EP059: The Group Visit Model with James Maskell

Welcome to the Perfect Practice podcast where we share the most innovative strategies to help you build a successful functional medicine business, attract your ideal patients, serve your community, and get paid what you're worth. Each episode is packed with practical steps that you can take to immediately grow your influence and serve more people. Our mission is to share golden nuggets from successful practitioners, technology experts and innovators from around the world. Your host, Sachin Patel is a functional medicine and success coach, international speaker and best selling author. He's calling in all his favors to bring this information to you so you can create your perfect practice.

Welcome everyone to Perfect Practice. This is your host, Sachin Patel. I am really thrilled to come full circle because episode number one, we featured James Maskell. And here we are, 55 episodes later, we're featuring James again today. He's going to be talking about a very relevant and important topic that I feel is going to impact functional medicine more than anything else has impact functional medicine, at least in my career. So make sure you stay tuned in. Listen up, listen carefully. Grab a piece of paper and a pen. You're going to want to take some notes and I bet you're going to probably want to listen to this one a couple of times because we're going to be talking today about the group visit model, which is an emerging model in functional medicine practices. And it's the only way, I feel, that we can scale what we do, impact people, but more importantly, create a sense of community. And I know James is going to talk all about this. The sense of community and the importance of community is really, really valuable to your practice and to your own personal sanity as a practitioner. Because let's face it, we do some very heavy work and that work can wear us down, it can tear us down a little bit. But if we can distribute that work and, you know, make that and spread that work out so that we have members of our, you know, practice community helping us and supporting us and supporting each other, then that burden becomes so much lighter. And this is a direction that our practice has been going in. You know, many of you listening to this have probably contemplated about going into a group visit model or a group care model. There's different ways that we can skin this cat, so to speak, and we'll talk about a few of those. But first and foremost, welcome James. Thanks for being here today.

Great to be with you again, Satchin. Honor to be on twice.

Awesome, my man. So I know you've spent the last couple of years really researching, you know, the group visit model. You've interviewed several prominent practitioners who are incorporating this into their practices. I know that when you and I went to Guernsey and spoke there, that community was the hot topic. It was kind of the golden thread that ran through everyone's presentation. And, and that sense of community is super, super valuable and really overlooked in our current medical model and even in the typical functional medicine practice. I think that sense of community, although people have tried to do some of that, I know we've done that with our community workshops and so on and so forth, but adding some structure to that can be extremely valuable. So why don't we just for the sake of those people that have been living under a rock for the last few years, why don't we talk a little bit about you, introduce yourself what you're up to, and then we can dive into the community model.

Yeah, absolutely. So look, I'm 15 years in to a plan to transform health care. And I came to America 15 years ago, and at the very beginning, my goal was to really understand from an economist's point of view, which is sort of how I was trained, how do you create a structure that controls costs and maximizes health? Spanish that's what I'm interested in, right? Because in my health economics, you can see America is like the worst example of return on investment in healthcare expenditure. And so how are we going to do this? What are we going to do? So the first thing I do is get involved in a practice that probably looks like many of the people who are listening to this. And I see working on the front desk, chronic disease reversal, right? And this is in 2005. And I don't think in 2005, there's not a lot of people that know that this is even possible. And I see people not just losing the labels of their diagnosis, but transforming as a human. Right? Transformational moments for the patients where they're empowered, where they understand their body, where they, you know, they start. They really have a very different kind of medical experience than anyone ever really knows is possible. So I'm like, okay, that's definitely a building block of this future, Right? Because it's this lifetime dependence on medication times 80% of the population that is leading to these exponential costs increases. Right? Self efficacy is what we're looking for. People who could just take care of themselves, people who are, you know, people who are independent of the medical system and know how to keep themselves well and can then inform everyone else in their community how to keep themselves well. So that's like the first piece. So then I dive into that Right. I become a sales rep and I'm selling to doctors doing that kind of medicine. I'm mainly working like it's more of a bioenergetic thing that I'm selling. So I'm working with more of the like energy end of the world, which is like acupuncturists and chiropractors and muscle testers. And I get like an N equals a thousand experience into the industry because as a sales rep I'm seeing four practices a day. Most practitioners are seeing one practice every day. Right. And so I'm just getting this like seeing how people are doing it. And that goes on for a number of years. Like I credit those three to six years with really helping me to understand the industry almost better than anyone else. Definitely better than practitioners. Practitioners because they're just not having a wider experience of what this looks like from, you know, the energy medicine person in their garage at home through to like some sort of specialist who has seen these bottles come in and like, what is this thing? You know, what is, you know, what is it? So do that for a few years. You know, I realized that the clinic that I worked in, the spa on Green street, which was, I worked there for a year and a half, was the best run clinic that I've still ever seen. Maybe the Living Proof Institute gets close, but these guys had run spas, they spas for 10 years. The operations manual is this thick. Every process is documented, everything is organized. The script that you answer the phone with, everything is like that. So I realized straight away there is a black hole of knowledge on the clinical side that even you practitioners will never know. So I can't compete with you on that end. So I'm going to be just the practice management guy. And so I started my first practice management company in 2010. On the side, I'm still like the sales rep. And now I'm hiring reps and whatever. And then in 2010, 11, I start going to conferences and I realized like, if we think of medicine on a spectrum from left to right, let's say on the very right hand edge is experimental drugs, right? Which is like, we don't know whether it works, but we're just going to try some random stuff. We're going to inject you with a measles vaccine and maybe your cancer goes away. Like that kind of stuff is happening, right? And then on the other end, on the very left hand edge, you've got remote energy healing where I'm just like setting my intention. And Sachin in England is like Recovering from cancer.

Right.

And everything in between. So if we go from left to right, you've got energy healing, you've got maybe like homeopathy, acupuncture, chiropractic naturopathy. And then just before you get to conventional medicine, you have functional medicine, right? Where it's scientific enough that doctors would do it. It's definitely a little left of conventional medicine, but it's not long distance energy healing. It's right in that zone where you're using the same lab test to determine what's happening as conventional medicine, but you're just doing a lifestyle first, nutrition first approach, rather than drug first approach. So I realized at that point, when I start finding out about functional medicine and the other thing is that everyone's doing it the same. One of the frustrations about working with naturopaths and integrative medicine, not that they're not on point with what to do, but no one's doing it the same, right? You can't scale it up if everyone's doing it differently. And so I'm just, I'm looking for how do we scale this thing up? So I start going to conferences. I see Jeff Bland, I see Mark Hyman. I'm like, wow, functional medicine, it probably is going to be the thing that allows medicine to start moving left, right, to start moving towards this area, which is what I'm looking. I see that, like, we need to move left. So I get excited about functional medicine. A couple of years go by and we decide in 2013, we're going to start the meetup group for doctors in New York who are interested in functional medicine and technologists and health coaches, but mainly for functional doctors. That becomes the functional forum. We try and make it cool to be a functional medicine doctor. We put doctors like yourself, but like Kelly Brogan and Jeff Glad, like aspirational doctors on stage. And it's all online for free. So very quickly, it's like the biggest media channel in functional medicine. We do a couple of digital summits. We learn about, you know, we learn about digital marketing. I hire ULI as my coo and, you know, we're off to the races in like being a content platform. And so, yeah, just before the functional forum. So it's now clear to me, and hopefully it's clear to all of you that functional medicine is a necessary evolution in medicine to get us to a point where we can reverse chronic illness. Right? And doctors can do it. And we're all here doing it. But I'm looking at it across my thing and I'm like, this isn't going to scale to everyone. Like, poor people are not going to get this. Like, Sachin could be unbelievably good at selling someone the $2,000 program. But, like, not everyone's going to be able to afford that, even if you're that good at selling it. And yes, poorer people probably prioritize their health and whatever, but that can't be the whole plan, right? That's a good start to get doctors to leave the system. Like, we need a bigger phase. One is build the army. We need way more doctors on the front lines doing functional medicine, individual functional medicine. And you've been part of that and I've been part of that. And it's still happening. And there's going to be a massive need for individually delivered functional medicine in the future. But, like, we're all, you know, we're all doing our thing. So then in 2013, I'm speaking at this call, this is three months before the functional forum. I'm sitting in there and I hear Shilpa Saxena give a presentation on functional medicine. Group visits. And I'm sitting there and I'm like, this sounds right, this sounds like the way that it could work. Because individual functional medicine, one, it takes too long. The intake is super inefficient. Like, you can never make that the standard of care. Two, it's unaffordable. It's inefficient, it's unaffordable. It's not even profitable to deliver. Like, I see these integrative centers going out of business because you can't make enough money. And then where are you going to hire these doctors? There's not enough doctors in private practice. Where are you going to hire 100 functional medicine doctors if you open the biggest awesome functional medicine center inside a huge hospital? Who are these doctors and what are they going to do? Like, there's five reasons. And also behavior change is hard, right? So you've got five basic reasons why functional medicine can't scale. Affordability, accessibility, scale of number of practitioners, behavior change and profitability. All reasons why this can never work. And I listen, I'm thinking to Shilpa, like, damn, in her model, it could be run by other practitioners. So you open up the opportunity for all these other people to be involved. It's affordable. She's doing it on insurance. It's profitable to deliver because you're billing 16 people's insurance at the same time. And behavior change is now not so hard because people see other people who are making Progress and their they're being inspired by other people in the group that there's peer to peer delivery of value. Right. The value isn't practitioner to patient only, it's peer to peer. Right. And I'm like that, wow, that's gold too. So then that energy starts the forum and I'm like talking about group visits. I'm doing it like I'm doing the practice management session in the early forums. Suddenly we've got 20,000 doctors watching the forum. I'm talking about it in January 2015 I have a chance to do my TEDx talk. And I talk about community, not medicine creates health. And I talk about group visits specifically. And for the next four years in the forum I'm talking about it a lot and I see what you're doing Satchin. So everyone that I meet along the way, I'm looking at them through the lens of do you have something that can help with the scale? And what I see you doing is doing these free workshops in the community and introducing people to each other. And I'm like, that's cool. Like that could work. That's a really good way of recruiting patients into an individual practice. Right? And then I see like, you know the FPC guys, they do in groups, but it's inside a $4,000 package. So you know, it's not the whole plan but they're using some group stuff and I'm like, okay, there's some cool stuff going on. But what I start to realize is, you know, in a one off group visit you may get some serious efficiency gains but you're not really tapping into the real potential of getting to the root cause of the root cause, right. If we're all root cause medicine people. So in 2015, I'm sitting, I've done my TED talk, I'm into this thing and I'm sitting there at the IFM annual conference and I'm listening to George Slavic. And George Slavic works for the UCLA stress lab and he does the most incredible presentation like with the genetic testing now they can see at the cellular genetic level that loneliness is the biggest driver of all cause mortality. More than nutrition, more than exercise, more than alcohol, more than smoking. Right? And we're the root cause crew, right? But we're not doing anything. We're, you know, these people are isolated in one on one appointments. So I'm like, okay, if we're really the root cause, what are we going to do about it? I just want to interject for a minute because you're going to learn this when you read the book. But the reason why, when I heard Shilpa's thing, I like knew it. I didn't recognize, oh, this is more efficient from the economy point of view. I'm going to come out of the closet in my new book in a big way. And the closet that I'm coming out of is that I was born in a commune in Colorado, right. I'm not like, I had a very different childhood than probably anyone else that you know, and I was in it for the first 11 years. I grew up in community and then my dad left the commune and I was put in boarding school. Right. So I don't know if anyone else has done that like shift, but it's pretty weird. Like two different communities. But you know, that commune that I was born in was like actually the beginning of the integrated medicine movement. They were all standard process reps and it was chiropractors that they were getting into the commune because one chiropractor could like share the message with their whole patient base. So like this has been in me since the beginning and this is why I like know a lot about the industry. And you know, this is this. And this was a, this was a decision that I made in 2005 to follow, not what I thought that I was doing. Like I was an investment banker for a year out of university. But like, you know, the mushrooms had an effect on me, Sachin, and I just had to like go for the real thing. So, you know, so you'll hear about that in the book. So anyway, I always knew that the value proposition of the group visit had to be right. Not just the efficiency of delivery of information, but solving loneliness by introducing people to each other and creating new friendships around people. And the phrase that I used a lot all the way through the forum is like the healthiest thing that you can do as a practitioner is introduce people who want to be healthy to each other.

Right?

And that's what I saw was kind of happening in your like intro events, right? Maybe there's an opportunity to introduce people there, but maybe not like it's a one off event. Maybe they become friends, maybe they don't. Is there any real peer to peer transformation? Because I'm watching you on Facebook and I'm like, he's doing a lecture. Like lecture's cool, right? But is there really a structure now? The things that I hear that you're doing, Satchin, that like really like heart resonate with me are like the cooking groups, right, where people are getting together and reducing their cost. Of healthy living by getting together once a week and doing community batch cooking. You remember how hot I was for that? Like, I was like, that's there. And by the way, that's in the book too. So I'm like, that is it. Like that's efficiency in action. That's solving loneliness, that's solving all of these problems together. And I'm like, okay, so that's it. So then time goes by and I'm excited about it. I'm also excited about health coaching and I'm excited about other things. But like, this is just who I am. And then we go on the, you know, new health pivots to become like an insurance alternative that's built around community. We could talk about that later. But what I come to is I come to the Cleveland Clinic center for Functional Medicine, right? And part of the reason, like that project has been indelibly connected to my work since the fourth ever episode of the Functional Forum. The first time we get the stream working, I mean, streaming was hard in 2014. You had to have like this whole setup to do it. We get the stream working the first time and Mark Hyman comes out of nowhere and announces the Cleveland Clinic thing on my show. No one else knew about it in the industry. That was part of the reason why suddenly we were awesome. And everyone was like, what is this Functional Forum? Because like they announced it on the show. So on the tour, October 2018, I go with my cameras to make an episode of the show Functional Forum and I'm going to do a tour of the Cleveland Clinic. And I see, and I realize at that moment that guess what? The Cleveland Clinic opens a center. It's the first time that a major medical academic center has opened a big functional medicine center. And guess what? Everyone wants to come and they've got demand up to wazoo and they got five doctors. Exactly the issue that I was saying, like there's just no scale. They got 2,000 people on the waiting list. You know, I remember having conversations with you, Sachin, over time is like, you know, you would say to your practitioners, like, hey, if 1,000 people wanted to come into your practice, or let's say even 100, what would happen? Like if you're onboarding people with paper and whatever, like if you know, is there enough efficiency in the system to even onboard 100 patients into a one on one clinic? And I'm like, no, like definitely not. So what I see that they've done there is they've created what I just knew was the way, which is like A functional medicine group, that's not a one off, it's a ten week group visit where over that time, basically the full curriculum of self efficacy is delivered, right? So people learn how to like, read their labs, nutrition supplements, how to sleep, how to eat, how to relax. All the stuff is there. And you get this new community and it's available on insurance and poor people can come and it's being done by the Cleveland Clinic. And I'm like, hallelujah, this is it. This is going to be the stamp of approval. Everyone's going to want to do it. And I don't even have to know how good the results are going to be because for the first time we're solving the biggest determinant of health that no one else is solving. It's definitely going to work. And the group visit in that structure has two advantages. One, you're solving loneliness. You're literally introducing people to each other. People are developing friends, they're developing trust. Like, I'll tell you more about people that I've interviewed who have been through these processes and see how they've transformed. But also it's the right structure for consistently applying the healthy behaviors that are necessary to maintain health.

Right?

Trying to do that alone, isolated, you know, think about your patient base, like how many people don't do the stuff, don't do the behavior change, right? And so forth. So then I'm like, okay, this is happening. So on that moment I'm like, I'm going to learn everything about group visits. I'm going to interview everyone who's ever done them. I reach out to my whole community who's doing group visits. I want to interview you. And I just start download, download, download, and I'm interviewing everyone I can find. In our practice accelerator, we do some tests to see whether or not what the hybrid group zoom group visit might look like. Could you develop enough real heart connection in one session and then do it through zoom after that? We're just doing some experiments because I want to just understand everything because I'm like, this is going to go down. This is the way that functional medicine becomes the standard of care and this is the way everything, you know, rolls out. So, you know, so that was it. So through my research, I start to interview people and, and a lot happens after that. So I want to take a breath just because that was a good rant and I'm happy that I went to it. So there's a lot more to say. But that's, that's part one. You can ask a Question now, Satchin.

Really passionate about what you're talking about. So just all kidding aside, dude, that was amazing. I can see your heart is in this more than anything else. And I've known you for quite some time, so I'm really happy for not just yourself to really find your dharma, but also for everyone else who's going to benefit from you kind of leading the charge. And one of the things that Andrew Skopik would say is you're like the snowplow in the night, right? You're clearing the road for us. And maybe Cleveland Clinic has done a lot of that and you're bringing that information back to us so that we don't have to go through the same trials and tribulations. And. And of course, we want to add, as a community, we want to add to that narrative as well. And you can see how many people are on this call right now that are literally glued to their phones or to their computers because this is the direction that we all know things need to go in functional medicine, as beautiful and as amazing as it is, it's not scalable. Let's just face it, in that one off type of business model, it's not scalable. And if you do this long enough and your practice reaches a certain level of success, it actually becomes a little frustrating because you've now got this waiting list of people that want to come in and see you, that you can't do anything for them. And that waiting list is just going to get longer and longer and longer and longer. And you know, I kind of call the waiting list a suffering list because people are suffering until they can get in and see you. And then from a business perspective, you know, if we're going to talk about that as well, you're not able to monetize those patients. And so they're just waiting there. And it's not necessarily adding to your bottom line. So by having some sort of group methodology, you can scale time, you can increase revenue generation for your practice, you can reach way more people, and you can reach people in various levels of financial status as well. Because we don't want this to be the medicine of the elite. We want this to be the medicine really for everybody. And anyone here will attest to the fact that our objective is always to put the patient in charge of their health. You know, not a hospital, not a practitioner, but really the patient. And I really can't see a different. I really can't see, at least for now, a better way to do this. And with technology, with, you know, Streaming being so much easier than ever before. You know, technology has kind of caught up to this vision and this dream and it's making it so much easier for all of us to participate in this emerging model. So I really appreciate all the work that you're doing and I love the five reasons that you describe why functional medicine can scale. I think that's really relevant and I just wanted to mention them again. One is financial, the other one is access. And that's one of the things that many of us as well might struggle with. Finding a good, well trained functional medicine practitioner is not as easy as people might think. And then of course we've got the behavior, the profitability, and then of course the practice itself. You know, it requires, you know, a certain amount of room and space in order for these things to be able to be facilitated. So the efficiencies in a group model are so much higher. And another thing that we want to make sure that, you know, we're mentioning and bringing up is also the health of the practitioner. Because even if you're making good money and you've got a successful practice, if the practitioner is feeling burnt out because of the one on one care and the fact that they have to keep repeating themselves and the fact that, you know, they're, they feel like sometimes we're dragging people up a hill, it can be so much more challenging. But if you've got the community pulling everyone up and elevating each other, then that, that distributes that, that energy, so to speak. So I love it.

Energy distribution is everything. So, you know, the things that I think would be valuable to discuss on this call, you know, just seeing from the questions that come in and maybe there's other things. So one I want to talk about like all the different ways that this is being done, right. So to give you guys some ideas of like you don't have, you could do it. You know, there are lots of different ways. Cash, insurance, Medicare, you know, different styles. And then I also want to take you through a few concepts from my book that I think will resonate as far as like how to think about it. And I've got some diagrams that I want to show you too that I think that would be helpful. So whatever order you think would be useful or if there's anything else you want to know, let's jump in.

Well, I do know that a couple of questions that are probably going to come up for me at least, and I know for other people who are tuning into this is what are the different versions of a community based practice or a group based practice model. So you have the in person, then you've got the potential online, you've got the potential hybrid option. So maybe you can talk about the different options. So that way people can kind of see which model works best for them. And then I know there's going to be some questions that come up surrounding, you know, how do I get people to commit to 10 weeks at the same time showing up here? Because that can be a challenge as well, you know, getting that, that commitment. Because usually when people book their appointments, they book it around their schedule. Now they've got to book it around the group schedule. So, you know, those are things that are coming up for me and certainly anyone else who has questions certainly put them in the chat feed.

Well, let's just. Yeah, let's get into it. So, you know, the good news is that I guess one thing I just want to say just because I know there's a lot of entrepreneurs who are listening to this, right? And one of the things you guys have been probably thought about is like, how can you scale your practice? So when I was at the Cleveland Clinic, I met a PA there, physician's assistant. When she was hired, she had never heard. She had never heard or run a shared medical appointment or a group visit, and she had never heard of functional medicine.

Right.

And she, within a few weeks, because the curriculum was set by the Cleveland Clinic in that case or by you in your case, as a clinic. She crushed it like from day one and was running these groups and, you know, and in their model they have a physician's assistant, a dietitian and a health coach, kind of like different times, you know, running it. So the PA is the licensed provider. If they have to like change medications or whatever, you know, the dietitian is there again, like licensed provider, you know, for the nutrition stuff. And then the health coach is that because you got to think over 10 weeks, two hours a week, that's 20 hours of content. So, you know, they're using these other practitioners. So they're basically dangling the carrot of Mark Hyman and say, like, hey, if you want to see Mark Hyman, you got to go through this process. Now, I think to answer your question, Satchin, about how we do this, like, let's say you get to a point where your practice is full and you're full with your practice now, you're starting to develop a bit of a waiting list, right? You have become someone that people want to see and maybe people that would. Someone would go out of their Way to see. And maybe something that if you said, hey, if I, you know, if you want to see me, Dr. Sachin Patel, like, you've got to go through this 10 week group visit before you ever get to see me. And that's the entry point to getting my attention and be part of my practice. Because you've obviously heard good things and I've got a track record reversing chronic illness. And this is just the entry point into the practice. And that's what they did at Cleveland Clinic with Mark hyman. Guess what? 40% of people are so much better, their promise scores have gone up by five points. Just to give you context on that, like the study that came up the other day where it showed that functional medicine was better than conventional medicine. Hopefully you guys all saw that in jama, right? In the regular clinic they went up BY I think, 0.3 points of a promise score. And in the functional medicine they went up by 1.6 points. Moving one point is very hard, right? In the groups, this is not published yet, but in the groups, 40% of people went up by more than five points, right? And between 50 and 66% of people were so much better they didn't need the doctor, right? So, you know, Sachin, one of the things you said that always resonated with me was like, why are we putting the most expensive provider at the the front? Like, let's just get the lifestyle delivery care at the front, the community care at the front. And guess what? You can serve a lot more people because if you're at the top of the apex of the triangle, like not many people get to you. And this is the vision that you talk about all the time. It's just like giving people the minimum amount to keep them well and keep them out of the system. Self efficacies, you put yourself out of business, right? That's why, like, you know, that's why Satchin and I developed this thing. Because you're talking the right language, right? You're talking the language of the, you know, the economist, which is like, the goal is self efficacy. The goal is maximum health span at minimal cost. How do we deliver that? You know, someone has to want to go through this process. So anyway, so that's when I start. So to give you an example, like the virtual group visit is definitely like bleeding edge, right? So you could try and do that. And you know, there's examples in the book of like, you know, virtual being used. And maybe that's what you want to do because you'll build you know, you bring from a wide audience, and I'd love to see, you know, innovation in that space. But let me just talk about in person group visits, because ultimately, whether or not you could develop friendships via zoom, not clear. Maybe, you know, Satchin, you know, develops his community by his yearly event. Right. Perfect Practice live, and then the Facebook group, and then these kind of things. I mean, I see you guys like each other, right? You guys are a community to a certain degree.

Right.

If are we solving loneliness? Possibly. Right. But it's not right in the zone. Like, if we're talking about delivering functional medicine for poor people, let's talk about what we're really talking about, which is introducing people to each other in person. So let me just tell you a few things. So one model is put people in a group and have them qualify to see the patient, see the practitioner. I like that because they have, like, a reason to sign up for the groups, and they're like, they invested in it because there's this end goal of what they think they want, which is the guru. But actually they realize in the meantime that the community's the guru and they get better and they don't need the doctor, and you just use your guruship to, like, bring them along. So I like that a lot. And that's the Cleveland Clinic model. There's a nurse practitioner that I met called Swathi Rao who does it the other way, where everyone comes in through the individual appointment. You know, that's the funnel. And then she uses the groups to just maintain healthy behaviors after they've gone through their initial funnel. So she's doing it the other way around. So she's just like, okay, now they're in this group, and then we're just going to use the group to maintain the healthy behaviors of after we've done the individualized reversal. And that might be something to do when you have a community of very sick people, but I doubt whether your community is any sicker than the people who are going to the Cleveland Clinic center for Functional Medicine. Those people are super sick. In some cases, they say they've taken people from whatever number of states who flies to another state to go and see care, Someone who's been to every doctor, probably even the functional doctors, and is not better. So, you know, so I like that as well. There are examples of people just using, you know, groups, not for that, but just for efficiency of delivering the things that suck about functional medicine. So my favorite example of this, and I talk about it in the book, comes from Lara Salier who's like the, you know, the most inventive and creative person in our practice accelerator and it's just a total baller.

She's awesome.

Yeah. So she is doing her practice in Wisconsin. 90 minute initial appointment. She's fee for service, 90 minute initial appointment, 300 bucks an hour. That's a $450 barrier for anyone in her community to see her. Right. Which is fine. And she's making a good living and it's good. But she's just like, I want to introduce more people to the functional medicine operating system. I want more people to know about the this. So she looks around and looks at her resources like, okay, I could probably fit 18 people in my reception. So I'm going to do an event twice a month. It's going to be $30 cash. And in that 90 minutes, I'm going to have 18 people. So that's $540 for 90 minutes. So that's, you know, about the same as you would be making anyway, a bit more. And I'm going to lead 18 people through their whole intake process. The timeline, the matrix, the antecedents, triggers and mediators, the five bottom lifestyle things. People are going to ask questions, there's going to be peer to peer delivery of value. It's a one off thing. But now for $30, people understand why functional medicine is awesome. Because if you go through that process, it's pretty damn clear that like, oh, one of the big things. So there's a concept called salutogenesis, which is what we're all doing. And I talk about it in the book. One of the biggest things about salutogenesis, one of the foundations is knowing where your disease came from. And one of the biggest frustrations that practitioners, patients have is it's like, oh, how did, how the hell did I get lupus? Like, how did that happen? What happened for me to end up having lupus? And everyone's like, oh no, you know, take your humira, you know, and then, and then they're like so frustrated by that process. Well, guess what? You go back through the timeline and you realize you had 18 rounds of antibiotics before you're 2 years old. I'm sorry, but lupus was coming your way. With that kind of environment, you did it like your parents did it to you. Right? I mean, let's just be real about what happened. They destroyed your microbiome. You never caught up. You were sick your whole childhood and now you suddenly have lupus. Hang on one second, I just got to pause. Talk amongst yourself. I'll Be back in one sec.

So a couple things that he was talking about is there's different ways to do this, right? So you can have a one on one and then refer people to a group type of model. Maybe that's where you get a better sense of their history, build a rapport with them, run some labs on them. And then the other model is you start people off in a group. And that might work really well for like a.

Guys, I gotta take five minutes and I'll be back.

Sure, we got you. And then you have a Cleveland Clinic type of model, or maybe some of you that have a bigger waiting list or more established practice where people are waiting for something like this, you know, they're waiting for a more affordable solution from unit. And I know that that's one of our objectives, right, is to be able to help more people, to be able to leverage our community, to be able to make our care accessible and affordable to people, but then to also make it so that our time is something that is being honored as well, and our energy. Because let's face it, if you were to see 18 people like Lara's doing, if you were to see 18 people with autoimmune disease, I mean, that's like two to three days worth of work that she can do in an hour, right? So think about how much time that she's bought back for herself. And you might wonder, well, if she were to see those 18 people one on one for an hour, you know, that's $5,400, let's say if she's charging $300 versus the 540 if she's charging $30. But guess what? There's no shortage of people that are just like them that they can perhaps bring or that they can refer. And so the impact of your practice can be so much bigger. And of course, you can still seize some of those people one on one in conjunction with the group. So there's a lot of different ways that we could skin this cat. And you've got to figure out what works for you. And as James is saying, like this is at the bleed, right? So having a zoom based group, you know, that's yet to be proven. So we're gonna, we're gonna go out there and see what we find and see what we discover. And so there's no single best practice just yet because none of us own a hospital. None of us might have, you know, a pa, A, you know, a nurse, a nurse practitioner, and also a dietitian or a nutritionist or health coach. At our fingertips, some of us might like. You know, I know Brad's got a pretty solid team, so this guy, he could easily implement this right away. Some of you may not have that team if you're kind of a solo or two man show. So, you know, figure out what works for you, what direction you want to go in. But the other thing, too, is that you could bring those people on. You know, it's so much easier at this point, at least from what I'm finding, to bring on a health coach, you know, to handle that side of the equation than it is to hire another practitioner. So practitioners are not. I'm not saying that a coach is a dime a dozen, but there's a lot of coaches that are looking to pair up and partner with healthcare providers, and that's probably a bigger majority of the people versus people who are looking to start their own practice. You might even have an easier time scaling your team if you bring in people like health coaches and nutritionists and people like that who are, you know, very hungry to be involved in, you know, in a practice like yours. All right, we got James back.

All right, I'm back. It's happening.

All right.

So, yeah, so there's all these different ways to do it. So I love that Lara Sallia strategy, because now for $30, everyone has an intake into functional medicine. Guess what? Some of those people will be like, this makes total sense to me. I want to be a patient. And so then they sign up and they move up the tree in that way. And so, you know, so that's really valuable. Another doctor that I met, Dr. Christopher Mote, he does all of his lab review in a group. So he's like, lab review is the most cumbersome part of doing the functional medicine. So it's like he's seeing whatever, 70 patients in a week. 10 of those people or 12 or whatever are getting a GI MAP school stool test. And so, you know, the next step for you. And this is like, when we're talking about recruiting people into groups, what I hear more and more is like, the next step here is a group visit. It's not like, oh, you might want to come to my group and see if you like it, and whatever. It's like, no, this is the way. This is the next step. So that's, you know, these are ways that, like, the cumbersome parts of functional medicine are being. Are being, you know, solved by the group model, the behavior change, the groups, the intake. You know, these are, you know, these are ways that it's that it's going down.

James, can I ask you a question? Not to interrupt your thought, but I know it's coming up for me, might be coming up for other people is what's the HIPAA workaround for this?

So, you know, you definitely need a, you definitely need a, you know, people to sign, sign the fact that they're joining a group. So, you know, one of the. So what Shilpa created was a thing called the Group Visit Toolkit, which is distributed by the Lifestyle Matrix Resource Center. And that is you can find that if you just Google Group Visit toolkits. In those toolkits, they have five different niches. So there's like pain, there's cardio, metabolic, there's gut, there's stress. And in each of those toolkits you get content to deliver. So like slides that you can talk through or just a video that you can put on.

Right.

With Shilpa narrating the slides, basically. And then there's soap notes, there's sign offs, there's all that kind of stuff. Yeah, you're gonna have to sign up. But look, here's the thing. It doesn't really, you know, if you guys remember the first book that I wrote, I think probably a lot of you read it, the structure is this like the Hero's Journey, right? And the reason why we make the structure of the Hero's Journey is really that you're able to deal with people. Like in the first book it was like, let's deal with the, you know, what are the main reasons why people don't want to do functional medicine? And let's deal with that as the challenges and doubts that come along as part of the Hero's Journey. So it's a. Of basically selling people over the process on this by dealing with those kind of things. So, you know, chapter two, the doubts. First doubt we're going to talk about is privacy, because it's the first thing that always comes up. Well, the truth is privacy is synonymous with isolation. We're way, you know, we got too much privacy. And by the way, all of us are giving away our privacy to Mark Zuckerberg only to be like paid on, only to be like sold stuff. And we're worried about telling other people in the room who can actually help us reverse our chronic illness being real with them. Like, you're probably, if anyone who's on any kind of technology and is worried about privacy, you're just not thinking straight because you've. That horse has sailed. That ship has sailed. If you use Gmail, that ship has sailed. If you use Facebook, that ship has sailed. Some random stranger on the other side of the world knows more about you than anyone and is selling you stuff on the back of it and you don't want to tell the guy next to you has the same disease as you about the struggles that you're having. No way. Bullshit. Right? It's bullshit. And we got to get over it and we got to start really realizing that if we want to be the root cause doctor, you got to get to the root cause. And the root cause is a lot of times loneliness. And loneliness shows up as you know, as you know, you can see all the data. But immune response and depression and all these kind of things, that's the key there. So that's kind of where we are with that. So, yeah, you're going to need to have a, you're going to need to set it up in the right way. But ultimately, you know, that's a problem you solve once and then it's just good forever. Right?

All right, cool. Thank you for answering that. So you mentioned you were going to go on and you were going to talk about the different tools that are available to us. So we've got the toolkit that's available.

So yeah, there's different things. So off the back of the book when you register, you could go to the community right now, you can put in your email and I'll talk more about that at the end. But yeah, so these are the things, these are the options. So there's a 55 page free ebook made by Hennepin Healthcare out of Mississippi. I mean Minnesota, the Kara Parker Made, which is a great handbook, we'll be giving that away for free to anyone who reads the book. Then you basically like start going up the price range. So for 300 bucks or something around there, you could buy a group visit toolkit, you know, for 500 bucks or you know, whatever, you can go to Dr. Jeff Geller's, one of his trainings for like a thousand, for a couple thousand bucks in January you could go to the Cleveland Clinic center for Functional Medicine and learn the, you know, this is starting in January, so we're like crossing the time. Like for the first time, you could go and learn at the Cleveland Clinic. You can go there. If anyone's interested. I can make an intro to you, to Tawny, who's the person running it, but you can go there and you can learn the whole system and you can go and meet the practitioners and it's like a three day training. They're starting that in January. And then for $25,000 or $30,000, if you run a hospital, you can bring the whole Cleveland Clinic to your thing and train everyone, like a thousand people at a time, or not a thousand, but let's say dozens of practitioners at the same time. So you've got all of those different options. So depending on how much you want to spend, how interested you really are in it, like you've got options to be able to do it. I think it makes sense to just, with medicine, go as far as you can with the least. And so I think the group visit toolkits are a great starting point because you're going to get all of the stuff that you need. But the truth is actually, like, just think about at the beginning of the functional medicine movement, they probably thought they had it all worked out. And look 30 years later where we are, where, like, look at all the innovation that's happened. Like, you've brought innovation into the space and you only started doing it 10 years ago or eight years ago or six years ago. Right. There's going to be a lot of innovation that's going to happen over the next years as people start to develop it. I think there are some good models, but I think there's innovation in clinical, there's innovation in technology, there's innovation in very specific things. So I'll give you an example. Let me give you an example of someone who I've been in real agreement with, whose practice has transformed in exactly the way that I've transformed. So Kelly Brogan, you guys know her, right? So Kelly's doing the hardest thing to do in medicine, get people off psych meds. Right. If you've ever tried it, you know, it's not that easy. It's hard. So when I first meet Kelly, she's practicing in New York. $4,000 to see her for her package because she's demand is way higher than the supply. And her massive brain has come up with this incredible protocol to get people off psych meds. And isn't she smart? Yes, she is. She's amazing. And her patients love her and whatever, but she's kind of like, this is cool, but, you know, it's quite taxing on me. These people are, you know, quite needy, and I'm not really, like, I'm looking for ways to help more people. So she writes a book, right? So she writes a book, and it's called Mind of your Own. And if you've been watching, if you, if you're a devotee, of the, the functional forum, you will remember. And Sachin, you were there in person at Powder Mountain where I interviewed about her experience. And so she created basically an online course that taught her protocol, right? So it's the protocol. And then just as sort of an afterthought with the course, she's like, well, maybe I'll just do a Facebook group. And people are taking the course, can like meet each other. It's almost like an afterthought for her. And then the course launches. Everyone's in this Facebook group and she's like, oh, no one who's tried to taper off medication, you know, psych medication, has ever met anyone else who's trying to taper off psyched medication. And that might be more valuable than that. And guess what she starts to see is that she's getting better results with the thousand dollar program in that where people are buying it and having community than in her $4,000 a month practice. And she was going through and continues to go through some big personal growth work because, you know, if you've been celebrated your whole life for having all the answers to realize that maybe you're not as important as you think can be quite arresting, right? And all of us, that's why we have to be humble to this process, because she started to recognize this is what you want to write down. Nothing sends a signal of safety to your patients quicker and more efficiently than community. No breathing, no supplements, no guru. It's community that's the safety to know that other people are going through the same thing as them. Otherwise they think they're unique because they're the only person in their friend group that's got lupus, right? And so they're just like the weird person who got lupus. Oh, woe is me. Whatever. Now you're in a room of 10 people who all have an autoimmune disease and you're like, hey, you know, there's a lot of people this is happening to. And look, I'll give you another example. Terry Wahls. So, you know, amazing. We all love Terry Wahls. So to get this, if this doesn't ran this home in the most clear way, I don't know, whatever will. Terry Walls has the same problem as the Cleveland Clinic. Everyone wants to see her. She can't keep up, so she starts doing groups. She told me this in a practice accelerator thing in 2017, and it just led me in this path. And it was, who's more inspiring to someone that's reversed Ms. Than Terry Balls? She reversed her Ms. Kelly Brogan didn't reverse her like psych med addiction. She just had Hashimoto's and realized motor psychiatry is bullshit. Right? Terry Walls reversed her own Ms. And yet when Terry Walls runs these groups, the people who have made incremental progress through the groups are more credible and more inspirational than Terry fucking Walls. Right? Think about that. Your story is not as inspirational as you think. And if you're walking the talk, I said this in my email last week. If you're walking the talk, which we should all be, and we've talked about walking the talk, and Satchin, you walk the talk and like, you know, it's a big part of it if you walk the talk too well. And patients cannot think that someone like you can ever have suffered like they're suffering right now. You are not relevant. You never had this issue. You look healthy as fuck, right? And so like, you don't know what it's like to have lupus, you know, whatever, you know what I mean? Like, that is powerful. And we're not delivering any of that in one on one functional medicine. And nothing sends the signal of safety quicker than that clinically. Right. They can't identify with you because you're too healthy looking. We have to introduce people to each other who look like them. And you know, if there's a list of, you know, it's also like, don't get all the worst cases in one group. Try and get a few people who have had success and they can pop in and be like, yeah, I'm doing great. I did all the stuff Satchin told me to do and I'm getting better. I know how you use those things in your, in your like onboarding sessions. So, yeah, so that's a big part of this, man. This is the missing piece. And this is like the thing that I'm gonna like swear from stage until people listen because this is a really, really, really important part of the future of chronic disease reversal and delivery. Making it more efficient, making it more affordable, whatever, you know, and then, you know, one thing, so one thing I wanted to say as well. So Jeff Geller, after I did the interview with Jeff Geller, you should go all go and listen to that. That was when I decided I had to do the book because the interview was amazing. He is amazing. And what he learned. And here's another mic drop moment, is that, yes, look at the Cleveland Clinic, the Cleveland Clinic thing, there's a curriculum and everyone learns the curriculum, whatever. Jeff Geller is like, screw your curriculum. Let the people come up with their curriculum, right? Ask the people what they want to do, and then they do it and they love it. This is a guy who's run groups where the groups have gone on for 20 years, right?

Just.

You want to find the interview, go just Google Jeff Geller Functional Forum or Jeff Geller Evolution of Medicine. There's a whole podcast series that I did. I did the woman with the Cleveland Clinic, Tawny Jones, Jeff Geller, whatever. Like, he's like, you know, first of all, he's like, yeah, I realized straight away, I'm working with undocumented poor people at a federally qualified health center. I have no idea what it's like to be, you know, systemically racially abused or to be. I don't even live in the same zip code as these people that I'm serving. I have no idea what it's like. Access to food. Oh, yeah, Eat organic, Buy this, buy that. We're all super guilty of that, right? Where like, yes, for the population that we're working with, the richest 20% of the community, you can get them doing that. But like coming in and preaching as to what people need to do who aren't even solving the basic social determinants of health. So arrogant and is. You know, when you start working with poor people, you're going to have to realize that you don't know everything. And honestly, if you listen back to an interview I did with Shilpa two weeks ago, it was on some other topic, but at the end we got real. And she's had to go through her own personal growth work because she realizes that she's been valued forever as having all the answers. And having all the answers wasn't having people get well. And it just depends on whether you're ready to go there. And it's fine if you're not. Look, the demand for single one on one functional medicine is not going away. It's only growing. You could do that forever. It's the future of medicine anyway. There's not going to be a running out of sick people, no matter how efficient you run your practice. So you decide what you want to do. But if you want to be involved in scaling this out to the masses, then let's have a real conversation about what that's going to take. And, you know, I can, you know, I can say that. So Geller, you know, in the book, you'll see there's all kinds of ways to do it. But Geller's thesis on what he calls his empowerment model is that if you really want to empower people. Let them come up with the plan, right? And what starts as a type 2 diabetes group. He's like, you never, you'll never feel alone in this group. But that's basically what you're delivering, right? No one's coming to a loneliness group. Marketing is important right from the beginning. But he's had groups that started as a type 2 diabetes group. Guess what? In three years, they've all reversed their diabetes, right? They're healthy, they've got the community. They don't need that anymore, but they want to keep meeting. So what does it turn into? A gardening group or a. Even better. This is a secret. If you really want to gel people together, and this actually is a great Charles Eisenstein quote, is that co consumption doesn't create community, it's co creativity that creates community. So getting people to do projects together and do things is really an incredible way of gelling the community. And my hopes for like the functional medicine meetup groups, right, that we started around the functional forum around the country, we're going to make a real effort to re engage those in 2020, because you'll see in a minute how everyone in those, everyone who comes to those communities is going to be necessary as we take over medicine.

Right?

They're all going to be necessary. And the only way that we could do it efficiently is, is to know each other ahead of time. And I'm going to finish on a story that I'm not going to tell now, but I want to talk about what are the implications to society of this transformation? But I'm going to, I want to show some diagrams from.

Sure, let's do it.

All right, so the first diagram I'm going to show you is the biopsychosocial model for care. Right? So biopsychosocial is a concept that came up in the 1970s and has been kind of like stolen by allopathy, honestly. But ultimately what it shows is that, you know, people have biological, psychological and social environmental issues, why they get sick. And ultimately, if we're only teaching the going with the biological, we're going to miss this big area. And the reason why functional medicine is the operating system of the future is because the intake is biopsychosocial. And the reason why group visits is the delivery system of the future is because the delivery system is biopsychosocial.

Right?

It's, you know, there's, you know, it's obvious in many ways that, you know, if these root causes that there are biological, social, environmental and psychological issues, you know, give you an example, your loneliness leads to triggering of an underlying biological mechanism like genetics. And the end result is depression. So social, environmental trigger, biological mechanism, psychological end result, right? That's like a vicious cycle on the other side. Enter a community, you know, epigenetics kicks in, turns off the genetic thing and you're better. Right? It works as a virtuous cycle or a vicious cycle, depending on which way you're going with it. So the biopsychosocial model is everyone's realizing like what diseases aren't biopsychosocial, right. It's clear that they most are, especially all the chronic ones, especially all the lifestyle driven chronic ones. So we have to understand that we're delivering care in the biopsychosocial concept. Does that make sense to everyone? All right, the next diagram I'm going to share is if we're building a rational system for the future of health. And basically in chapter eight, which is the conclusion, this is basically like the Maskell thesis for healthcare transformation. And the Maskell thesis for healthcare transformation is built on a concept from naturopathic medicine called the naturopathic therapeutic order. And the naturopathic therapeutic order just postulates, and this could make sense to you as a clinician, it should make sense to you as a human. And it makes sense to me as an economist, which is basically that you start with the least costly, least invasive interventions first and work your way up. So the bottom we have the social determinants of health. If the person doesn't have a car, they can't. Like here's another mic drop thing from my book for people who are disempowered, right? Individualized medicine is a fairy tale. It's a fairy tale. Individualized medicine is the future of medicine. But if you don't have a car, you can't get to the appointment. Like Jeff Geller talks to empowerment as being able to try new things. When you're working in clinic and you're asking people to try new things like diets or whatever, if they're disempowered, there's no way they're doing it. Right. There's no way they are able to participate in a personalized medicine structure. Right? So we have to solve the social determinants of health. Right. The next, and that's very cheap to do, the next thing is to stimulate the self healing mechanism, right. The third thing is to support and restore weakened systems. That's basically like functional medicine, nutrition, address, proper physical alignment, chiropractic physical therapy, whatever natural symptom, control, green Medicine, green allopathy.

Right.

Using stuff to put out fires. Right. If you still haven't, it's like you use the least costly, least invasive intervention and work your way up.

Up.

Synthetic drugs is sixth. And then at the top, high force interventions like autoimmune biologicals or chemo or surgery. We're living in a world where health care costs way too much, where harm is way too high. The level of harm that we're delivering, I can't see how you can argue with this personally. Right. This is, I think, the greatest gift that naturopathic medicine has given us. So the question that we have to ask ourselves is what does that look like in terms of delivery? And this is again, you'll read this at the end of the book. This is Maskell's therapeutic Order. I'm not going to call it that because the naturopaths will kill me. But we need empowerment groups at the bottom. Jeff Geller's empowerment groups solve the social determinants of health. That's it. Modality groups. Next. Right. You will read in the book about Jim Gordon reversing 80% of PTSD by doing mindfulness based stress reduction groups in Puerto Rico and Kosovo and, you know, the worst. And Gaza. Right. You want to know what it's like to live in Gaza.

Right.

Jim Gordon went there and trains peers in mindfulness based stress reduction group. An 80% reduction in PTSD, 80% full reversal. That's better than MDMA.

Right?

So modality groups. So what groups could you do in a modality? What modalities can you do at a group? Suddenly acupuncture is not unaffordable.

Right?

10 people getting an acupuncturist. Acupuncturist, 100 bucks an hour, 10 bucks each. And we can all have ear acupuncture while we talk. And they just go one. Sachin, you probably know like you've seen. Like when I was having my n equals 1000 experience, I saw group community acupuncture, but they were all in individual rooms. The person just went round and did it. But they were all in their own room. What if you put them all in the same room? The point in the head is good. The ear points are good. You could do. There's enough points that you can do on the head and the ears so that people could maintain a conversation and get value that way. Why wouldn't you do it like that? Right. The acupuncture is still getting paid 10 times. Many people are getting served and there's value from the Peer to peer delivery. So modality groups, mindfulness based reduction. Look at qigong, right? Qigong always delivered in a group. If we're going to, we're turning on the self healing mechanisms, that's the modality groups. Then nutrition groups is functional medicine groups, right? That's where we're really starting to help restore weakened systems through that. So three different groups, these are the layers. How these bottom three layers should only be delivered in groups because it's super efficient and cost effective and everyone has access to it.

It.

And guess what, it's the same group, right? If you're doing the group in your 10 week methodology, you're doing nutrition, you're doing modality and you're doing empowerment. Those three things are all happening. So you're solving the bottom three levels of the social, of the naturopathic therapeutic order with the same group, right? That's unbelievably efficient. So now guess what? If you just want to do functional medicine one on one, no problem. You can see where it is in the triangle, right? It's just a bit further up, right? Integrated therapies. You want to do chiropractic. It's right there. It's right there. It's in the plan. Think about what happens when everyone in society gets those bottom five levels. You think the amount of people that need the top two levels is going to go down drastically? You think that's not the actual personification of Sachin's vision, right? This is it. This is everything. The only thing that I don't like about the naturopathic therapy, naturopathic therapeutic order. The only thing, there's only one thing that I don't like about it. Can you guess what it is? Let's have a guess. Anyone? We're done with the era of the pyramid. Ladies and gentlemen, the pyramid is over, right? That is control from the top. The food pyramid died. They brought the plate. The plate was alright. Dairy is not a certified drink, but you know what I mean? Like the plate is better than the pyramid because we eat on a plate. You know, this is the future is the circle. And so this is what I shared. And this is basically, this is the community cure. This is James Maskell's ip. This is what I'm here to deliver. Think about the same concept as a therapeutic order. We want to use the least costly, least invasive intervention first and work your way up. So on the outside we've got to create a culture for health. Sachin, do you remember me talking about this? Like it was slightly different but when you talked in Minneapolis back in 2017.

I do remember, yeah.

So I just come back from Australia, I sat in a group, I sat in a clinic in Australia where they had 15 practitioners who had a monthly BT and this is slightly adapted from that. But basically culture and you are affecting culture in your clinic right now. It's way easier to affect the culture on a micro level than on a macro level. But you need to use all methods to change the culture. And that's the content that you put out, it's the social media that you do like that is free, a point of delivery and it's just sucking people into your ecosystem.

Right.

So that's changing the culture. What is the culture of this organization? And this five part thing could be how the NHS transforms, it could be how you deliver thing in your practice. It could be different pieces here. The next step is community. So that's group visits, that's groups getting together. It could be group visits inside the medical system, could be groups outside. The next level is coaching. Right now it's kind of one on one. Sometimes coaching can be done in groups. I'm part of a men's group and there's some coaching going on in there outside of the medical system, just coaching. It's like, you know, specific things that you need to work with and you're being coached by a group or a person. Those are the first three layers, right? Those are the first three layers. Then we have care. And care could be functional, medicine could be chiropractic, could be primary care, could be, you know, levels level six, I guess, in the therapeutic order. And then cost sharing is in the middle. And the reason I started New Health was to do an experiment which is a million Americans use Christian based health cost sharing structures in America today. Could you recreate a cost sharing community built around solutogenesis, right, where that is the religion? And I think on that end it works like we got people who are resonating with it and are signing up and that's it. But the cost sharing is there to pay for the things that just happen to you that you can't deal with. Like you hit by a car, you're in an accident, you crash into a tree skiing, you get a mystery cancer diagnosis. Like those things happen, they're going to happen to a percentage of the population. Hopefully they're going to happen to a few percentage of the population if we get better at doing everything else. But we need to have some sort of structure of paying for those mishaps. And cost sharing is what I think it should be because it's an evolution of health insurance where people take community responsibility for the funds. Do you remember that in When Tom talked about that in Guernsey, Sachin? It was like community responsibility for the funds. Super, super important part of that. So with this model, the most easy and obvious place for us to build the solution to loneliness, solving social isolation is in the medical system, you guys, the medical system, whatever. One, because lonely, sick, isolated people end up in the medical system. That's where they're going anyway. Two, there's already budget assigned for it, right? Medicare, Medicaid, whatever. Like there's budget assigned for the creation, the delivery of care. So you might as well let's create some groups. But the potential of healthcare transformation. I said this on Hyman's podcast that came out yesterday. If you haven't watched that, go and check it out. It was on the doctor's pharmacy yesterday. The potential of health care transformation or the potential of health creation, how we create health at scale to solve this problem happens outside of the healthcare system. It's just communities getting together together, right? We can't wait till everyone's sick and lonely and deaf and dying to solve this problem. We need to get out ahead of it. And let me give you an example of that. So Dean Ornish, right? I speak about him in the book. How's Dean Ornish got the results from his program? It's in a group. Clearly it's in a group, right? And you may not, you know, who cares about the diet? It's in a group and it works in a group, right? So, you know, you can disagree or agree, but it's in a group, and that's how it gets the results. But how do you get the Ornish protocol? Six practitioners have to get trained. People have to get a cardiology diagnosis in order to be able to be paid. It took him 26 years to get it to a point where people could, you know, could be paid for by Medicare. And it's amazing, don't get me wrong, it's amazing, but it hasn't scaled. It's hard to learn how to do it. You have to get six practitioners trained. You have to be a cardiology practice to do it, because you have to have enough people with cardiology diagnosis to get in to get paid, right?

So.

And it costs the insurance companies $9,000 and the practitioner can pocket that. And if you're a cardiologist, it's a pretty good idea. Let me tell you about Joel Kahn. So Joel Kahn is an Ornish devotee. He's a cardiologist in Detroit, Joel Kahn, and one of his patients, a guy who reverses his heart disease with Joel Kahn realizes there's a lot of lonely dudes in Detroit who are struggling with, you know, implementing these healthy behaviors. He starts to think of the plant based nutrition support group very quickly. They have 7,000 members. No one pays to be a part of it. They have these regular get togethers, you know, small groups, whatever. Look at the Daniel plan. It's delivered by a church. It's not delivered by the healthcare system. Health creation is disintermediated from the disease care system that has no idea what they're doing. Right? You guys are the turned on ones who realize that health creation is the solution to chronic illness. But yet we have to unleash that power, unleash that transformational potential. And the thing that makes this an exponential movement is that people, you know, some of the most exciting examples that I've seen are where. The journey from. Do a health person getting healthy to their next generation teacher is short. And I've seen it. I've seen people who after the 10 weeks or 16 weeks open source wellness that I went down and started saw in Berkeley, California, basically like this homeless guy, after 16 weeks trusts people again for the first time, has a supportive community. His life is transformed. And at the end of 16 weeks, what does he want to do? He wants to help other homeless people have the same experience. That's the basis for an exponential transformation healthcare. But it takes the group and that's what I wish for. And I want to give you one last example. And I'm interviewing these guys next week. I should have put it in the book, but whatever, I'm going to talk about it now and I'm going to tell you about it. But look up this place called Froome in Somerset in England. So I talked about this on the Functional Forum. Two years ago, Froome decided that they were going to use community as a solution to their healthcare issues. They develop all kinds of community. They do an inventory of all the communities that already exist in the whole town. They, you know, they basically save a ridiculous amount of money on emergency, you know, all like admissions to hospitals or whatever. Because they use community as the solution. No surprise with what I've just said. Spent the last hour and whatever, 20 minutes talking about, look what happened with Froome in the last election. You could Google it. It's called flat pack democracy where the implications of Froome building community meant that the people in the community were so Empowered. They decided, I'm done with politics as usual. They took over all of the local seats by a new political party that they started and they started advocating for Froom. That's amazing. And ultimately, like this is the potential. And I guess the last thing that I want to say before we take questions is this. I know some of you are Canadian, I know some of you are English and by the way, I'm giving a talk on 2 December in England. I know, I think I saw someone who's from England in Birmingham. It's called the Community Cure for the nhs. And it's basically going to be pretty much what I did here, except we're going to super focus on the NHS in America. Let's look at what 2020 is going to bring us, right? This is the, you know, the shift, actually. I'm going to put myself on full again, get rid of this thing.

Okay?

2020 is an important year in our community. It's an important year for the planet. It. Okay, look at the solution, look at the options that we're being given to solve health care in America in 2020, right? You've got the government based system, Bernie, Medicare for all. Government is the solution, right. On the other hand, you've got Trump solution, which is markets. And honestly, some of that resonates, right? Direct primary care, cost sharing, like a lot of the stuff that the Republicans are coming up with advocate, you know, puts us on an even playing field where we can compete, which is interesting. I'm not letting it like I'm putting my book to Bernie's people. I'm putting my book to Marianne Williamson's people. Like I'm playing all sides on this one. But on that side it's interesting too. So it's like, will the market solve the problem or will government solve the problem? That's the choice in front of you. Well, what is the truth? The truth is it's not either of those. The truth is, and this is the best book that I read in the last year, it's heavy, it's like 19 hour audiobook. So you probably, you might not want to go there because it's not really about medicine. But it's called the Third Pillar and it's by Rajasthan Rajan and he was the chief economist at the imf. And he talks about the fact the only reason why we see that these two solutions exist is because over the last 400 years, but particularly the last 10 years with technology. And when I say technology, the automobile meant that we could all live in suburbs and led to the death of the town, right? And so now you didn't know your shopkeeper, you don't know who works at Walmart, you don't know who's packing this chicken right where you're buying it. And now even five years later, everything's been delivered from Amazon on. So we're helplessly independent to the people that live around us. But we're, you know, we're self sufficient to our neighbor. We don't need to know the neighbor, but we're like, we're, you know, we're reliant on these people in China to make the phone. Right? You know, so it's like, it's crazy. So the reason why these two things exist is because of the death of the third pillar. And the third pillar is community. And ultimately, rather than looking, the only reason why markets and government is because people need to pay for the things that were delivered months by community. Grief counseling, babysitting, elder care, right? These are all things that we have to pay for now that used to be just delivered by the community. And we've done such a good job of monetizing and commodifying things that used to be part of community. But ultimately that's the next step. So you'll see all of that in the book. I set the context and I guess I just want to say one thing to finish off right, so last time with this book, the way that we did it is that for five days Amazon will let you have the book for free and we'll let you do the free Download. So for the 14th to the 18th of January, this book is going to be available for free on Amazon and we're going to do a huge ass affiliate deal where everyone can send their people there and you can get it for free and then you could buy the book or whatever. I can see the reason I designed this book is that you like it was hopeful. I think in the first book that I wanted doctors to read this. The goal with the first book is if a doctor read it at the end of it, would they want to do functional medicine? The goal with the next book is like will we do functional medicine? Group visits. So this next book is a great resource for every one of you people here to be able to give to health systems and people decision makers in your town because suddenly you're gonna look like the hero because you're the one who worked out functional medicine when it wasn't cool, but it was just like a sort of a heart thing that you had to do. You felt A moral compulsion to do it even before you knew that you were gonna make money doing it or whatever. You just had to do it. And I think this book is gonna like, knock, knock the socks off. Two days before I had to like give in the final manuscript, that Cleveland Clinic Jam article came out. So I was like, okay, divine timing. That's in the second paragraph of the book. So, you know, so that's, this is a resource. So I want to, in January we're going to go at it. We're going to try and get this book in as many decision makers hands. And ultimately I can see that there's real financial advantage to you guys to be able to, you know, get your city decision makers in your community fired up about functional medicine. And I hope that you can help us to, to do that. So that's me. Thank you, Sachin. Thank you for the opportunity.

Well, James, that was amazing, brother. And your passion certainly comes through. I love the stories. There was the point when you, when you mentioned the third pillar, I got some major goosebumps. So this is definitely in alignment with my core values. I know the core values of everyone who's tuned, tuned into this call and everyone who's going to be listening to the podcast. So thank you, thank you, thank you, brother. What I would like to do now is, you know, maybe answer some questions that people do have. I'm going to turn off the podcast recording, but thank you once again, James. And then just so for the podcast listeners, where can they learn more about the book, the launch, like how can we.

Yeah, so you could go to the community cure.com right now and you can opt in there and we will keep you up to date with everything about the launch. A couple of other things. So in, in December, the week of December 9th, we're going to run a group visit challenge for our current community where we're going to have everyone, you know, we're going to do a five day challenge to have people start to run and plan a group visit for the first quarter of 2020. And that's going to be a learning experience for us. And we want everyone in the community to participate so that we can make the challenge even better. Because then in March, when we have this huge email list of new people who are interested in groups, we're going to run the challenge again and make it better. So December, the week of the 9th, we're going to run that five day challenge. And if you just get on my email list, if you register for a functional forum, if you get on the communitycure.com email list. We'll keep you up to date.

And.

And yeah, so we're going to run that the week of the night. So that's just really like this. You know, you've probably done it before with Sachin, but listening to 20 minutes of content and planning out maybe your first group visit for 2020 and in the December functional forum is on biotransformation and detox. Because the obvious group visits to do is like a detox group visit. Right? It's the group is the easiest thing to do. People have been doing it for years in our community and you know, it's a great way to get people into the community. So yeah, the community cure.com if you are a practitioner, you can join us on that. And yeah, I'm really inspired by the power of the community that you built in your community. I'm on the Facebook group with you guys. I see what it means to you guys to be involved in that group together. And look, the power of our community to do something about it. Your ability as the living proof community to really take this and run with it and be a beacon of light. The rest of functional medicine because you guys get it, is huge because you're organized and you're good at doing things like Sachin's turned you into doers. You're good at executing your executors and that's what we need.

Well, thank you. Sometimes I will be totally transparent. Sometimes it doesn't feel like I know what I'm doing because things are changing so fast and this has been an amazing and beautiful evolution and it's great to see that there's this ability now for us to reach the masses with a tool like group visits. And so we're promising to everyone that's listening to this and to you, James, that we're committed to making group visits the way we practice in the future. And we've already been doing online group programs so we've kind of got our toes wet and in 20002020 we're going to jump all in. So this is very timely in terms of the knowledge and the information that you're bringing to the table. We're fully in support of your launch and we'll be sure to share this with our list so that more people can have this awareness that there are different options. And hey, like James said, you can still do the one on one if you want, but you can also incorporate groups if you want or you can start incorporating the groups. I mean there's so many different ways that you can skin this functional medicine cat now. So it's pretty cool to see what's available to us. So thank you, James, once again. I appreciate you and appreciate everyone that's listening for tuning in. This is the future of healthcare and I love being in the throes of it. And there's never been a better time to be a functional medicine practitioner because really, really, truly, the best is yet to come. So thank you again, James.