COVID19 is upon us. Months earlier, we scheduled James Maskell to discuss his recent book: The Community Cure. Amazingly, his message today is all the more urgent. James argues for the group visit model, was an early adopter and proponent of group visits (in fact, we discuss the pre-publication Cleveland Clinic group visit research findings, which are astonishingly good; even better than the first JAMA publication comparing functional medicine one-on-one with family medicine.) Now, with COVID19 and self-isolation, the virtual visit and the virtual group visit (where James saw FxMed eventually going) is upon us. And specifically, his vision is that this model works in insurance- and even Medicare. James’ message – the promise of functional medicine – is timely, inspiring and essential. ~DrKF
Making Functional Medicine Accessible and Profitable with James Maskell
Functional and integrative clinicians face a host of challenges when it comes to reaching people who could benefit from a functional medicine approach: the cost of care tends to be high, insurance rarely covers the cost, and access to group care and community support is limited. If you’re a clinician faced with these issues, and if you’ve ever thought about building out a membership model or developing more robust digital infrastructure for offering virtual support, this episode of New Frontiers in Functional Medicine is for you. In today’s show, Dr. Fitzgerald talks with James Maskell, the founder of the Functional Forum and the world’s largest functional medicine conference, Evolution of Medicine, about group sessions, telemedicine, and working in and around the insurance system. He is the author of, most recently, The Community Cure: Transforming Health Outcomes Together.
- Scalable models for group visits that are workable with insurance
- Cost effectiveness of peer-to-peer support and information delivery
- Health outcomes of family medicine versus functional medicine
- Increased positive health outcomes associated with group visits
- How to create digital environments that drive positive health outcomes and foster feelings of accountability, vulnerability, and support
- How the cost barrier has kept functional medicine from becoming more mainstream
- Profitability potential of group visits
- How in-demand doctors with waitlists can benefit from instituting a group visit model
- Overcoming social and cultural barriers patients may have about participating in group visits
- Regulations around insurance billing for remote visits
- Role of functional medicine in the COVID pandemic
James Maskell has spent the last decade innovating the cross section of functional medicine and community. He is the Host and Founder of the Functional Forum, has written two books, “Evolution of Medicine” and “The Community Cure”, speaks and hosts around the world.
Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes (JAMA October 2019)
DrKF FxMed Resources
SPECIAL July 23, 2020 Webinar: Functional Medicine, COVID-19 & Racial Disparities: Bridging the Gaps (register here)
Clinician Professional Development: DrKF FxMed Clinic Immersion
Dr. Kara Fitzgerald: Hi everybody, welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine. Today we’ve got not only one of the best minds but really one of the coolest minds, one of the, I don’t know, kind of inspirational minds of our space. It’s James Maskell. I know most of you listening know who he is. He has spent the last decade innovating the cross section of the functional medicine community, and he’s going to talk about that today. You know him as the host and founder of Functional Forum. They’ve been doing that for years, putting out loads of podcasts, just actually creating community, just this really beautiful functional medicine community. We’ve got a functional medicine meetup here inspired by James and the Functional Forum. Anyway, he’s the author of Evolution of Medicine and The Community Cure. He speaks all over the world. You’ve seen him at AIC and all the other conferences. James, it’s just really terrific to have you here.
James Maskell: Great to be here too, Kara. Thanks so much for having me on the podcast. I’m excited to connect with your community today.
Dr. Kara Fitzgerald: The first thing that I want to know about, it’s sort of selfish I really do want this, the answer. You’re a fixture. I mean, I would imagine the majority of folks listening to this podcast will in fact know who you are, will be familiar with your work, well, think that you’re inspirational and you’ve done good work. You’re not a physician by training. I think you have an economics background. But here you are in our world just committed to revolutionizing it. So how did you end up here?
James Maskell: So yeah. It’s an interesting story, and I kind of came out of the closet in my last book at sort of sharing the truth of it. But the truth of it is I was kind of weirdly bought into it. I was born in a commune in Colorado. That commune was like… The people in that group were very much involved in the very beginnings of the integrative medicine movement. They were all Standard Process reps. If you know the industry, you know back in the 1960s, Standard Process was the only professional supplement company. Then the ’80s, you started to see Metagenics and Designs for Health and these other ones come up.
But I grew up in that, and I was the weird kid at school who did natural medicine. I was the only kid in school whose mom insisted that she be called before I be given antibiotics. I just didn’t realize this was just weird that I was different from all these other kids in the way I saw a homeopath. I never really saw the regular doctor, and I just didn’t realize that was weird until I got into school and realized no one else knew what any of these things were.
So that sort of set me up. But then I had a rebellious phase where I thought I used to want to be an investment banker. I did a degree in health economics. What I learned from that was the cost of care was going up in a really exponential way. Whether that’s in the US, where you can see that that was going up or in the UK, where I grew up, where they have a single payer health system, everywhere the cost was going up, and I just sort of had a moment of clarity when I was working in the bank in the first year. It’s like maybe something of my weird childhood in this commune with natural medicine was a solution to this seemingly unsolvable and super vexing problem. I just decided to take a punt on it, and I quit my job, and I moved to Georgia, and I started working on the front lines of integrative medicine.
The first clinic I worked in was a naturopathic clinic inside a spa, and I saw people reverse their chronic disease. I saw it with my own eyes. I saw not just the names going off the chart, but I saw people becoming vibrant. Right? I think most people just didn’t know. This is 2005. Most people didn’t even know that was what was going on. I quickly worked out that clinical information in this space was like a black hole. You can never know enough. There was always more to learn. I mean, you’d been doing this forever, how long, and I’m sure it brings a certain amount of humility just to how much there is still to learn. Right?
Dr. Kara Fitzgerald: Yeah.
James Maskell: I just realized that my skill was practice management. That center that I worked in in Georgia for the first two years, 2005 to 2007, it was run by people who had run spas. The day spa industry was about 10 years ahead of the functional medicine industry and understanding how to run a clinic and how to get cash from people and how to have a good operation. So we had an operations manual. It was like eight inches thick. Every process was documented. It was run with military precision. Then I came out into the world, and now I was a supplement sales rep selling to practitioners, and I just had this incredible knowledge of how to run a practice.
I sort of positioned myself as a practice management guy, and I was selling to basically a little bit left to functional medicine, so a lot of like chiropractors, acupuncturist, naturopath, a lot of people who did muscle testing. I was in this super, super niche world of people that were doing bioenergetic medicine. I lived actually in Connecticut, not far from you. I moved to New Haven, Connecticut, and my territory was Virginia to Maine. In the next four years, Kara, I got a crash course in the industry because I was calling 40 doctors every day. I was going into practices that range from people doing weird stuff in the garage of their house right through to physician specialists who are working in hospitals, whose wife had recovered from some ailment and who had no idea what these little bottles did.
I got a crash course in the industry. Then from there, in 2010, I started my own practice management company. I had an opportunity to speak at a few conferences. Eric Goldman from Heal by Practice, really, he gave me the first opportunity to speak on stage in front of doctors. For the next few years, I spoke there, and I spoke at some other conferences. Then I was sitting at the Integrative Health Symposium in 2013. I was listening to Jeff Bland, and I was like, “Oh my God, this is amazing. This is scientific enough for doctors really to get it.” I just looked around and I was like, “I can’t believe no one’s videotaping this. This information is going out to a few people and then just disappearing.” That was what led to the desire to start the Functional Forum in 2014.
Dr. Kara Fitzgerald: That’s such a great story. God, that is so cool. I love it. I love just hearing the dots connect. Yeah. I grew up with… I didn’t grow up in a commune in Colorado, but my mom was really savvy. In fact, Deanna Minnick and I have talked about this, the whole Adelle Davis and getting brewers yeast sent by mail and organic, the only way we could access organic was through mail, and so we’d get these big packages in our house, and no, they weren’t like toys. For me, it was supplements and organic foods. I rebelled from it. Just it sounds like you went through a bit of a rebellious period, and then it became my calling. It’s really kind of extraordinary. It makes sense to me now why you are here. I get you just connecting those dots.
It just really makes sense. It’s very organic, how you’ve evolved and how you’re… I can see why the community care book would be created by you. I remember learning about it. You and I actually were podcasting on some of my content, and you are sort of opening my eyes to what you were working on, and it was just I was very excited for you and just really interested. So talk to me about the book and sort of the motivation for you. I mean, you just shared a lot of it. But how did you end up-
James Maskell: Well, that was-
Dr. Kara Fitzgerald: … creating this?
James Maskell: Yeah, that was the initial motivation. I guess, having spent a few years in functional medicine and helping doctors make the switch to functional medicine and helping functional medicine doctors maybe build business models that would make it more affordable, things like membership practices and telemedicine and whatever, I was sitting at the IFM Annual Conference. So I had heard about group medical visits. The third Heal By Practice that I spoke at 2013, and this was before the functional forum started, like three months before the first Functional Forum, I had heard Shilpa Saxena talk about the group medical visits at Heal By Practice. I was like, “This sounds interesting.” Because now, she’s doing functional medicine on insurance, which I had never heard of before.
At that point, I was like, “Okay.” Because I was always thinking like, “How do we take this idea of reversing chronic disease and getting people well and make it available to everyone?” Right? More people need to access to this. Not just because they don’t know it, but because they’re never going to spend money outside of their insurance to do it. So how is this going to work? So I heard Shilpa, and I was like, “Okay. That sounds like an interesting piece.” I was actually sitting next to Shilpa at the 2015 annual conference where George Slavich did that talk about human social genomics and basically put this slide up that said, “Social isolation is the biggest driver of all-cause mortality more than nutrition and alcohol and exercise and smoking.” I was like, “Man, we’re the root cause doctors. We’re the root cause community.” At this moment, functional medicine is really being delivered in a very lonely way too. It’s just still a one-on-one appointment. If loneliness is the biggest driver of all-cause mortality, what are we going to do about it?
In the Functional Forum, I talked about group visits quite a lot here and there, and I tried to get people on it, and it was kind of a… It was not really sexy, right? It was just something that I saw that was going on. It wasn’t really being taken up a lot. Then my desire to write the book really shifted when I visited the Cleveland Clinic. So on the bus tour that I did in the summer of 2018, I got to go and tour the Cleveland Clinic. What I saw then was the thing that I always knew was kind of missing from Shilpa’s model. Shilpa’s group visit model was really cool because it was efficient, right? It was really efficient to deliver information to 20 people at one time, and it was efficient to bill it on insurance and not to do five minute appointments with people.
I liked that element. But what I really realized is that the power of the group is that you start to deliver value peer-to-peer, right? The value transmission is not just from doctors to patient. There’s patient-to-patient value. I just realized that’s not really possible in a one off 90-minute session. So when I went to the Cleveland Clinic, what I saw was this was a 10-week program. In that 10 week program, there was so much to like about that program. One, it was kind of like a funnel for… Just think about the kind of people that are getting referred to the Cleveland Clinic Center for Functional Medicine. I mean, this is probably pretty sick people. Probably the same kind of sick people that are entering in your clinic and probably most of the people listening to this, like chronic diseases, autoimmune, all kinds of chronic illnesses.
Well, in order to go, and they would sort of dangle the carrot. If you want to see Mark Hyman, you have to go through this 10-week program where you’re going to learn how to take care of yourself, read your own labs, how to sleep, how to meditate, how to eat. I saw that one, the results were spectacular. People were getting really well really quickly without a doctor. This was being run by PAs and health coaches. Secondly, it was on insurance, right? So this wasn’t outside of insurance. Third, on that tour, I met a PA who had never heard of functional medicine and never run a group visit before her training. But because there was a very structured curriculum in six weeks was crushing it and getting people better through this model. I was like, “Here is a scalable model that’s available on insurance where we can get a lot of people well, and it’s got the Cleveland Clinic stamp of approval.”
I was like: “I want to learn everything about groups now.” I just want to hear anyone who’s doing anything in groups. Because I’d heard of other people in integrated medicine that were doing groups. So after that tour when we finished, I got home and I just put out a message to my community and said, “Look, if anyone here is doing groups, if anyone’s doing anything interesting, I want to meet them, I want to speak to them, I want to hear from them.” That became the group visit. I did a series of podcasts last year on the group visits. The first interview I did was with Dr. Jeffrey Geller, who’s kind of well-known in the integrative medicine world, and he’s been doing group visits in federally qualified healthcare centers. That interview was incredible. That guy is amazing.
After I did that interview, I was like, “This has to be a book.” That’s kind of what led to it. I just followed the same kind of structure as the first book, which is kind of like a hero’s journey to inspire the reader to want to do group visits. The first book was a hero’s journey for doctors to want to do functional medicine. So yeah, it just came together really quickly. I’m still super excited and really indebted to all those physicians who kind of just took it upon themselves with some sort of moral quest to go out and work this out at a time that it wasn’t easy and just to be able to report all of those results in the book and sort of structure it in a way that anyone who read it would at the end of it be like, “Yeah. We should probably start doing these groups.”
Dr. Kara Fitzgerald: So just, again, that’s very elegant and your journey, just how you are articulating it in those key moments of inspiration are just really neat, really nice. I know this is jumping ahead a little bit, but Cleveland Clinic outcome in JAMA, pretty impressive. Any comments on that?
James Maskell: Well, I do have some comments on that actually. Yeah. So if you’ve read the JAMA thing from last October, what that compares is family medicine to functional medicine, one-on-one functional medicine, right? The family medicine at six months increases 0.3 to a PROMIS score points, and functional medicine is like 1.5. So there’s a stark difference of six months between the outcomes of functional medicine and family medicine. But what hasn’t come out yet still at the day of this recording is the results from the groups. The reason why I knew about that too is that the Integrative Health Symposium 2019, I went to the lecture and I heard Mark share the preliminary information from that. The outcomes from the groups is even more staggering. 50% of people improve by five PROMIS score points or more. Five PROMIS score points is basically like a complete reversal of chronic disease. Right?
So that data, as far as I know, is not out yet in a journal or that has been kind of talked about in different places. Tawny talks about it in the interview that I did with her. She’s the one who runs the Cleveland Clinic Center for Functional Medicine. So if there was some hullabaloo when those results came out in October, I expect we should have a street party for these results.
Dr. Kara Fitzgerald: It’s just so exciting. I can’t wait. We’ll, link to the October 2019 write-up that we’ve just referenced, and we’ll be paying attention. We’ll keep our ears to the ground for any kind of a preliminary release of the group findings. So where are you now? When was Community Cure published?
James Maskell: Well, yeah. The Community Cure came out January 14th, and the coronavirus is already in circulation in China. Yeah. So then the book came out. In December, actually, we did a group visit boot camp, basically, a five-day free challenge where we helped people get their first group up and running. In some ways, it’s been tragic, in that, obviously, there are no physical group visits happening anywhere around the country or anywhere around the world right now. For the first time in human history, everyone’s doing the same thing at the same time, which is really, really interesting.
But what’s really interesting actually is that in chapter seven of my book I talk about the future. I talk about essentially where I see the group visit movement going. What’s really amazing is that what was pitched in the book as the future is now definitely the present because, ultimately, I talked about the connection to technology. So literally, just a few days ago, I did a webinar on virtual group visits. A year ago, we had done a session in our practice accelerator on virtual group visits and how to use Zoom to be able to create environments where you could create this kind of accountability support, vulnerability in a digital environment.
Then some of the other things that I spoke about in the book as sort of a future are very much in the present right now. I think some of what I spoke there I think just in this last week, I’ve come to the realization that some of what I talked about in that book and some of the innovative clinicians in our space will be the sort of vehicle by which… I think we’ve all said over the years, Kara, that in a few years, we won’t call it functional medicine. It’ll just be medicine. I think what I’ve seen in the last week helps me think that this is not just some fantasy that a bunch of us are deluded by, but actually a very much emerging reality.
Dr. Kara Fitzgerald: It’s true. Certainly, virtual visits, telemedicine has a leap forward. Insurance coverage is coming along with… I mean, the medical system is transformed across the world with COVID. Group visits, moving into that will be the next step, even though I think, as you say, in our committee, you’re already teaching people how to do it. So my question is, those of us who are inspired to launch into this group visit structure, how do we make that happen?
James Maskell: Absolutely. So look, I mean, I think prepping your clinics for in-person group visits and innovating on the front lines of virtual group visits, it’s time well spent. I mean, ultimately, in order to do any sort of group work, what you need to do is have a structure in place to recruit the patients, right? Ultimately, you need that, whether it’s virtual group or regular group. For your average functional medicine clinician who is practicing by themselves and doing cash, maybe it’s not going to be so easy to execute. I mean, that’s kind of… Some of the feedback that I got in the last year is realizing the group visit model for functional medicine is probably more like the way that functional medicine is going to make it into mainstream delivery systems.
If I wasn’t dealing with COVID right now, I had a plan to go and visit the CEOs of hospitals all across the country and talk to them about the Cleveland Clinic model, talk to them about different ways of doing group visits because finally, I think we all have to take a step back and realize that one of the reasons why functional medicine has not made it into systems is because it’s nowhere near as affordable or efficient enough to do it. I mean, look at the continuum center, look at University of Arizona, look up in Minnesota there. Anytime physician-centric, long-appointment functional integrative medicine is being tried in academic or big centers, it’s been a failure. If you look at the New York example and continuum, it wasn’t a failure because it didn’t work, people didn’t get better, and it didn’t bring new people to Mount Sinai. It was a failure because the people that, when there was a takeover, they started to think, “Oh well, how much money per square foot is the integrative medicine making?” They’re like, “Well, it’s not making as much as the heart stents. Let’s do heart stents.”
When the economists and when the business people get involved, it takes the heart out of it, and it gets taken out because it’s not really efficient enough. Well, group visits is really the opposite of that. Instead of having one doctor spend a lot of time with one patient, you have one non-doctor spending a lot of time with a lot of patients together, and suddenly, it is affordable, and suddenly, it is profitable to deliver, really profitable given what I just shared is that you can book a lot of people’s insurance at the same time for one lower cost provider, and then you can sort of subsidize the doctors by having a very profitable group model.
I think that for many clinicians, maybe it’s not a thing that you’re going to do. But if you are feeling cool to it, where I’ve seen it be most effective, Kara, is for doctors and practitioners that are busy and that have waiting lists in their practice. So it’s like, if you’ve built your practice to a point where you’re really busy and you’re booked out a few months ahead, that’s been a perfect moment to launch groups. So Terry Wahls’ groups launched because there was a resource constraint. Shilpa’s launched because of a resource constraint. Also, the Cleveland clinic launched because of a resource constraint. It just wasn’t enough care to deliver. So now, we’re going to do it in groups. Then when you launch it in groups, you realize, “Hang on a minute. These people who were not able to make behavior changes at home with no support or just their wife are suddenly now able to make behavior changes because they meet other people that are like them.”
I think if there’s one takeaway from the book that I would just want to share with everyone, if we’re talking about New Frontiers of Functional Medicine, it’s that if your patients have never met someone who’s like them but is just a little bit further along in reversing their chronic disease with a lifestyle root cause approach, you’re doing them a great disservice. Right? They need to see an example of what it looks like to reverse their chronic disease. So in the last few years in the Functional Forum, we’ve showcased a lot of different models. Some group visit models, some group new patient acquisition models, like doing local talks where you invite your current patients to come back and give testimonials, in all of those situations, you’re finding a way to put examples of people just like them in front.
I had this moment of clarity when I was interviewing Terry Wahls. She was telling me about her group models because she told me that in her group models where you think, if you have MS, Terry Wahls might be your hero. They should be because she reversed her MS. But what she shared was the in her MS groups, the people that had been in her MS groups and started to reverse their own MS in those groups were more powerful example of her protocol than her, and she’s the hero. I was like, “Oh my God, this power of peer to peer is amazing.” Because even Terry Wahls who should be everyone’s hero is saying that someone else is their hero more, and that’s just some random person in the group is having success.
For many of the clinicians in functional medicine who are svelte and not chronically ill, perhaps their overweight patient is trying to lose weight, can’t identify with them because they’re like, “Hey, you never know what it’s like to be overweight because look at you.” I feel like walking the talk is definitely important. But at the same time, we need to find a way to introduce every patient who’s at the beginning of their journey to someone who’s a little bit further down the journey and that groups are the most efficient way to do that.
Dr. Kara Fitzgerald: I love it. Yeah, that makes total sense. So, correct me if I’m mistaken, but I believe Terry, Shilpa, and Cleveland Clinic are all doing their group visits within an insurance model. Is that correct?
James Maskell: That is correct, as far as I know.
Dr. Kara Fitzgerald: I mean, so how was this… It seems like this is a viable, perhaps more reachable goal for those of us in the insurance model already. Would you say that’s true, or no?
James Maskell: Yeah. I think it’s good for that. I think in the cash and groups, if you’re rich enough that you can pay cash, then you maybe have an aversion to groups. One of the things that I’m starting to see is that white Americans, the individualized culture of America has made it feel like people don’t want to be in a group, right? They kind of associate it with like AA. It’s like, it’s not really an aspiration to be in a group. But what I’ve heard from people in the front line, I’ve interviewed a ton of people, ethnic groups inside the US, Asians, and African-Americans have a lot more of like, it’s just normal to be in a group structure. They have a lot more of a community culture.
If you’re serving those kinds of groups, Hispanics as well, the group is just a lot more of like a natural thing for them. So one of the things… What I’ve also seen is that when people actually get in a group, they can be resistant to getting in a group, but once they’re in a group, they’re like, “Oh, this is actually really amazing.” So I think we have to help people overcome that hump, and there’s definitely projects that I’m working on to make it a bit more cool and aspirational to want to be in a group. So I think that’s a big deal. But yeah, look, if you’re taking insurance, I think this is a no-brainer because the models are there, the insurance companies like it, you can scale it up.
What we’re also seeing, in chapter seven of my book, I spoke about a doctor in Houston called Dr. Chang Ron. What he was doing was… He’s the one doctor that I know who is taking insurance, doing functional medicine, and has his eye super, super clearly on the ICD-10 codes. What he was able to identify when ICD-9 switched to ICD-10 in January 2019 was that remote patient monitoring, remote patient monitoring was now insurance billable. So what he was able to do, which is really exciting, was to essentially do group visits plus remote patient monitoring plus medical nutrition therapy on Medicare in his ACO and build a profitable business billing insurance, doing functional medicine, which is very, very tricky to do. The number of people that had been able to build a successful practice taking insurance, doing functional medicine was small because mainly they were doing long consults. Whereas what he worked out was this group plus remote patient monitoring.
The reason why this is really exciting is because now COVID comes along, and he’s got this system where doing remote patient monitoring, well guess what? There are two really important groups of people in the COVID thing that aren’t really being talked about. It’s like high-risk people who don’t have the infection and low-risk people who do have the infection. Both of those groups need to be at home recovering or just chilling. One of the things that he’s been able to do is to see, “Okay.” This is why a functional medicine doctor had to come up with this. There’s a gap between healthy and sick. If you can catch people in that gap, you can help.
So as an example, he told a story on a podcast I was on with him the other day of a couple patients where they had the remote patient monitoring. They start to witness that this person’s temperature is starting to go up. It’s gone past 97 to 99 to a hundred. So what do they do? They get over to the house, they get the vitamin C, they drop off the oxygen. These people have oxygen, have vitamin C, and the temperature comes down. Those people were infected. Those people were high risk. They were on their way to being like someone that was going to be in the hospital if they hadn’t have intervened. But they intervened early. They get the people’s temperature down, the oxygen saturation, come back into line. Ultimately, you’ve avoided a hospitalization of a high-risk person by having that kind of infrastructure in place.
We’re in a situation today, Kara, where we have hospitals that are overrun, and we have primary care doctors that are out of work. It’s crazy that that back and forth exists, where we have overuse and under use. I think some of these strategies don’t just make sense here or actually have been used effectively in Italy, and it’s a decentralized community approach. Just with what I was saying earlier, when everyone in the country is starting to measure their own oxygen saturation levels, this is how functional medicine becomes medicine because that is a measure of function. Ultimately, what we’re going to see is that once everyone starts measuring themselves, which has been a kind of a weird biohacker thing up until now, people want to know, “Well, do I improve my numbers?” Suddenly, the medicine that you know and love and that the whole community knows and loves will be front and center.
We’re already seeing that echinacea is sold out. Vitamin C is being used at hospitals. The weird medicine that was weird 10 years ago is not just cool now. It’s absolutely necessary for the maintaining of health across the population.
Dr. Kara Fitzgerald: All right. Nicely said. Oh my goodness. Listen, I just want to circle back to AA. You might be aware that Cochran did a really good review of AA and determined that to be effective and of course considerably cost saving. So Cochran review, just looked at AA back in March 11th, they published. So just –
James Maskell: Amazing.
Dr. Kara Fitzgerald: I know. I know. It is amazing. It’s really kind of about time because we’re obviously in the middle of a pretty serious addiction epidemic, not just opioids, but alcohol, food, et cetera. The nine yards, I think we’re in a full-swing addiction epidemic. So to see these tools and to see somebody like Cochran, looking at it is important. What else do I want to say? So I think what you’re articulating, so there’s some of us, like myself, I do some clinic, and then I do a lot of education for professionals and so forth. That’s how my career has unfolded, and I love it, and I’m grateful for it. So some of us are going to remain in sort of this tertiary kind of a functional medicine practice. It’s just what’s working for certain models, and it’s really good for that chronically ill individual who needs heavy hands-on individualization.
I think there’s a place for this tertiary care model. However, the bulk of us, if functional medicine is going to be just medicine, this outline, the vision that you have and your experience of going around the country and figuring out who’s doing it and how they’re doing it and really teasing apart the step-by-step instructions, it’s essential, James. I mean, there’s just no doubt about it. I mean, we have to do it.
James Maskell: Yeah. No, I feel super fortunate. I mean, right from the beginning, the first thing that we did at the functional forum was to set up these concierge calls where anyone could call up, and we’d hear about what was going on in that practice, and we sort of helped them to find different resources, whether it was telemedicine or… One big issue that we’re seeing now and we’re probably going to do another thing on it is a membership practice, right? Those doctors that have switched to a membership practice right now are so happy because guess what? The money keeps rolling in, and they can do telemedicine appointments to make it. Whereas a lot of people who are still fee-for-service or packages, they have to sell packages to keep the doors open and sell appointments. So that’s a big deal.
But yeah. We had a window into what was going on, and we just kept our ear on the pulse. For most clinicians like yourself, I mean, you have a bit of a different situation because you’re mentoring these other practitioners. But for most people, they’re having a very limited experience to what’s happening in functional medicine. They have their own clinic, and they have a few colleagues maybe they connect with and through the meetup groups and then through our sort of role in the industry. All we’ve really done over the last six years is found people that we thought were interesting and what would you say, our viewpoint of what’s interesting is how do these concepts of functional medicine make an impact at any sort of population level? Which I think we can all admit to ourselves that functional medicine has yet to make an impact at any sort of reasonable scale.
I think we can all sort of in chew it that it has the potential to because groups of people supporting each other to get themselves well or people reversing a chronic illness. If you’ve ever had a patient that reversed their autoimmune disease and got off a really expensive medication, you realize you just saved whoever was going to pay that bill millions and millions of dollars over the next 20 years by doing it. So I think we all in chew it that this is something that needs to happen for medicine to really transform. But we’re all struggling to work out, okay, how does this happen to any sort of reasonable scale? So the work will continue. I mean, ultimately, I started an insurance alternative because I realized like, “Wouldn’t it be great if we could create a way that the first port of call for people would be lifestyle and root cause approach and not the last thing when everything else hasn’t worked?”
All the other projects that I’m involved with are really to find ways to make it easier for more people to access the functional medicine operating system and to grow access, to grow affordability, and to ultimately work out ways that this could become a standard of care. So you’ll see other things that I got going on. Ultimately, the vision here is really just, how do we make this really the standard of care? It’s going to look a little bit different than it has. Those clinicians that have been on the front lines for decades, getting the results, it’s built on the back of those results. But it can’t go on being the same old way, long appointments, all for cash, whatever. It really needs to be lifestyle first, right? How many patients have you seen, Kara, that really didn’t need a full functional medicine workup? They just needed to sleep properly for a bit.
Dr. Kara Fitzgerald: Yeah, that’s right.
James Maskell: There has to be that. Then it really has to be looking to fire up this peer-to-peer delivery of value because ultimately, that’s really the only inexhaustible resource that we have.
Dr. Kara Fitzgerald: Let me ask you. I just have a couple more questions. One is, well, just quickly, I wanted to ask you about the insurance alternative. It sounds like that’s going well. Is it working out?
James Maskell: I mean, it’s working out. It’s growing. I’m learning a lot through the process. Ultimately, my vision for what it could be straight away, I think it’s going to take a while to get there. Once we get to a certain number of members, then we’ll be able to really enforce the rules that we want with our partners. There’s a little bit of that there. But I mean, look, I read this morning that 17 million people are going to be unemployed in the next six months. So yeah. It’s a much more affordable… I mean, I modeled it over my own care, Kara, which is like, as someone who is passionate about functional medicine, when my daughter was born, the insurance that I could have got wouldn’t have covered the home birth that I wanted to have, wouldn’t have covered Dr. Larry Palevsky who was the pediatrician that I wanted to see. It wouldn’t have covered any of the things.
It’s like, “Well, why am I going to pay $2,000 a month for something that’s not going to do that? Why didn’t I pay a lot less to take care of just the downside risk of something going seriously wrong and then pay for Dr. Palevsky’s $300 an hour fee because he’s the best pediatrician I’ve ever come across. I want him. He doesn’t take insurance. So, I’m just going to do that.” I think for a lot of us, it makes a lot of sense to decouple risk prevention and care. Ultimately, I think everyone just thinks about insurance like, “Oh, what’s your insurance?” What they’re actually saying is, “What’s your health plan?” Because the thing that you buy from Blue Cross Blue Shield isn’t insurance. It’s a health plan disguised as insurance. Ultimately, by decoupling risk prevention and care, you could actually choose functional first. That’s what I saw.
I mean, it’s working. It’s growing. It’s had its challenges. I’ve learned a lot. My business partner died a year ago in the middle of him starting to work this out. So it’s definitely had some teething issues, but ultimately it’s working. People are getting it. People are saving money. People are using it. The partner that we chose that does all of the medical cost sharing is by far the best player in that space in terms of quickly processing claims, having an app that you can submit claims, not being in the eyes of the regulators as doing the wrong thing. There have been some bad actors that have come into the medical cost sharing space that have kind of like poisoned the well a little bit. But the organization that we partnered with has basically zero complaints, and that’s why they keep staying in business, and we are accepting people in 47 states because the service is excellent, and that’s all I can say.
Dr. Kara Fitzgerald: Okay. That’s cool. Yeah, I agree with you. I’m using a cost share service too. It was no brainer for what we were paying or-
James Maskell: Yeah, you get it.
Dr. Kara Fitzgerald: Not much return. Okay. So COVID is upon us at this recording. Virtual visits are happening. Virtual group visits are starting to happen. Originally, we were going to just talk about what you’re up to. I still want to. But I want you to just address what you guys are doing over there, what you’re thinking about James, just in light of this pandemic and the new information it’s brought forward. So what’s up for you now?
James Maskell: Yeah, look, first things first, if you’re a clinician listening to this, you’ve got to have a way to interact with people digitally. So we’ve been talking about this for six years. If you go to goevomed.com now, there’s a blog which will give you step-by-step instructions on how to get set up with telemedicine one-on-one, so how to book appointments, how to deliver on the appointments, how to do the supplements, how to do the labs. I mean, that is just 101. You’ve got to be ready for that. If you go back and see, we did make a webinar on virtual group visits, and I think that anyone could be executing that either, A, as a revenue producing engine itself or B, more likely a way to add value and keep engagement with your patient population and then let them know, “Hey, we have telemedicine appointments.” So a way to drive revenue of the telemedicine appointments.
I think that’s the very, very basics, and then just adding value to your community. So I’ve had some clinics out there that have just been making… They set up their telemedicine, and then they have their assistant and the front desk who’s not doing anything because they’re not booking appointments with a nice script calling every patient that’s ever coming in, just saying, “Hey, this is Jane calling from Dr. Smith’s office and just wondering how you getting on. I know this is a testing time.” And just having micro conversations with all these patients and trying to schedule them into telemedicine visits and otherwise.
That’s kind of where we’ve been helping the individual clinician. If you’re interested in finding out more about this remote patient monitoring and that part, in the next month, we’re going to be kicking off actually with the PLMI event on the 16th of April. If you’re interested in that, if you got to goevomed.com/remote/patient/monitoring, if you go there and just fill in a form, we’ll be able to connect you with the resources. I mean, ultimately, that’s really for people who are already taking insurance and want to sort of work out how to do that a bit more efficiently and maybe even take Medicare again. It’s a big stretch to think that a person who’s not taking any insurance is suddenly going to open a Medicare contract, but maybe they will.
But yeah, I mean, I think ultimately, I guess I just want to say, Kara, I feel like the future is extremely bright for our community. I think there’s going to be a dip in the short term as everyone’s attention is on this microbe. But at this exact moment, there’s no drugs, right? There’s no vaccines. There’s no solution apart from doing all the things that functional medicine doctors have been telling you to do for 20 years, which is to make yourself hard to kill. That’s about having a strong immune system. Dr. Palevsky, who was my pediatrician for my daughter, he used to say, “You can’t boost your immune system, but you could take the things away that are killing your immune system or reducing its function.”
There’s a lot that we can do personally. I would just say that the biggest thing that I would recommend is finding a way to use things like Zoom technology to be able to build community. For the meetup groups that we have around the world, we’ve been encouraging our meetup groups of practitioners to form connections on WhatsApp and Zoom and still have community in that way because loneliness is the biggest driver of all-cause mortality. Find ways through your practice to introduce patients to each other in a Zoom environment. Right now and by the time April and May comes around, people are going to be super lonely. I’m very fortunate I’m in a family of three plus a dog, so I have some people around me. But I know there’s a lot of people that live by themselves.
So being a sort of a leader in bringing local people together through digital environment I think is a great positioning for you and your clinic moving forward. If you have some time in the next two months, really think about, what do you want your clinic to be like on the other side? Because the chances are this isn’t the last time that this happens.
Dr. Kara Fitzgerald: That’s right.
James Maskell: I really love for all clinicians to really think like, “Is this the time that I plan and execute a membership model? Is this the time that I start to really plan around my digital infrastructure?” If you have any of those questions, we’d love to be in support.
Dr. Kara Fitzgerald: Fabulous. All right. Thank you so much for dropping in on New Frontiers today, James. It’s really good to connect with you. Your message is timely.
James Maskell: Thank you, Kara. Thanks for being on the front lines. I know a lot of people look to you as a leader in the space, and I’ve learned a lot from you as a clinician. Ultimately, it’s going to take all of us as a community to improve the quality of care, improve the delivery systems to make it more affordable. I called my business The Evolution of Medicine because I was like, look, it’s just medicine adapting to its new environment. I think a lot of people have started to realize that that environment of chronic diseases, functional medicine was a necessary adaptation. Well look, the environment just changed. So we got to adapt, and that’s what it is.
Dr. Kara Fitzgerald: Yeah. Well said. Okay. Thank you.
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