155- Inside a New Way to Practice in Silicon Valley

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Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. This week we are back with part two of our story on Crossover Health. This time I have Dr. Dan Lord, their program director of Physical medicine, as well as Dr. Mason, who practices in one of their most robust and awesome practices out in Silicon Valley. So this is an episode that touches upon the day to day of what happens in a healthcare model that is pushing into the future. As always, this episode is brought to you by Rocktape. Rock Tape is proud to be a sponsor of the Evidence Based Chiropractor. And if you have not checked out Rock Blade's Mohawk, I would encourage you to do so. It's an awesome soft tissue tool. It's 175 bucks and they have continuing education courses going on around the world regarding it. So head over to rocktape.com but without further ado, here is myself, Dr. Dan and Dr. Mason. Mason, what is crossover health to you?

So crossover health to me is an integrative approach of taking care of patients. It's like the next level of healthcare of not just looking at one provider for one person, but looking at a team per one person. I think that's key when you're looking at healthcare today because outside of crossover, what's happening is you'll see a patient go to a medical doctor who has no idea that the patient's also going to a chiropractor and a pt. And so there's a lot of conflict that happens for that patient. And I don't think the patient gets the care that they need. And so whereas when you're at crossover Health, you have multiple providers working together and communicating together within their expertise to give that patient the best care that is needed. And that's healthcare. That's not what it should be. That is healthcare. So pretty excited to see it.

I think that's awesome. And Dan, I'd love for you to speak to that a little bit in terms of how did you guys build that team approach? What do you look for when you're bringing on a provider that makes sure that they're going to be the best of your ability, a fantastic fit for your system?

Yeah, no, that's a really good question. And it's something that we always work really hard at, is Finding the right people. One of the things that our leadership will always say, and Mason will say the same thing, is our people are our products. And yeah, we've got a great tech platform and we've got some really cool products, but I think when it comes down to it, it's the people behind those products that really make the difference. And so, yes, we've got some detailed onboarding and we take people through what we call our crossover university when they come in to understand integrative care and to understand all of the services that they have access to. But to your point, you have to find people that are open minded and an expert in their field. In order to work in this model, you have to have a little bit of experience, you have to have a lot of knowledge around your specialty, but then you have to be able to play in the sandbox nicely. So you have to be open to other opinions and other ideas. And the other kind of thing that we always say is the best idea always wins. And so it could be coming from the medical director or it could be coming from one of our hosts at the front desk. I think that drives our culture where whoever has the right idea that one wins and that's where we go. So I think you have to hire certain people that are okay with, that are okay with, you know, not just a higher hierarchy and a top down type of system. We believe in servant leadership. So the medical director or the Cairo or anybody else on staff, they might be running and grabbing towels, right? They might be the ones that are, you know, cleaning up or helping the patient get checked in. You know, it's a true team environment.

I love that. And Mason, how does that play out day to day? So tell me, what's a typical day for you as a practicing doc in a very unique system? What's it look like? Every day is going to be a little bit different, I realize, but give us some insight into what your normal day looks like. Seeing patients, taking care of people and engaging.

Yeah, so I normally start off my day, I'll probably see one patient around 8 o' clock, and from there actually I'll see two. And then from there at 9 o' clock, we have what we like to call a huddle. And that's where all the providers come together in the bullpen and we start to communicate about different cases a lot. I would say majority of our patients are seeing other providers. And so I love that moment because it's like that's where the source of crossover happens, where you're able to see like, okay, well, what can you do for this patient? And what can I do for this patient? And it's like, it's also gaining knowledge, kind of like how Dan related to. It's like, there's no one better in the room. It's just like, how can we help this person out? And so it's just a great time to just like, communicate with other providers. From there, we go right back into the physical medicine area where we start to really focus on patient care. And there's times where I'm not just sitting in the room doing adjustments or doing manual therapy. I'm really more out into the gym and the physical medicine area, really trying to re educate people on functional movement, learning how to calm down the nervous system and just get them going back to that optimal level of what they are wanting to achieve. I think the goodest. Not the goodest, but the greatest thing about crossover, giving you the ability to really find out what's the patient's goal. I think it's one of our biggest thing with our care plan is just not to get them out of pain, but how can we get them to that next level where they're confident in going back out and doing that marathon or confident in picking up their child again. So a lot of my day is just really trying to get people to their optimal level of health. So we do that. And then on Tuesdays, we also designed a class where we try to educate people on how to work on their posture. We call it posture hacks. And we try to get our community aware of how to move. Not just relying on coming in, but also taking tools and implementing it into their day as well.

Yeah, that active care is so important. Dan, go ahead.

Yeah, absolutely.

Rip off of what Mason was saying a little bit. The other, I think, cool design feature that I think makes us or differentiates us is our deep integration in our physical medicine team and our physical medicine space. So we're working in the same space as the physical therapists and the acupuncturist. And we've got. In many clinics, we also have strength and conditioning coaches. And we all work in this nice open gym area that looks like if you went to a CrossFit gym. We've got a little rig in there. Sometimes we'll have kettlebells. We'll have lots of functional movement equipment. And also there are bands and other PT equipment. But it allows us to deliver what we call a continuum of care. So we don't want people to, one just rely on passive therapies. Like we Already pointed out, we want to move them into active care, but then we don't want them to be in rehab purgatory. Right. Where they're doing clamshells for months.

Right.

Like, just do more clamshells. Your glutes will activate, right? Well, we gotta. Yeah, that might be a part of it, but then we gotta move them to more and more functional activities and into fitness. So you're creating resilience. You're not just creating somebody who's good at doing their rehab exercises. And so I think that unique environment where you have a PT and a chiro and ACCU and a strength coach all represented, and there's a lot of overlap between everyone. There's also some specialization between those different providers. And so within the physical medicine umbrella, we can deliver something that meets the patient where they are and progresses them along a continuum of care.

That's awesome. And, Mason, what's the biggest challenge that you've experienced working in that deeply integrated setting? So, I mean, we all can very clearly see the benefits. I mean, that's where everything's going. It's where a lot of docs want to be practicing, is really when they can have those curbside consults, when they can have that deep integration with the other providers. But what's one thing from your experience, maybe that's been a challenge, as you've heard gone through that process.

You know, there is challenges, but I think it's funny when you mention that, because it's not the challenges that we would actually think. I think their biggest challenge is allowing people to know that you don't have to use chiropractic so much. But, like, the challenge is taking them from that passive care and really getting them settled into that active care and staying there, you know? And so I think that's. That's more of the challenge more than anything. But as, whereas we, like, integrated, we're integrated when we're working with PTs and ACCUs and medical doctors, man, there's no challenge there. I think so far, they open us with arms wide open, and we're able to really communicate and collaborate really well with pts and accuse. Very well.

Great.

And as far as the tool set, I'd love to have both of your insights on this in terms of, you know, and I know, Dan, you and I have talked about this a little bit offline, but, you know, where one ends, where the next one begins. As far as utilizing a tool set, I'd love to hear from Mason, kind of what's in your tool set that you're using just day in and day out doesn't have to be a physical tool. It could be a technique, could be a little bit of everything. I'd love to hear from you on that. And then I'd love to kick it over to Dan to say, okay, from a strategic standpoint, how do you go about kind of making some decisions while retaining autonomy for the provider, but making sure that you have great care throughout the system? And I know that that is always a challenge, but Mason, kick us off with a little bit of what you do day in and day out.

Yeah. So a lot of some of the tools that I use, one that I use a lot is just understanding pain and pain science. And just really, I think the biggest tool that we have in our toolbox more than our hands is education. And I think it's really, really important to really learn how we can calm down the nervous system by educating our patients on pain science. So I've lot of research on pain science and understanding. And so I think communicating and learning how to communicate to patients is a huge tool that I use towards my advantage. Another one is I do a lot of FRC, functional range conditioning stuff with Spino. Dr. Spino. I think that's really great for really teaching people how to control their movement, because once you get them out of pain, you got to get them into a system where they can control. Control the movement. So learning that is really key. And then I'm really big on strength conditioning. How can I get people to do functional movements with load, like getting in on it with the kettlebell and learning how to do deadlifts, learning how to do a plank squats, Just getting them to do those functional movements again, just to prime them up so that I can send them off to physical therapy and they can just add the next layer to it. So that's really my main things. I do manual therapy. I do the manipulation if the joint is needed. But I think the biggest one that I really like the most is pain science and frc.

Cool. Underdog. I love to hear new stuff. I was not expecting that. That's awesome. And Dan, from a system perspective, what are your thoughts on where you can go, where you guys are trying to take it and maybe what you've seen in the past, Right?

Well, if you look at kind of the new research on treatment based classification, they're putting people into buckets, really, so you've got the first bucket where it's more symptom modification. And so there's lots of tools you can do manipulation. You can do manual therapy, you can do acupuncture, and I'll throw in a couple more tools there. I'm a rock tape guy. I really love the rock blades. I like the Mohawk, I like their rock pods. You can use those tools to modulate pain really, really well. But then we move to, you know, more of a movement control. Like once somebody is out of pain, once somebody can start moving, teach them how to move well. And so that gets into what Mason talked about is there's the frc, there's functional movement screen, there's all sorts of tools that we use. I don't think we're exclusive to any tool, but we learn all of those tools and apply them based on our clinical background and what the science is saying. And then I think the next kind of bucket is really sports specific or job specific, optimizing your movement. And so that might be one of those kind of points where, yeah, Cairo might be working on somebody in that bucket, but I'd say a majority of people in that bucket would be PT or strength and conditioning, where I think where chiros shine in our model is getting people out of pain really quickly and into specific movement patterns that reduce those symptoms and create resilience. And so I think the other challenge from a high level strategy is, well, where does the patient start and when do you make those decisions to refer? Not everybody needs the kitchen sink. That's a waste of resources. If somebody comes in with general low back pain and you see a chiro, you're going to get better. Our tools work really well. And if you educate them, like Mason said, around pain science, meaning guess what? Your prognosis is good. Back pain is a normal thing to have happen and most people recover and you're going to be fine, you're not fragile, you're not gonna have some chronic disease or problem. Let me teach you some tools also. Hurt doesn't always equal harm. And really getting that concept through is so important. And I think it's one of the things that also separates us from providers in the community. And so I would say the other layer is what's the patient's preference? There's a ton of research and you want to really build that therapeutic alliance where there's trust and if you get over the hump where the patient trusts you and there's an alliance and there's an understanding and there's an expectation, then you're much more likely to have a great outcome and reduce symptoms and get people where they need to go. And so if somebody would like to start getting their journey with an acupuncturist, we won't stop them. We encourage that. If a patient wants to begin their journey with a physical therapist, that's great. But then after that initial visit where you can create that relationship, then we'll move patients where they need to be as soon as possible. So if there's somebody who has a lot of restrictions, limited lumbar extension or a mobility problem, has a lot of joint restriction, our PTs are sending people right over for adjustments and different manual therapy and manipulation, just like we would if there's somebody who's got a really big deficiency with their core strength. Not to say that Mason couldn't train somebody with their core strength, and it's not to say that a PT wouldn't do manual therapy to unlock restrictions, but depending on the patient, depending on the situation, we work very closely together. And so you get into a rhythm, and it's not about a turf battle, it's just about that patient. It doesn't matter who has the right tool or solution. It's about getting that patient better. And when you think about it that way, it becomes easier.

Yeah, I think that's a really important point. And I know Mason and I were talking last year when I was out your guys way, and as he was saying, man, it would be really difficult, if not possible, to go back to kind of a traditional way of practice after being exposed to what you guys are doing. And Mason, I'd love for you just to talk about that a little bit. You know, kind of what's your experience been obviously, you know, getting into a really new setting. I would just love to hear your thoughts because a lot of docs don't have that exposure or experience that you've been fortunate to have.

Yeah, you know, I think it's obviously we're very blessed to do what we're doing because when you look at where you look at just doing chiropractic by yourself, and then you get exposed to this whole new approach, even just in the physical medicine era. I'm not saying that we're limited, but we're limited compared to what we can do for the patient. There's so much more that we can do and we fit right into healing the patient's body. So, yeah, like I mentioned last time, I just, I don't. I can't see myself working outside of an integrative approach because I know that I can't do it all, and I'm okay with saying that. And I just know where I fit best within the musculoskeletal disorders and treating them. And I know where physical therapy comes into play and I know where acupunctures come into play. And as a team, this is what is needed. This is what we need to be a team in order to really do some really cool things to help progress people's optimal level of health and just, even just getting them out of pain as well. So, yeah, cool.

Jeff would say we're sitting here, we're talking about the great care that we provide and we're giving this great experience and if there's people that are listening that are like, oh, that's all great, but how do you pay for it? Right? I mean, the other, the other thing that we haven't spoken about is you actually save dollars with this system. It's not as expensive if you manage people conservatively and solve problems in this way and we can show health outcomes, we can show that we're getting people better, faster. And so that's why not only is this a better way to practice, you also can make an impact on healthcare. Our doctors prescribe five times less opioids than the community because they have this system to refer into. So it's a win, win for everyone.

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