a busy conventional medical practice in 2006, he lost 50 pounds, transforming his personal and professional focus toward integrative care.
He is a 2009 graduate of the University of Arizona Integrative Medicine Fellowship. He served as the medical director of a hospital-based integrative practice in Fort Wayne, IN, before a 2010 spin-off into GladdMD Integrative Medicine, a direct pay consultative practice.
Dr. Gladd founded and launched PureHealthMD.com, a website housing professionally-authored health content, which successfully sold to the Discovery Channel. He created and launched the web’s first nutrient depletion calculator, Mytavin.com which was recently acquired by Fullscript. He has taught the business courses at the U of Arizona Fellowship and AIHM.
Currently, he is the Chief Medical Officer of Fullscript, a virtual dispensary aiming to change the way health is prescribed. He advises a variety of healthcare startups, as well as insurance and tech companies while he continues to run GladdMD Integrative Medicine and GladdMD.com.
Dr. Kara Fitzgerald: Hi everybody. Welcome to New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine, and today is no exception. One of the biggest requests that I hear, not just in the land of the New Frontiers podcast, but on the website, emailed directly to me, in our clinic immersion program, in our nutrition residency program — just over, and over, and over when I’m in person somewhere is, “I want to understand how to run a good, solid, functional medicine business.” The question around business is always big. We’ve talked to Tom Blue in our clinic immersion program. We’ve pulled in other experts like Dan Kalish and so forth to talk about business. Today I’m going to be mining the expertise of Dr. Jeff Gladd, who I had the privilege of presenting at A4M with in DC a few years back. He and I hit it off, and I resonated with his message. We’re going to mine his brilliance today and talk about some of the cool projects he’s up to, and some of the things we’re collaborating on. Let me give you this background and then we will jump in.
Dr. Gladd graduated from Indiana University School of Medicine in 2001, he’s board certified in family medicine. While running a busy conventional medicine practice in 2006, he lost 50 pounds transforming his personal and professional focus towards integrative care. I have to ask you about that, Jeff. That’s pretty impressive. He’s a 2009 graduate of the University of Arizona Integrative Medicine Fellowship, and he served as the medical director of a hospital-based integrated practice in Fort Wayne, Indiana, before a 2010 spin-off into GladdMD Integrative Medicine, a direct pay consultative practice.
He founded and launched purehealthmd.com, a website housing professionally authored health content, which was successfully sold to Discovery Channel. He created and launched the web’s first nutrient depletion calculator, mytavin.com, which was recently acquired by Fullscript. He’s taught the business courses at the University of Arizona Fellowship and at AIHM. He’s currently the chief medical officer at Fullscript, a virtual dispensary aiming to change the way health is prescribed. He advises a variety of healthcare startups as well as insurance and tech companies while he continues to run GladdMD Integrative Medicine and gladdmd.com. Dr. Gladd, welcome to New Frontiers.
Dr. Jeff Gladd: It’s great to be here. Thanks for having me.
Dr. Kara Fitzgerald: Absolutely. Folks, you can hear from Jeff’s bio why I want to talk to him today. He’s so experienced in making the business of medicine work. First of all, Jeff, just the fact that you were able to launch a successful conventional family practice is a big deal in this world where everything is owned by hospital conglomerations. A, that’s a big deal. Then within that busy model, because I know it’s crazy, you had your own transformation over to integrative and functional medicine. You changed your life within that model and then you changed your practice. Talk to me about that journey.
Dr. Jeff Gladd: Yeah, I mean, to think of it now because I’ve been in this steady model and practice for now 10 years. Everything just, really rapid fire, happened very, very quickly. I had this very conventional family practice. Not only was I seeing the 30, 40 patients a day, but I was also doing OB, and delivering babies, so I’m on call in a small town every night pulling my shifts in the urgent care, rounding on in-patients. I mean, it was what I thought I wanted to do. It’s certainly what I was trained to do. That, over the course of a couple of years with a very poor lifestyle in terms of diet, and lots of diet Coke, and poor sleep, and so on and so forth.
I mean, I was overweight. Probably, if I wouldn’t have known about prediabetes and investigated those markers that I investigate for everybody now, I would have found myself pretty sick. But I was also self medicating myself for panic attacks. I mean, I was taking samples out of the drug rep closet to manage those since medical school. It was a mess obviously, and it was a really… The initial was, “Hey, I need to lose weight.” As I just focused on better nutrition, cleaned up my diet, lost 50 pounds, mental clarity, got off of the medications. It was just this really big Aha! moment that what I’m doing in delivering care isn’t actually doing anything about people’s health.
I studied nutrition. Again, like I said, just everything was kind of boom, boom, boom. Because about that time I left solo practice for the exact reason that you mentioned, how hard it is to do, and joined the local hospital to become an employed physician, because it just wasn’t sustainable from a financial standpoint, and it was just such a burden to handle all that, and-
Dr. Kara Fitzgerald: Well, it was destroying you. I mean, you go into the art of medicine, you have this calling and you’re destroyed in the process. Of course you had to join the hospital practice.
Dr. Jeff Gladd: It was. At that time it was just, that whole thing was just starting. The hospital acquisition of doctors was just starting. Because it’s, Parkview Hospital now, it’s hundreds of physicians. I mean, literally hundreds of physicians. I was like physician number eight. As I had this Aha! moment and I figured out that integrative medicine was this calling and this desire for me to go down the road of, “This is how I want to practice. This is the content I want to know,” I, because I was one of eight physicians, had the ear of leadership at the hospital. I went to the CEO and I went to the CFO and said, “Hey, I want to be an integrative medicine doc. I want an open integrative medicine clinic.”
They said, “Whoa, what does that mean? I mean, how do you do that?” I had no business experience. Even though I had the solo practice, I still didn’t really understand an organization, and budgets, and what really is going to speak to them. But blessedly they had the foresight and the passion, or at least could appreciate my passion and said, “Okay, well let’s try it. Let’s open the Parkview Center for Integrative Medicine. You do it two days a week, it’ll be an insurance-billed integrative practice. You’ll spend time with patients, you’ll work on health, but keep your day job. Keep your primary care practice three days a week.”
Within just a couple months, I mean, the demand was huge. I was doing a live news show. The community was understanding this, and there was a huge desire for this because it really didn’t exist. Two months later they said, “Okay, we get it. This is now your full time practice. Go ahead and do integrative medicine full time.” It was just such an exciting time. But meanwhile, I was also feeling the burden of employment. Being a tech guy and running a startup, I was in between patients having to login past the firewall of the hospital to get access to the internet every time. Then wanting to make any changes in the practice and having any unique ideas, just, you needed the six levels of approval and it just was, it was stagnating. I was doing the Arizona fellowship, I was also now designing my ideal practice. “What will this look like?”
Dr. Kara Fitzgerald: Before you jump there, because obviously everybody wants to hear about that. I want to ask you, you made this rapid-fire, successful, hospital-based program, and I do understand all of the levels of bureaucracy. We were talking about it before, and why you would want to transition elsewhere. But I also want to just mine a couple of your thoughts around what made it spectacularly successful. For instance, how did you end up on TV? Were you speaking locally? Are there any… Just give me a couple of thoughts there because we’ve got a lot more to talk about, just around what you did at that time. Not everybody ends up on TV when they start a practice.
Dr. Jeff Gladd: No, for sure. Again, this was part of the intention of, “I need to launch this integrative brand with the hospital. I don’t know if my community is ready. I don’t know if they’re interested. I don’t know if they know what this is.” I’m not ready, as a guy who was in quite a bit of school debt and all kinds of other personal financial debt, to take this risk on myself. I was able to guarantee a salary with the hospital, but I was also able to utilize their marketing to get this message out in the community.
Now, we can talk down the road of how someone who doesn’t have that luxury can basically do some similar things and gain exposure and become a brand in their community. But, again, being one of eight physicians in the hospital and being as unique as I was, I had the marketing folks working with me to figure out, “Okay, hey, how can we get exposure? We got an article in the paper coming out. We’ve got this, it’s called the Noon Extra.” It was a call in show on weekday, ABC Television locally in Fort Wayne, where it was a live call in show. I came on and was fielding questions, and obviously wanting to talk about nutrition, and health, and being a doctor. I mean, the phone lines were always packed. What started out as an every other week TV spot became weekly, and that really grew the practice.
Then I had a team outside of the hospital that was helping with my branding, who was now cutting up all these Q and As and turning them into YouTube clips. Now I had all this video content that I was doing already and it was helping lives. Now I’m repackaging that and, I mean, those clips still live on my Facebook page and on our YouTube channel. It was utilizing them. Now as I made and left the hospital, I, early on before I officially left the hospital, talked to the news station and said, “Hey, I want to keep this going. I hope this isn’t just a hospital thing. I hope this is helping your programming and getting people to tune in,” and they’re like, “Yeah, for sure.” For a year and a half after leaving the hospital, I was still doing the live news show.
Dr. Kara Fitzgerald: Oh that’s perfect. There’s so much beneficial information you’ve just given from grabbing little clips and popping them on your YouTube to accessing the hospital’s platform. I mean, I don’t have a hospital-sized platform by any stretch, but we have worked on building our platform and one of the things that I continually do, since we’ve got such a large collaborative team here. I always want my folks who are inspired to do so to contribute content to the platform and not only build their brand, but it’s just a nice quality of content. I don’t want to be the lone person here. Really sharing, I think that finding a platform you might be able to jump on would be a good chunk of advice for new physicians transitioning in or new practitioners of any stripe.
Then if you do write content, like you said Jeff, you can pull some of those quotes and pop them up on YouTube if you’ve got the visual, or we pull quotes, all of… there will be quite a few quotes pulled from your content today and we post those on our Facebook and though… excuse me, well, we do post them on Facebook, but on Instagram, these New Frontier quotes are probably our most popular bit. Thanks for highlighting that because we’re doing our own version of that. All right, so let’s just go back to you transitioning into and building your dream practice. Talk about that.
Dr. Jeff Gladd: Yeah, let me jump in first though just to piggyback off of what you just said. But even working with the local hospitals, if you’re not a hospital employee, no problem. I mean, we’re seeing more and more hospitals and institutions understanding the patient demand for integrative and functional care. While some of them are actually opening clinics, all of them, I’m sure, are looking to partner with really good providers in their area in some way, shape, or form. You actually might utilize their marketing channels and might utilize their power in the community just as some partnership and messaging about health. Don’t let that stop you.
I mean, I haven’t been hospital-associated now for 10 years, and the hospital I left still has an active integrative clinic, which is basically the one I started. But the other hospital has come to me just in the last year and said, “We somehow want to be aligned with you because our patients demand integrative care.” That opportunity exists for anybody out there who has a really good practice, and a good focus, and just has that passion. Go knock down everybody’s door because everyone’s looking for this in some way, shape, or form. If you’ve got a legitimate practice that you’re doing it, there are opportunities out there.
Dr. Kara Fitzgerald: Well, and that’s in the brick and mortar space. I would argue that those same opportunities exist in the digital space where you can-
Dr. Jeff Gladd: Even easier. Totally.
Dr. Kara Fitzgerald: We’re going to be talking about our clinic immersion, and this collaborative care model, and mentorship, and all of that. You build your community by doing this outreach, you build your collegial community, you build your inspiration, you just have more, not just patient contact, but just this rich collaborative environment that we can lose if we’re siloed in our little practice. Actually, with that note I want to circle back and hear about how you built your practice and some of the things that you did there that are useful. We’ll continue on this other conversation in a few minutes.
Dr. Jeff Gladd: Yeah, for sure. For sure. As I was in the insurance-based, hospital-employed integrative practice, they had sent me to the old Heal Thy Practice conference that the Holistic Primary Care Journal had put on for a few years. I think it was the first one I went out to. It was a very business-focused conference. I was able to design this dream practice as I was already practicing, and realizing that it can’t work with insurance companies. If I want to spend time with patients, and I want to give them the time they need, and there’s no pressure for productivity, it just can’t be insurance-based. That was what I realized had to happen.
Then I started having conversations with patients. As I was making this transition, my guaranteed salaried contract with the hospital was coming up and they’re like, “Hey Jeff, we love what you do. You’ve got a six-month waiting list. It’s amazing. Your reviews are off the charts. We need you to see three times as many people and we’re all good.” It was just like, “Yeah, I can’t do that.” That was the launching point. I started having conversations with patients and I said, “Listen, this is what this is going to look like. Insurance just doesn’t support the type of care we’re delivering,” and then started to build out how we were going to be able to do this and bring on other providers.
I was able to bring on two nurse practitioners when we launched, this is August of 2010, that had had some training, nothing official, nothing formal, in terms of the residency or fellowship programs. Then largely trained by me and worked alongside me before they saw their own patients. Now those two nurse practitioners, one of whom is my wife, has been with me now for over nine years seeing patients. I charge a lower rate for the nurse practitioners, so we have an opportunity to be able to see as many people as we can, but also still deliver that same type of care.
We used a platform that was able to handle confidential messaging. We do email visits, which is a much lower expense and lower costs. Patients who just have small changes that they need to make or tweak can do of the virtual visits. We’ve certainly embraced the telemedicine aspect of things, and now we’re using health coaches to deliver a lot of the lifestyle content, which is taking the more expensive provider visits and utilizing them for more of the high level focus as opposed to just focusing on everything.
Then, it really is about delivering that message and explaining to patients why you’re doing this, what it means. Because initially, we had a lot of patients who were used to the insurance-billed integrated visit who were resistant to paying for it. It was just a matter of explaining, “This is why. We understand if it doesn’t work out for you.” What I found was, in the three to six months of launching the practice in 2010, we saw a whole lot of new patients. Because we had this huge waiting list that we had access to. We reached out to all those people and we said, “Here’s the new practice. We can actually get you in tomorrow, not six months from now.” That really fueled the beginning of the spin-off practice.
Meanwhile, the patients who were reluctant to go into a direct pay practice and pay out of pocket were realizing that the conventional alternative that insurance covers wasn’t what they wanted, and it wasn’t the type of care that they wanted for themselves. Those patients then started to come back. Meanwhile, we just kept delivering the messaging. We did a couple of movie nights where we hosted documentaries about the type of… We did Food, Inc., was the big one, and just kept spreading that message. I was still on television. We were then packaging, again, all this content online, and just really trying to deliver as much education about what we’re doing, but also being very open about the finances of the practice, and why we’re passionate about this model. That just kept building upon itself.
I think the whole move toward higher deductibles, obviously aligned with the timing of what we are doing too. At the same time we’re leaving insurance, more and more patients are becoming consumers, and so the first, now, five or $6,000 out of pocket is theirs in healthcare. They get to choose how they spend that. I don’t want to spend it with a seven-minute office visit. I want to spend it with an hour with you guys. That obviously worked big time to our advantage.
Then we continue to be a very cost-focused practice. I have financial conversations with patients all the time, and a lot of our clinical decisions come down to dollars. Do you want to do all this testing? Here’s what it’s going to cost, here’s why I think it’s valuable, but we could also empirically try some things here, save that lab costs, see how it goes and go from there. We then built a relationship with LabCorp. We have incredibly inexpensive cash labs through LabCorp and so we advertise that. Our patients know now, if they take my office visit and the lab work, it’s over the course of the year, thousands of dollars saved versus going to the hospital to get your lab stuff. It’s just fast.
Dr. Kara Fitzgerald: Yeah, absolutely. Yeah.
Dr. Jeff Gladd: We’ve saved money there, big time, and then we use the GoodRx for prescriptions and we help patients save money on their prescriptions. Now we use MDsave all the time.
Dr. Kara Fitzgerald: All right. I got to flesh some of this out. People are going to have a lot of questions because you just said a ton. Okay, so first of all, direct pay model. Is this an hourly, are you guys doing an hourly or did you design-
Dr. Jeff Gladd: It’s hourly.
Dr. Kara Fitzgerald: Hourly. Okay.
Dr. Jeff Gladd: Yeah, the package is interesting. I think it’s a model that clearly works. I thought the packages would create too much sticker shock. Again, we’re customizing the journey for people, so sometimes that second visit doesn’t need to happen in four weeks. We might be able to push that out three or four months. I still think by doing it hourly visit, by visit, we’re saving patients a little bit of money in the long-term, and avoiding that sticker shock of what a package might look like.
Dr. Kara Fitzgerald: Okay. Absolutely. That makes total sense. Then, I mean, what is your first office is it? How long do you suggest, do you tell patients it’s going to be approximately?
Dr. Jeff Gladd: It’s always 60 minutes.
Dr. Kara Fitzgerald: It’s always 60-
Dr. Jeff Gladd: It’s always been 60 minutes. The initial visit is 60 minutes with the provider, and that’s either myself or one of the nurse practitioners, plus 60 minutes with our nutritionist/health coach. We-
Dr. Kara Fitzgerald: Two hour.
Dr. Jeff Gladd: That’s it. But it happens. We then started pushing that second visit. I thought the back-to-back provider visit is already a ton of information. You’re overwhelmed, you’ve got brain drain, excuse me. Then you go ahead, we move you across the hall and now we expect you to change your nutrition.
Dr. Kara Fitzgerald: Yes, it’s a lot.
Dr. Jeff Gladd: That nutrition visit happens after the second visit. It’s already paid for in the initial visit. It actually happens in the second visit, which we find works better.
Dr. Kara Fitzgerald: Yes, we have the same model. We do the same thing, I mean, for exactly the same reasons. We actually have our initial visit. Our initial visit here is two hours. They prepay their initial visit, which includes an additional two hours for nutrition because it’s so integral to the success of the functional medicine model. They don’t actually, the therapeutic dietary prescription isn’t prescribed until they meet with the provider at the second visit-
Dr. Jeff Gladd: Second visit. Got it.
Dr. Kara Fitzgerald: Then they schedule with the nutrition team. It’s actually a third visit where they then circle back and meet with the nutrition team. We found that to work very well for us. It sounds quite similar to what you’re-
Dr. Jeff Gladd: Very similar. Yeah, no, I agree. I mean, my favorite example, and I think this is how it works so well. First of all, I baked the nutrition fees into the initial visit because in the first couple months of the practice, patients would come for the initial visit, then cancel their nutrition appointments.
Dr. Kara Fitzgerald: Yes, yes, yes. Exactly. That’s right.
Dr. Jeff Gladd: Then so all of a sudden, and this is my mantra whenever I teach business and all the courses I’ve ever taught is, ready, fire, aim. You just make the change and then go back and track what worked or what didn’t work. That was one day where my dietician came to me and said, “Listen, all these people are canceling.” Boom. That day, all of a sudden, now the nutrition visit’s free. The initial visit costs more, but the nutrition visit’s free, so you should attend.
But what I find, and you probably have too, in this initial visit, we’re still seeing lots of really new people to integrative health and functional health. The concept of an elimination diet is new. I usually will say, well, Paleo is at least a template that you can find recipes and you can find guidelines. Let’s start a Paleo diet and you’re going to do this on your own. Here are some links. Here are some resources because I want you to start to spirit this on your own. You are not going to do it right.
We don’t expect you to do it right, but it makes your nutrition visit so much better because you just spent four weeks following this and now you’re going to sit down with a nutritionist and say… Most people already feel better by making those changes to their diet. Now they’re motivated to figure out, “How do I maintain this?” Now the nutrition visit is really this beautiful interaction with our health coach and nutritionist on, “Okay, what do you like about what you’re eating? Because here’s a bunch of more recipes like that. What are you missing? Because we can find and fill those gaps with some healthier versions of those meals. When did you get stuck? When did you go off and go back to your old ways of eating? What was that interaction like? Were you eating out?” Because now this is a much richer type of a visit.
Dr. Kara Fitzgerald: I want to make a comment on that, and then I also want us to stay on task. We could continue this conversation for a long time and this is all so important, but what’s interesting about your model, what you’ve just said. It’s similar in structure to us and we found it to work very, very well, but we actually would consider ourselves, well as Tom Blue calls us, a tertiary care functional medicine practice. This is why we’ve got a two-hour first office visit with our providers and then a two-hour second office visit. I mean, it’s definitely more of a drill down.
The bulk of our patients really in the high 90s percentage are coming from a journey of physicians and often a lot of integrative docs as well. We’re a small practice, and it’s hyper-focused, and there’s a lot there. Our folks tend to be extraordinarily savvy. Most of our folks come well-versed in elimination, versed in Autoimmune Paleo, versed in Ketogenic diets, et cetera, et cetera. They need a very granular level of refinement. Oftentimes we’re layering in diets and we’re doing investigations on different kinds of food reactions, immunological and intolerances. It’s a different patient base that we’re working with here, but the same model applies.
I would just say for the clinicians listening to this, you need to think about our two distinct models, and what it is that you want. Certainly the content that you’re putting out into the world, Jeff, is going to reflect what you’re doing. The demographic in your location will be the folks that are coming in. We have some opportunity to choose who we’re going to work with.
Dr. Jeff Gladd: No, I think you’re exactly right. I would say, it’s really a great point. I’m definitely more, I call it soft primary care. It’s not official primary care. Our patients have a primary care provider, but we’re sort of that extension-
Dr. Kara Fitzgerald: Yeah, ours do, too.
Dr. Jeff Gladd: … of primary care. It’s a lot of patients’ initial entry into this type of healthcare and it’s really where my passion lies. It’s a great point. As a provider, you’ve got to figure out, first of all what you’re passionate about in terms of what kind of patients you want to see, who you want to work with, but also be flexible. Because sometimes the market needs you to be a different provider. Sometimes your community has a bunch of integrative providers who are doing the frontline things like I am and they need more Kara Fitzgeralds who have a deeper expertise and can go deeper and can… You’re somebody I would refer to is really how I would see that.
I mean I’m kind of the Jack of all trades, the integrative provider. I know definitely enough functional medicine to get started and to take care of a majority of patients that see me, but there’s a limit to what I know and to what I’ve trained in, excuse me. Here’s a great business pearl, your staff needs to understand that. Your staff has to know what you do, how you do it, what patients you want to see, because they’re the ones that have to talk to these patients and figure out, “Are you a good fit or not?” My staff is very, very good at this now.
If they hear about, let’s say the kind of patients that your practice is seeing, we’re going to be really honest up front and say, “Gosh, it sounds like you did a lot of the things that Dr. Gladd would do and the journey that he would take with you. We’re happy to give you an opinion and give you an idea of where you might go next. But if you’re expecting this to be the end of the road and the answer, you might want to reconsider.” Really making sure you’re having deep conversations with your staff is a key, key piece.
Dr. Kara Fitzgerald: Yes. That’s fab. Yeah, that’s great. It is great. Okay, so one more just quick question. What’s the email platform you’re using? What’s telemedicine? Are you using a HIPAA Zoom or? Just give me those basics.
Dr. Jeff Gladd: Yeah, the texts. We’ve used Hello Health ever since we started. Hello Health was a company that was really, they were just launching as I was envisioning this practice. I started working with them, and actually consulted for them, and helped design some of the platform, and some of the things that are there. Hello Health, for us, has been this great way of being a documentation center, but also handling emails, being able to bill for emails, being able to house everything in one place. They do have a telemedicine option. I have used HIPAA-compliant Zoom as a preferred option. It’s just more nimble, and it works, and it’s more consistent. We were using Skype for a while and Zoom just… it’s just better-
Dr. Kara Fitzgerald: It’s easy. Yeah-
Dr. Jeff Gladd: Yeah, totally.
Dr. Kara Fitzgerald: That’s right. It is. It’s easy. It’s easier for patients. Although I do have my staff set them up before I get on so we’re not doing tech, although you’re a tech whiz so maybe you’re ok…
Dr. Jeff Gladd: Well, but patients aren’t. You need staff, yeah. But then, like you just did for the podcast. Let’s have a phone number backup. Because guess what? Sometimes it just doesn’t work and it’s not necessarily user error. That’s what we use. I would say the only, the tech piece, one I’m interested in that just launched this week that I’m going to work on implementing, and another one that I’m trying to get brought in. Which is, Fullscript now has the interfaces with several EMRs.
Dr. Kara Fitzgerald: Oh, fabulous.
Dr. Jeff Gladd: The ability to make a supplement recommendation in your electronic medical record, for that then to become a Fullscript that the patient gets in their email, makes a purchase, and handles all the renewals, and that’s documented in your record. That’s a big gap for us in our practice.
Dr. Kara Fitzgerald: That’s a big gap.
Dr. Jeff Gladd: We’re having to double.
Dr. Kara Fitzgerald: That’s a big gap in everyone’s practice, are you kidding? We’re going to circle over and talk about our clinic immersion program, and how there’s a lot of clinicians tracking with what we’re doing here in our tertiary care model. But one of the things that our first cohort witnessed was our movement into an EMR and our movement almost as fast out of the EMR and how traumatizing that was. I am so thrilled about the Fullscript and EMR collaboration. I mean, it is, it’s just a mess. Trying to practice functional medicine in an EMR is still an evolving thing. I want to hear about who Fullscript is collaborating with, and I want to hear more, I want you to talk about that.
But I also want to say too Jeff, because there’s way more than we’re going to be able to cover today. If you’ve got content that you can put on our site, like some of the collaborations with the EMR from Fullscript, some of the business pearls that you’ve been teaching on for the last better decade plus, anything that you can share that we can give to our clinicians to download and just… People will have the transcript, and we’ll put links to our clinic immersion program, and all of these… As much as we’re talking about, we’ll harvest and put links up. Then Jeff, if you can think of anything else that would be good for our professional listeners, I’d be most grateful as will they.
Dr. Jeff Gladd: Yeah, for sure. I’m missing the Fullscript interface, and so I’m working with Hello Health to bring that on board because, again, it’s game changing. Then the one I alluded to from this week is Amazon Transcribe Medical, now through AWS. They just launched medical dictation because they’re trying to solve the pain points for practicing medicine, which is documentation and typing all this out. I’m curious how that works. I have my doubts. I’ve tried to transcribe before, this is now specific to medical, but it winds up being about $4 and 50 cents for 60-minutes worth of dictation. If I think about my providers and how much I pay them to document, and if now they can just speak.
Actually, some of this could be really savvy. I think it needs to be fleshed out, it needs to be kept an eye on. But imagine just letting your clinic visit be documented by transcription and now it just attaches. Obviously, you’d have to tease out some of the highlights so that you could review that for follow-up visits. But that’s an interesting addition from a tech perspective to help practitioners too. But I think it’s just worth keeping an eye on at this point.
Dr. Kara Fitzgerald: Listen, I actually want to ask you one more question and then we’re going to transition into where I’ll ask you more questions. But we’re going to transition. We’ve got like a part A and a part B to this podcast folks.
Dr. Jeff Gladd: I think we need a Kara and Jeff business podcast.
Dr. Kara Fitzgerald: Well, we need a series. I know, that’s right, that’s right, so fun. The final parting question, mining your business clinic brain, is additional revenue streams. What are those? I mean everybody leans on supplements, and you’re talking about this new Fullscript collaboration which is going to be awesome, but just talk to me about some of the other things that you’ve done because I know you’ve done some cool stuff.
Dr. Jeff Gladd: Yeah. I’ll talk specifically in-clinic. Winds up being… supplements becomes a big part of that. Again, it’s all about honesty and being upfront with your patients and letting them know that this is part of supporting the business and keeping it going. Certainly, the whole lab piece for us, one of the biggest sources of revenue has been the administrative fee we put on doing cash labs for patients, because that takes time. It takes my staff, and it took some tech to build, to create an easy way of ordering these LabCorp labs. You’re saving patients thousands of dollars basically per every draw, hundreds of dollars, even if you’re just looking at thyroid. There’s a little bit of an admin fee on that, so that’s helped support the practice as well.
My health coach is very entrepreneurial, and I’ve been able to support her. She’s running programs and she’s doing this optimal research program which has got ProLon baked into it, followed up with a Whole 30. We just launched a year and a half ago, the journey program. She now does monthly membership to coaching where she’s able to connect with these people and keep things going that way. Those would be the main in-clinic revenue streams that we’ve had going. From a personal standpoint, speaking becomes a revenue stream. If you wind up working with supplement companies or working with any of the educational companies, that becomes an opportunity, and then-
Dr. Kara Fitzgerald: Well, let me just say. Let me say this, is folks, you’re thinking, “Well, Jeff is out there lecturing all over the place and da, da, da, da.” Reach out to your reps. If this is interesting to you, paying your rep, your lab rep, all the myriad supplement reps that come and let them know that this is something that you’re interested in. I guarantee you your rep will respond to you and be interested to hear what you have to say and you’ll likely establish some collaborations, so do it.
Dr. Jeff Gladd: Absolutely. I’ll add to that, but have a passion.
Dr. Kara Fitzgerald: Yeah, that’s right.
Dr. Jeff Gladd: My passion is business. Nobody asks me to speak about MTHFR and methylation. Nobody asks me to speak about SIBO. I can deliver it to a patient. I don’t speak on that stuff. My passion is business. Have a passion, have a unique twist or practice, or you’ve gone down the road of looking at evidence of a certain condition, let them know that. If you’ve got some specifics, then it becomes more relevant to whoever that rep is. But absolutely.
I just… As you continue to do this, and you have your platform online where people can see you, and you’ve got a profile on LinkedIn, there are all kinds of places. I mean, just look at Amazon getting into healthcare, and getting into medicine, and getting involved with insurance. I mean, there are big, big players wanting to figure this out. If you’ve got an integrative passion and a functional medicine passion, you’re part of the solution and they know it.
The more you’re out there, the more you need to start taking these meetings, and taking these calls, and responding to people who are reaching out to you, because that’s what I’ve done. I never say no to the first call or two, because I’m always interested. Now, the advantage that I would also say that I have that was intentional was, I only practice two and a half days a week, and I only ever have since August of 2010. Because number one, I want work life-balance is a big passion of mine, and number two, I want diversity. I want to be involved in other things, and I want to have time for that. I carve that out from the beginning so that I’ve got a couple of days a week to be able to do those things.
That’s what’s allowed me to be a part of building Mytavin, and then being able to work for insurance companies and help consult them, and Hello Health, and now Fullscript. Again, some of that was very, very intentional, but like we were talking about, building that brand and building your platform is the absolute place you should spend all your time and energy now. That’s what’s going to help you then extend out to be just a practitioner, if that’s what you want to be, or a practitioner and a speaker, or an author. I mean, your story is very similar to that.
Dr. Kara Fitzgerald: Yeah, that’s right. Yeah, it is. It is. Yeah. There is some soul searching. We actually created… Our vision and mission statement is on our website, and it’s… God, it was just such a great journey for our team to get together and be guided in creating it. Then to see it manifest, just see us birth it. One of our key pieces is the global transformation of the medical paradigm, the medical model. Just globally. I remember one of our team members chuckled when one of us put that out there, but in fact, we are doing that and having this virtual platform.
I’ve had the honor and the privilege to be able to lecture around the world, I’ve had that. But really more pivotal, I think more important, has been this platform design. Again, opening the doors of our clinic in a HIPAA-compliant way, but really opening the doors of our clinic in the clinic immersion program and our nutrition residency program, those two things. Inviting clinicians and nutritionists in to actually witness what we’re doing. We’ve had folks from all points in this country and really many, many other countries outside.
We have our content recorded, but we also have these live offerings. People can attend our rounds. If you’re way off, you might have to set your alarm if you want to be in our live rounds or you can just access them online. There’s many ways that you can have touch points with us in the live setting that will meet different time points. But just throwing the switch open and going live with our platform, because we have a small brick and mortar setting here in Connecticut, but our virtual space is broad. All of our clinician meetings are on HIPAA Zoom.
It’s just, to have clinicians who are as excited as we are, track with us in the virtual space, pay attention to our collaborative care model, participate, ask us questions in the Zoom chat box, and just… It’s been such a unexpectedly rewarding journey and very much a part of our mission, so I-
Dr. Jeff Gladd: It’s really brilliant, Kara. I mean, when I heard about this, it was just such an, “Of course that makes a ton of sense.” Because I’ve done a lot of business consulting, I’ve done a lot of business speaking, I’ve taught the courses. Every single time I’ve got folks that come up to me and are like, “When can I spend a day at your practice? I want to come to Indiana, I’m coming to Indiana.” I had a product that basically was, spend a day with us. I had it mapped out. You’ll meet with our staff and your work with our reception staff. You’ll follow me. Guess how many people came? None. Because it’s hard to get up and go and spend a day or two anywhere, let alone Indiana. You’ve built the virtual experience, which now is accessible to everyone in their home or office. It’s really brilliant.
Dr. Kara Fitzgerald: It took some courage. First of all, I want to say that, shame on folks for not coming in and hanging out with you because it would have been fabulous. We do have people here, we’re easier, we’re not in Indiana, we’re like a train ride from the city, from New York. We’re a spitting distance to White Plains Airport so people can access us easier. We do have clinicians, but that’s one clinician at a time. We know, being on IFM faculty, we’ve been talking about it forever. “How do we…” We’re giving the didactic content, this lush, just extraordinarily well-prepared didactic content, but people need to see it in action over and over again.
People need to have the safe collaborative space to ask the questions, to mull over the latest science, to think about what intervention they’re going to use, and to vet that. Vet the supplements, vet the labs, learn from industry leaders, learn from thought leaders. I guess because I’ve been in this space for a long time now, and I have access to a lot of the thought leaders and the industry leaders in this space. That was another, a cool offering because I… Everything is because I do this as a doctor when I’m working with a patient, yes, I’m going to ping brilliant friend X who’s really good at intervention X when I need it for this human being sitting in front of me.
I’m going to have connect make an appointment with the medical education team at a laboratory to discuss data that I don’t understand. As I envisioned this mentorship that is so deeply needed, it was, what am I doing in practice all of the time that I can flip the light switch on and say, “Hey, we’re doing it on a Zoom platform and Dr. Gladd, you’re going to be speaking live to our whole clinic immersion and residency programs.” Nobody said no. Everybody loves it. I mean, it’s fun. I think it’s… Arguably, it’s more useful and enlivening to have this group that you get to track within a live space than just me talking to a tech expert at a particular company.
Anyway, the whole design has… it’s just been rewarding and just unexpectedly, I don’t, kind of successful. I want to underscore that it was unexpected and rewarding and it took a burst of courage from all of us, our whole team here. Because when I present cases, and I’m sure you’ve presented cases, even though you’re focusing on business, we polished our cases. I mean, I published a case book for professionals, Case Studies in Integrative and Functional Medicine in 2011, I published that. You can’t show the sausage making or you would have a tome and no one would ever look at it. You have to pull out the key points when you write about a case for publication or you present a case in a lecture. You have to pull them out.
One of the big things was, “Let’s let folks actually see us puzzling through. Let them see us actually hitting a wall, not being successful, bringing it to the group, rethinking it, what direction do we take now? How do we implement our therapeutic dietary prescription, et cetera, et cetera.” Just letting folks see the warts of a functional medicine practice as seasoned as we are. Just that authenticity, the realness, the camaraderie, the collegial connection just felt very important to me, although a little bit of a risk.
We jumped in and IFM recognized also, Jeff, that it was a creative model and just jumped on, and they’ve been a huge support of us. Actually, in fact, I want to talk about Fullscript because, of course, not only are you CMO now, but of course we’re partnering on this journey with Fullscript as well, so that’s been really thrilling. Anyway, talk to me a little bit about your thoughts on anything that I’ve just said, but also the Fullscript. What Fullscript is doing and where they’re heading and your work with them, and anyway…
Dr. Jeff Gladd: For sure. I mean, I think what you just said is so true. I mean, I think a couple of other points on top of that is, why do all these providers go to these conferences? Well, part of it is education. I’d actually think a bigger part of it is community, because you finally get to hang out with people of like minds, that are passionate in the same ways that you’re passionate, who eat like you eat. It’s community. It’s why I loved Arizona and looked forward to the res weeks where we got to spend a week with everybody in Tucson. This is an opportunity to build community virtually so that you can have more regular connections, and that’s a big deal.
Then like you and I talked about before we jumped on the podcast, I’m on an island. In my practice in Indiana, in my little business, yes I have staff and I have some colleagues, but for the most part I don’t have a strong link to peers. This gives this great opportunity for having peers in the field, bouncing ideas off of, and so it’s all really, really great. One of my big passions over the last couple of years is, “All right, I’ve got this practice. It’s very fulfilling. Personally it’s helping people, but how do I help more? How can I be involved at a bigger scale?”
I didn’t want to grow my practice in any way that had satellite offices and 15 different doctors. That wasn’t my passion. My passion was, “How do I use tech? How do I use some of the practice tools and pearls that I’ve learned and used?” I’ve known Fullscript for years. I’ve known Kyle for a long time, and so we finally started talking about, they’re growing, they’ve got a lot of stuff going on. They really want to get in with more conventional doctors that are open to and starting to learn to use supplements. That got me excited. How do we help get more providers practicing, not all out functional medicine, but just more health-promoting care. How do we do that? We’ve got to deliver some education, we’ve got to give them some evidence, we’ve got to make sure that people aren’t just making these supplement recommendations on a whim. That’s what…
The opportunity at Fullscript for me is to truly… The tagline we use is, let’s change the way health is prescribed, and that’s where we’re going. By creating this great library of clinical decision tools to help decide, what’s the most evidence-based recommendation you can make for a certain condition or a certain symptom? What products have that supplement in it at the standardized form and a standardized dose? Working in partnership with your clinical immersion program in terms of actually executing the delivery of this type of care. I mean, all these things are incredibly exciting to me. Then to work with a team of really nimble tech folks who just know how to get stuff done in that arena, but also get some of the pain points of the practitioner and the industry.
I mean, it’s really a unique company in that they have so much wisdom, yet most of them are pretty young, but yet really wise in terms of the industry and the way it’s being practiced. I mean, those are the things I’m really excited about in being able to play a role in that. Okay, from the provider’s seat, how do we improve that experience? How do we, in some ways, clean up the industry? Because you’ve got a lot of supplement recommendations that aren’t necessarily sound or they came from not a sound source, not a clinical source. How can we give them, at their disposal, at their fingertips, evidence-based recommendations to make… but then also the tools to be able to prescribe them. That’s where the EMR interfaces work really well too. I mean, that’s a game changer like we talked about-
Dr. Kara Fitzgerald: It’s a game changer-
Dr. Jeff Gladd: … because now, not only is the recommendation going to be sound, it’s going to be documented, and that helps. They took over the… they acquired the Mytavin database which is now, you enter the medications the patient’s on, and you know what potential nutrients are being depleted, and that’s going to be part of the clinical decision making tool as well. Do you recommend supplementing that because they’re at risk for deficiency? Do you work that up and test that level first? All along, just helping that patient experience.
Dr. Kara Fitzgerald: That’s just fabulous, and it really fits in. I mean, if we’re going to change the healthcare paradigm we need this. We need to enter into the conversation at every level. Sometimes we’ll have clinicians in our immersion program who are still… they’re practicing in a very conventional model and that’s often accompanied by discouragement. “I’m still seeing 20 patients a day and it’s really depressing, and I don’t get to practice this full functional medicine that you guys are doing, and they’re disappointed.”
The fact of the matter is, Jeff, you can change a human being’s life in those five minutes if there are a few key pieces. I can see, as I hear you, this is your calling to work in this model and then assist people transitioning over. As they’re doing this walk and they begin to embrace a bigger functional model, then of course we’re here. Actually, we have people joining us at all levels of entry. You needn’t be called to tertiary care functional medicine. I think there’s a place for everyone here, but I appreciate your commitment to functional and integrative care delivery regardless of the setting, and keeping it straightforward, and keeping it evidenced-informed, and providing these tech tools. I mean, it’s bravo you guys.
Dr. Jeff Gladd: Yeah, no, it’s a lot of fun and everybody’s on board and on the same page. Like you said, I mean, any… This is relevant to all providers.
Dr. Kara Fitzgerald: All providers.
Dr. Jeff Gladd: I’d love to know the number, but it’s got to be the majority of doctors, primary care conventional doctors who realize that vitamin D is important, that a probiotic has its role, and that fish oil is probably something people should be taking. Because I hear these recommendations all the time, but they’re having patients go to the drug store or go to the grocery store and buy medicine, and that’s dangerous. It’s flat out dangerous. If you’re already making these recommendations, let’s connect you with opportunities to connect them to the high quality products that you know are going to be effective, that are going to be safe.
I’m a big fan of the Fullscript no margin account where, don’t take any profit. If your employer doesn’t want you to make money off of supplements, if that’s uncomfortable for you, you don’t want to get involved. We have a no margin account where your patient now gets a 35% discount off of the sale price. Now they’re getting high quality, they’re saving money. I don’t think there’s anything wrong with generating revenue on recommending supplements because that’s a lot of education that we’ve had to go through and helps your practice flow as long as you’re upfront with your patients about it. But for patients in a hospital system or an employee situation, use the no margin account. Don’t make any money on supplements if that’s what’s holding you back.
Dr. Kara Fitzgerald: Yes, yeah, agreed. Okay, so we’ve talked about a lot folks. We’re going to link to clinic immersion and give you the background on what that’s about if you’re interested, or our residency program which I know is pretty competitive. Our 2019 end of the year deadline is upon us. If anybody wants to apply, just hustle. We’ve talked about Fullscript and some of the offerings at Fullscript. Of course we’ve talked about Jeff’s… we’ve mined Jeff’s brilliant mind in the business world. We’re going to try to gather as much as we can and just put it on our show notes page for you. As always, feel free to leave a comment, ask a question and we’ll get back to you.
If you want another drill down on business, if you want it from a different angle, if you want to learn more about what the immersion program is, et cetera, just leave a comment there too, and I would be more than happy to accommodate what it is you’re needing. All right Jeff, any final words of wisdom as we sign off here?
Dr. Jeff Gladd: I mean, again, my only big, big message is in figure out what you’re passionate about, as a provider, align yourself with staff. If you’re a health coach or a nutritionist, I would encourage you to find providers in your area that you can work with, not necessarily under. Then it’s just that the whole business philosophy I love is just that ready, fire, aim. Too many of us drag our feet, wait to make that decision right. Just like you said, clinical immersion. Fire and now you aim, figure out how to refine it. You’re going to miss the target sometimes, but you keep firing, especially if it’s something you’re passionate about and something that is good for society, things are going to work out.
Dr. Kara Fitzgerald: It’s so exciting. It’s so true. Thank you, Dr. Gladd, I really appreciate reconnecting with you and just look forward to our work together. Thanks for joining me on New Frontiers today.
Dr. Jeff Gladd: Oh, my pleasure. Thank you so much.