How Group Programs are Transforming Medicine w/ James Maskell

Well, my friends, welcome, welcome, welcome. Today you are in for a treat. I have my dear friend, James Maskell. I think this is the third time James and I have interviewed each other for the Perfect Practice podcast. So he's a regular in our community and somebody who I would say has probably been one of the most influential people in my career as a functional medicine practitioner and practice coach. And I really want to say, James, thank you for all that you do. For all of us practitioners who are doing our best to try to make the world a better place, doing our best to make our practices a little bit more effective and a lot more efficient and just helping spread the word. You've been truly there from the very beginning, and it's been wonderful to see the contribution you've made to our profession. And I want to take a moment to honor you for that and also acknowledge you for your commitment to just really seeing this vision through. Because I know that as we'll talk about today, there's been ups, there's been downs, there's been ups, there's been downs. And you've just stayed really true to the message. And I'm so excited to have you back. And there's always so many nuggets that I know you're going to drop and share with us. I want to start with a recent trip of yours to England. I'm really fascinated about what you shared there, what you discovered there, and what the reception was like in terms of what you shared as well.

Yeah, look, it's been great to be with you, Satya, and I just would shout all that back to you as well. I feel like super aligned in what we're doing in the world. And, you know, I love all the wordsmithing you do online and I, I wish I had some of those skills or that. I wish that I prioritize that, but I'm. I think what you'll hear is like, yeah, it's really exciting news. So, you know, why did I come to America 15 years ago or 17 years ago to get involved in American health care when I've got an English accent? Right. I mean, I grew up in England, I went to school in university, I did health economics in England. The truth is, the English health care system does not prioritize innovation or did not prioritize innovation because it's just a single payer system. Right. And every doctor that, you know, that I went to school with, you know, that chose to be a doctor, they were sort of knowing that they would have a lifetime in the NHS, because back in 2005, there wasn't the kind of, like, innovation and, you know, different things going on that there is today. And so I was like, look, I want to understand, is chronic disease reversible? And the place that I'm going to go and find out is America, because the history of private practice means that doctors kind of do whatever they want. And so you've got a lot more weird stuff going on, right? And I wanted to learn all about it. And so that was. That was the beginning of my journey. So now to come back 17 years later, I always had in my head, like, one, I want to learn because in my health economics, I'd learned, right? Chronic disease is driving this massive upswing in costs in our lifetime. We're all screwed if it just keeps on going exponentially. So let's work it out, right? Let's first of all work out what drives chronic illness. Is it reversible? And then think about how can we reverse it at any sort of scale? And so, having been in America 17 years, learned a lot, you know, from all kinds of people. But also, you know, from doing the functional forum, we've done 101 episodes. So, you know, just being in all that content, plus all the practice management and other stuff that we've done. And now to come to a point where, you know, I feel like what I've created with your community is something that could actually solve the problem at the level that exists for the first time.

Right?

And I think part of why I've sort of shifted, I'm still involved in, like, helping doctors build successful practices, for sure. But I also just feel like there's, you know, there's huge swathes of the population that will always get their health care through healthcare entities where they use Medicare or Medicaid or, like, in Canada or England, where you have the system where a plan to just sort of, like, get all the doctors to leave and start their own functional medicine practices is not really viable. And in England would actually destroy something that I think is really valuable. Like the fact that in England, you know, you can, you know, like, my mom was taken such good care of. The fact that there is, like, a social contract where we take care of each other, that's really powerful for me, you know, I think that there's something powerful in that. And so I've always thought, okay, I wanted to go back with, you know, with a solution. And over the last few years, and we, we spent time together, we went to, you know, Guernsey that time together. And, you know, so I decided to go back because I was speaking, I was working, I was seeing a conference, I was speaking at a conference. And I also had the opportunity to record a podcast on Dr. Chatterjee's podcast. And you know, you know Rongen from our time together, but he's basically like the Joe Rogan of England now he has the biggest podcast, 1.6 million downloads each week. He's like very, very diligently built his audience over the last five years. He's like a total content machine. And I think people just resonate with the heart of the man. You know, you can listen to him and he's, he's humble and he's clear and he's lo loving and he's willing to talk about vulnerable things. So there's no surprise that he's such a big star in the uk.

Yeah, total stud. I love his energy, I love how he shows up for the world and takes courage to do what he's doing. So it's remarkable and it's interesting that, I mean, if there was a race in terms of innovation in healthcare, who would get the gold medal right now? What country do you think would get the gold medal?

Look, I think it's straight up innovation. I don't think it didn't have the most solid foundation, but I think America has got it going on just because there's so many people doing so many things right. You've just had a glut of funding for digital health, you've had a glut of people looking for an alternative. What else should I do with my time? Doctors taking all kinds of different roles in industry and so forth. So I think America has got it going on, obviously, starting from the most crime, chronically ill population on the planet too, right? So there's a lot of distance to go. But interestingly, like, it hasn't got better. It's not like chronic disease is reversing, it's getting worse every year. So like, whatever innovation is happening isn't reaching the scale that is necessary to like tip back the balance. There's green shoots, you know, there's exciting things that are happening. But still, you know, the push is towards more chronic disease, more isolation, more mental health issues, you know, more lifestyle driven chronic disease, more pollution, more glyphosate, you know, more deaths from, you know, deaths of despair, you know, so it's, it's not good. But like, at least there's a lot of interesting stuff happening because I kind of have my, have my finger on the pulse. So I guess the first thing that I Want to just chat about here and we're talking about group medicine. And, you know, that's, that's my passion and that's what I'm involved in right now, all day, every day, is I wanted to share an example that I saw from England. You know, I think a lot of times when we've talked about group programs, you know, within our clinics, it's been like, oh, that's cool. Like, yeah, I could add a little group program here and there, even though the main thrust of my work has to be like one on one care, because, like, that's what I do. And I'll do a little group program here and there to try it, but, like, you know, whatever. So I want to share the story, and I shared this at one of the presentations that I gave in England of This guy called Dr. David Unwin. And Dr. David Unwin, his wife is a psychologist. So he has, you know, sort of a competitive advantage in a certain way that he had her there a few years ago. Like in 2015, he recognized that type 2 diabetes was reversible with just very like simple dietary changes and the right support. So in 2016, Dr. Unwin, he was NHS Innovator of the Year in 2016. And he decided that he was going to start these type 2 diabetes groups in his practice. And I just want to show you this graph. This is for the BMJ earlier this year. So what this shows, on the left hand side you see sort of like when it started. So it started in 2016. On the left you have the sort of mean duration of how people are eating. In this modified low carb way, you see the number of type 2 diabetes. So on the right hand side you see the number of type 2 diabetic patients on his whole register, right? So in his whole practice, how many type 2 diabetes patients are there? In March 2017, there's 416. And then by now there's 536. So now he has rolled out this program. You have type 2 diabetes in, in his clinic, he recommends everyone to come into the group program. And you can see here that 224 out of the 536 are doing the group program. And you can see that now 52% of those, so over half have reversed their type 2 diabetes. Right? So this is what it looks like when you take one disease category. This guy's a gp, so he's seeing all kinds of stuff. He's not just a, he's not a endocrinologists, Right? This is one disease category, type 2 diabetes, one change of approach, and there's 117 people, or 22% of the whole Norwood practice, have reversed their type 2 diabetes. So what does that mean for the. For the clinic? Generally, it means that his spending on drugs for diabetes is basically less than half of everyone else. Look at this, like, may less than half of this and, like, way less than all of these. These are example practices that are similar to his. Now, what this doesn't capture is that everyone with type 2 diabetes probably has anxiety, depression, COPD, heart disease and all these other comorbidities. Right. And that there's probably all those drugs as well. This is literally just the cost of the diabetes drugs that he's able to send back to the nhs, because we don't need them anymore, but because these people have reversed their type 2 diabetes. So I just wanted to give this as an example to see, like, this isn't just some guy who's doing a few diabetic groups on the side for people who want it. This is the guy who's transformed the standard of care in his practice to group, and you can see the implications for that. And he reckons, based on this math, that if every medical practice in England uptook this strategy just for type 2 diabetes, it would save £270 million, right? So almost a quarter of a billion pounds. One disease category, one saving thing. It's not all the savings of, like, them not coming back for more appointments because they don't have it anymore, it's just the cost of the drugs. So I guess I just wanted to share, as a starting point, to say, like, this is what's possible, right, Where I think we're aiming a little bit too low now, we need to aim a little bit higher. And I respect Unwin for just taking it big and just being like, let's see what this looks like if we just extrapolate it through as much of the practice as possible. So what are your thoughts on that?

Well, the first thing that jumps out to me is the word Norwood, because that was the name of the first practice I worked at, Norwood Chiropractic. So immediately it brought me kind of full circle from a name standpoint. But I think that's amazing, right? And I know you and I are not shocked by that. I know people are probably listening to this, may not even be shocked by that, because we know what our bodies are capable of, we understand the power of functional medicine. But what we might be shocked at is how efficient it is to deliver services like this, because it doesn't have to be complicated. I think that at least I can say this. I can't speak for you, James, and maybe you could certainly add your perspective, but I feel like we've overcomplicated healing, especially as functional medicine practitioners. I don't think it gets any more complicated than working with a functional medicine practitioner through that classical lens of functional medicine. And it becomes very costly. It becomes very prohibitive in terms of even doing the lab testing and things like that. And it doesn't have to be that complicated. It can be actually really simple and elegant, which is what you've demonstrated here. So let me ask you this. Where do you think this process is stuck? Or, like, what do you think needs to happen? Because clearly, economically, it makes sense. Logically, it makes sense. I mean, who doesn't want to be healthier? But where do you feel like is the next breakthrough to really get this into more practices?

Yeah. So let me just. I guess let me just go back to Dr. Chatterjee, right? So, you know, Dr. Chatterjee reversed type 2 diabetes on his show Doctor in the House in 2015, and it went out to 5 million Britons, which is like 1 in 10 of the population, right? And that's how he sort of started his process of becoming this massive celebrity. And those changes stuck, and it was just like an amazing story. And it was, like, very hard to not realize, like, this is really valuable because it was happening right in front of them, you know, in front of your eyes. So, you know, I went onto his podcast and, you know, we. We talked about Unwin, and we talked about, you know, some of these examples, and I shared, like, there's a few things that get in the way. One is, obviously Unwin cares about this so much because it's kind of his thing, right? He made it, and his wife is a psychologist, and so they did the groups together. And because it's his thing, like, he's really heart bought into it. So he's going to do the emotional labor that's necessary to, like, dramatically change his workflows, overcome the little objections come up when you're trying to, like, change the way you practice. And most other people won't do that, right? Because they don't really care as much. You know, they. They don't care. You know, they don't. They don't have the same incentive to change. The other thing that I said on Rongen's podcast, I think in general, doctors are the wrong people to be running groups, right? Because what we've seen time and time again, if you look at the doctors that are amazing at groups, Jeff Geller, Shilpa Saxena, they've had to go through what I would sort of term as an ego death, right, to be able to do it effectively. Because if you're an expert, where you've been validated for your expertise for your whole life, right, the expert is actually not the right person to hold the groups because what you're not looking for is expertise. And their first entry level groups is all about the efficiency of delivery of information. But the real action is in people helping each other, right? That's where the, that's, that's the force that we have to like, activate to transform healthcare. And that can only happen in environments where there's trust and that trust, and the trust in the container can only be created where the person leading it doesn't always have the answers and lets the other people in the group tell the answers. So the trust in the container can develop. And coaches are very good at that, peers are very good at that, doctors are generally not good at that. So Rung and asked me in the podcast, like, what have you learned about running groups? And I was like, I don't think doctors should be running, running it. Now, that's not to say that there aren't some doctors that are be amazing at it. There obviously are. But if we're talking about systemic transformation, betting that enough doctors will go through enough ego death to make it all viable, and the doctors are so valuable, right? Their insight is so valuable in so many ways. Let's get this group of people that is incentivized, that does want to participate, that does want to be part of the solution, that is more of a peer and less of an expert. Let's get them involved if we want to try transform healthcare. So I think that's, that's a, that's a missing piece. And then obviously, you know, in the uk, you know, you just got to make it easy, man. Like, you just got to make it easy. You got to reduce the friction. And that's what we're learning in the US too is like everything that we've done to try and, you know, scale group medicine. It's like if every doctor has to work it all out on themselves, I mean, you create an incredible support ecosystem for that. But, like, it's going to be a long road. It's going to be a long run, right? And so ultimately what I'm excited to share is that I think we've got a nice through doing Rangan's podcast and some of the things that have just been like, I feel like the universe really has my back on this one in like the craziest way. So, you know, I think we're going to be able to run our Heal Community groups in the UK in a sort of the same way that we do in the us, which is really like a groups as a service. Right. And so what the whole point of Heal Community is is that we can attach ourselves as a sort of a bolt on to any existing healthcare infrastructure. So the NHS in the UK who are incentivized to cut costs, which is one of the things that groups can do if you run them in the right way, because there's nothing more cost effective than people helping each other. Or in the US where we bolt ourselves to allopathic practices, functional medicine practices, now hospitals, and even like ACOs and payers. Because in the, in the hospital world, the other thing about groups is that it can make money much more efficiently than one on one care too. Because in our model in America, you can build 20 people's insurance for the same provided spine. So, you know, groups have this like incredible dynamic, which they're both, they're better in fee for value and they're better in fee for service. The economics work out better in both situations. And so, you know, I think what we're seeing is just that when, when a group partners with us and says, okay, you run the groups and all we have to do is push people into the groups and like work out the finances, it just removes all of the really boring, really annoying, really basic objections that get in the way of scaling group care. And I'm sure you know what some of those are. We all know, because it's typically like, oh, the front desk person doesn't want to change the workflow, or this person doesn't want to do the outbound calls, or the charting's too hard, or the car park's not big enough, or all these ridiculous things which are like stopping this really transformational sort of delivery system for functional medicine, getting to the people that need it the most.

Yeah, I definitely agree. I mean, sometimes we're our own worst enemy. And if you can have somebody else come in and, you know, do some of that mentally heavy lifting for you, then it just makes the process so much more inviting. Another thing that you said just as you were speaking, that I wanted to draw attention to is you said insurance covers this. And most people may not know that, especially those who are interested in, who may have an existing insurance practice are interested in providing wellness based services, maybe functional medicine type of care, but are assuming that there's no way insurance will pay for this and I have to have people pay cash. So let's talk about that a little bit because I think there were some fairly recent changes that took place in insurance coverage that have enabled this opportunity so that people can still have their cake and eat it too, so to speak. They can still service their insurance clients and they can still offer functional medicine group based, lifestyle medicine group based care using their clients insurance. So they eliminates that objection of having to, you know, charge, you know, fee for service or you know, restructure their financial model in their business. Let's talk about that a little bit. And what are some of the rule changes that practitioners need to know about?

Yeah, so yeah, here in the US the law changed the biggest change in insurance law in 30 years, right the beginning of 2021. And there were lots of different changes that would affect a functional medicine provider. And look, I just want to caveat this by saying, look, I understand that insurance has given many people PTSD over years. I'm not necessarily advocating for functional medicine practices to take insurance. I think that there will always be demand for people who can reverse chronic illness. Right. And so I think that's it. But I also feel like, you know, this, this actually came up with a client of mine, a friend of mine who's a, who's a doctor. He's a, he's the best known functional medicine doctor in his, in his town and he's got all these allopathic friend doctors that send him like the serious, craziest, hardest cases, right? He's got this one group of four rheumatologists and they him these hard cases. But what happens when they come down because they don't know what he does. They're never going to go to ifm. They don't want to take the training. They just know that he can take care of it and he gets good results. They're not really that curious about it. And he was just like, can you guys not do any of this, right? Can you not just like at least get people eating a little bit differently? I mean these are rheumatology patients are still eating, you know, McDonald's. Like, can you not just do something in your practice? That means that when they come to my practice, maybe some of them won't need me. And if they do, we won't have to do all the like boring, heavy lifting of getting people to change their diet. So that was kind of like some of the Original part. But yeah, look, in 2021 a lot of things change. There was some. There was some changes to like how doctors could bill and how they could bill the core codes, the 992-122-1321-4215, which is sort of like the ongoing visit codes. And you know, there were some changes that would relate to actually getting paid for some of the work that you might do to support a patient that you previously hadn't got paid for, like looking through their charts and that kind of stuff. But the area where we found that was really interesting was this shift towards medical decision making as a way to determine what code to use. And in medical decision making forever, you could only bill a 99214 based on time and severity. You had to spend 30 to 40 minutes with a patient face to face to get the 99214, which is the average payment is about $120 to $130 across the country. Right. So that doesn't make for great economics. If you're 40 minutes a patient, that means you're making $200 an hour. If you're just seeing patients one on one for 99214. But under medical decision making, it's really focused on what decisions were made, particularly about medication and about the social determinants of health. And so what we've done is we've created in heal community, we're a bolt on where we bolt on to existing practices. And essentially the only thing that the practice has to do is everything that they do already, which is establish the patient, prescribe the group and bill the insurance. And we teach them how to do it. But then they have to provide one of their providers, normally a nurse practitioner or a PA to essentially sit in a zoom environment like this and to be in the breakout room while our coaches are like holding the container and take people in one by one during the break to, you know, during the session to fulfill the criteria for medical decision making. And ideally, like, we've got some really cool things happening with chronic pain. Ideally it's to deprescribe that patient, but you're seeing them regularly enough, you're actually seeing them every month for just a very short moment. The patient is having a fully biopsychosocial experience. Right. They're meeting other people, they're working on their breathing techniques, they're changing their diet, they're making these behavior changes and that's happening 24 7. But once a month, they check in with the practitioner for a short period of time where the Practitioner can adjust their medication and that whole system that I'm talking about makes money like four times as quickly than doing one on one care. So the most exciting thing happened this last weekend that I want to tell you about, Sachin, is that I went to an allopathic medicine conference, right? The food was ridiculous. I think if you guys were following me on social media you could see it was like, it was just, it was kind of like it was weird because I haven't been to, I haven't been to a conventional medicine conference ever, right? I've only been to the like functional medicine ones where now the like, the food's really good and everything's green and then, you know, they really take it seriously. So like being in a time warp, right? Going back to like Sprite and what, what do you want to Dr. Do you want Sprite, Coke or Diet Coke? Right. Those are the choices to drink.

Diet. Diet, right. Is that what the healthy people are saying?

I'm in that, I'm in that world. But guess what? These doctors are buying this, right? Doctors know that their patients aren't doing the healthy behaviors. They know that those not doing those healthy behaviors are sabotaging their health. What they don't know is that there's a way where they can add that onto their practice in a profitable way where they don't have to change their workflows and they can create health in a scalable, profitable way. And that's the game changer. And so, you know, right now we're, you know, working with allopathic doctors who get it big, big, bigger systems where there's like a small, you know, lifestyle medicine, integrative or functional medicine department that want to sort of scale their care. Functional medicine practices that take insurance, there's not that many of them, but to extend their care beyond those few providers to actually make it profitable. And I know that the topic of profit in health systems is not really that exciting and probably turns everyone off, but I have to say this. Look, the history of functional, integrative and lifestyle medicine is littered with examples where a functional, integrative or lifestyle medicine clinic starts inside a hospital normally because of some gift from a philanthropist and, or just the CEO thinks it's a good idea and it goes for a little bit until either it gets sold or there's a change in management. And they look at it and they say, whoever the new owners are, go, I don't know what's going on over here, but it doesn't make us any money. Let's get rid of it. That has happened so many times in the last decade. And so actually having a profitable lifestyle medicine, functional medicine department in allopathic medicine is really valuable because it means that that medicine will stand on its own two feet and will be able to grow and scale. And ultimately what that means is we're getting closer to this being the standard of care. We're further along the path. It's not just a niche thing that a few people, rebellious doctors do. This is just an obvious, obvious, obvious, much better way of treating chronic disease. And I know that everyone knows that, and I know that the people who follow you know that, and I know that all of us are probably wondering why the other people don't get it. And I think the biggest gap has been the operationalization of it. And I think that now we're coming with like, hey, we'll do it all for you, and it's going to be four times as profitable. It's like, hallelujah. I always wanted this. Thanks for sorting it out.

Yeah. I think that the resistance people probably have is not with the method, but it's more with the implementation. And you're taking that off of their plate and doing it for them. So with that being said, if somebody's listening to this, I know there's many people who are listening to this saying, okay, how do I. How do I do this? Like, what are, what would be the next steps and what would that process look like if you could paint out and describe a timeline of what it would look like for a practitioner to implement something like this into their practice?

Yeah, very, very simple, actually. And, you know, we're doing this all the time. We actually have. I have a guy on my team called Dr. Steven Sabatier, who's actually a physician. He's actually a naturopathic doctor, but he's, you know, he's helping doctors to really get into the details of implementing it. You know, the good news is, is that it's hard and that we've, you know, ever. We've been just doing. We're doing this for two and a bit years now. So every time we're getting more and more clear as to, you know, as to how it works. But actually, I can just show you. Let me just pull this up here. So, you know, ultimately you can go to healcommunity.com you can fill out the details just to give you an idea of what this looks like. So on the financial side, depending on, you know, you can make more money doing it, obviously, the more groups you can fill. But One of the things that I'm just blown away about is just the volume in allopathic medicine is ridiculous, right? How many patients are seen by a doctor every day? So like, you know, if you can start a new group of 20 patients every quarter, it annualizes into sort of this much profit per month. If you, if you could do it every, every other month. So you're starting six groups, it can turn into that. Let me just go back here. And then if you can start one every month, it grows a lot more quickly. And then obviously if you can get up to every week, you know, they can be much bigger. And some of the groups that we're talking to like have 200 primary care doctors or 200 pediatricians, or, you know, just huge systems. So like this, you know, this is sort of like the economics of it.

Well, James, just for a second, not to detract you from what you were saying, but for the people who are listening to this may not be able to see the slides. I just want to go review the numbers with them. So what James is showing is that every quarter, if you start a group of 20 patients, that's going to lead to a net income each month of profit rather of 2 to $3,000. If you start a new group every month, that's going to lead to a net profit or net income rather of 3,000 to 4,500. And if we go all the way up to starting one every week, that could lead to anywhere from 24,000 to $36,000 in new revenue per month, bottom line, to your practice. So it's the numbers add up pretty quickly. And especially for those of you that already have an existing patient base, the diamonds are already there. They're underneath your feet, so to speak. And the diamonds in the sense of not just the value to your practice, but the value that you can offer these individuals, the life changing care that you can give them, that's proven right. We know this works. Research shows it. You know, Cleveland Clinic released a study that found that group care was more effective than one on one care. So as an evidence based practitioner, it kind of behooves us not to be looking into this and figuring out what is the most frictionless way that we can implement this. And that's exactly what Heal Community does, is it creates a frictionless way for you to introduce an evidence based approach to helping people reverse chronic illness.

Absolutely. Let me just share the outcomes because these were our first outcomes that we ran into the beginning of 2021 to the middle of 2021 hot off the press. I haven't actually told anyone about this yet because we're going to announce it on the webinar that we do tomorrow. We're doing a chronic pain webinar, but actually we've now got the results that from our October, November groups that finished in like March, April. And it's, it's ridiculous. You know, it's, it's actually better than the Cleveland Clinic groups. It's not exactly apples to apples because theirs is a 10 week group and ours is a 24 week group and it measures health over 24 weeks in both cases. So like we're actually like in it the whole time with them. But you know, the results like very similar on these kind of areas. I think the pain is better in the new results and the sleep is better. But this time we actually also were tracking a global mental health score and a global physical health score. And it's pretty much like everyone who goes through those, everyone who goes through those groups get better. And how could that even possibly be? It's because if you, you know, in our model we essentially do one month, four weeks on each of these six pillars. So building community and foundations, Building trust in the community. Eat, nutrition and digestion, relax and de stress, movement and exercise, sleep and natural rhythms, relationship and environment. You know as well as I do Sachin, that if someone makes a permanent change, change in each one of those areas and they stack on top of each other, that's a different person in six months. You know it, you've seen it in your practice and you've done it too, and all supported in the different ways you asked about what it looks like. So typically, you know, if you, if you called up today and we were ready to go, you know, we would essentially, you know, in eight weeks we would have your first group running and that would be that. Like, you know, every, for the first few weeks there's a few details to take care of. So we've got to sign the, sign the contract and sort of set up the whole relationship. There's a billing and marketing meeting with your billing person and your marketing person to just say, hey, look, this is what's about to go down. You know, this is what you're going to have to do to like fulfill the partnership. We have an enrollment strategy meeting where we're looking at the different ways to enroll patients into the group. Could be a prescription, could be an email. We can even call out to, well, you know, patients that are a good fit for it. We can actually call out on your behalf. And then the next one three weeks is about filling the group or filling the groups. And then one week before the group starts, we'll do a dry run with the provider in their first group just to make sure they understand how to do the zoom and how it all works. So, you know, for these big clinics that have a number of, let's say, you know, nurse practitioners or PAs on their staff, this is typically a really good fit for them. And ultimately, you know, the way that we've organized it is so that the charting and, you know, ultimately all the charting and billing is super straightforward and that ultimately, you know, the patients really understand why they're there and we're holding their hands all the way along. Everyone that the patient speaks to will be a functional medicine trained health coach. So, you know, they're going to speak to people who have reversed their chronic illness. And I think that is the missing person in healthcare.

Right?

And we've talked about this a lot. I remember you telling me when we first met about these like, like group sessions that you used to do to recruit patients, right? And you would say, let's bring in someone who already reversed their chronic illness. And like, they're not like a plant in the audience. They're there on purse, they're there in person. But like, if you tell someone that you can get off your opiates or you can get off your, you know, autoimmune disease medication, your biological through functional medicine, it's not that believable, right? It hasn't been that believable. It's happening. But because of all the work of all the people in our community, all the summits, all the podcasts, all the books, like, it's really clear to a big subset of the American population today that you can reverse your chronic illness. And that's actually maybe something we could talk about in a minute here. But I would say that. But yeah, I remember you telling me that right at the beginning. And I was like, you know, it's so true, is that if I, if I want it, if I didn't believe it, I'd want to speak to someone who'd done it. And it's rare that the doctor's done it. In some cases they have. And then normally that doctor straight away builds an unbelievably busy practice and, you know, can't see any more patients because patients will just flock to them. But like, that pivot point of someone who's actually done it ends up being more inspiring than the doctor themselves, even if that doctor's had their own incredible transformation. And I learned that from Terry Wahl. So, you know, as I said, just been paying attention over the last 17 years and listening. And I remember, you know, talking about you and the way that you used to fill your programs. I was just thinking, you know, that's so true, and what if we could just introduce each patient to two or three people that have reversed a chronic illness and see how that affects their mindset?

Yeah. I mean, there's a framework that we talk about. So you can be a vendor, you could be a thought leader, you could be a hero, or you could be a sage. And, you know, a lot of times, you know, we want to. We definitely don't want to be a vendor because that's a commoditized way of approaching services. And then we don't want to be a thought leader. And that's what many practitioners are. They're thought leaders or they're, you know, people who are forward thinking. But the hero is the person that we want our clients to be. And if they can see themselves in somebody else who's now going to help them, then that's so much more empowering. Right. Because it's. It's one thing to say, yeah, you could do it. You're a doctor. You know, you have all these resources, you have unlimited money, you have all these things. And of course, people make up their own stories, but when they see somebody who's just like them doing it and on the other side of that mountain, then it actually becomes more attainable and real for them. So there is, there is an important psychology there. And again, I love this, and I know you and I are both aligned in knowing that group programs are the way to go. You said something that I want to just draw. Draw people's attention to. You said something about Zoom. So are these done on Zoom in person? Both. Like, what's, what's the logistics?

Like, it's 100% virtual. So everything's virtual, which aids with so much of the friction. It's just like getting people in rooms together, parking, getting a ride to the office. There was an amazing Harvard Business Review article that I'll recommend to everyone called I think the era of telehealth is just, just begun. And they were saying essentially that, look, if you really care about helping poor people, it has to be telehealth because more people have a phone than a car. And so, you know, ultimately. So it's all virtual that we use Zoom twice a month for the, like, interconnectivity, face to Face. Everyone knows how to use zoom. There's tons of great functionality like breakout rooms that we take good advantage of. But the majority of the experience that patients have is in what we call the hub. And the hub is, I'd say, most analogous to a Facebook group. It's a place where the group and the coaches can talk to each other, you can direct message the coach, so you have your. And you can direct message what we call your progress partner. That was an innovation that we came up with that we really love, which is pairing peer patients together in a thoughtful way to have them support each other. Like 24 7. Kind of like that mentor role in Alcoholics Anonymous, right? Where you have the person who's got sober. They're not in this case, they're just peers helping each other. But it just sort of creates this another layer of support that is free, that is valuable to both people, which we love. And so that's the main experience. And then we also have obviously the learning management system. So people are learning all about the things in those six pillars. And when we started off, we had it virtual, but we're working with Medicare age people, older people. And so we actually send every patient a physical work workbook. It's 150 pages. And that's the sort of process that they go through over the six months where it's like a workbook, where it's also like taking them to videos to watch little things that we want them to learn along the way. So there's, there's an offline component, there's an online component. Thinking about it, right? The offline is really about the learning because we don't want them to learn when they're in zoom necessarily. Because what we've really found is when you have them in a synchronous environment like Zoom, the most powerful thing is to get them share their own experience, experience of their life, right? And the least powerful thing is to give them a lecture. And again, like when we tried to do this with doctors or even functional nutritionists, it was always that the, the sort of, the, the idea, the, the sort of default was like, I've got so much information I want to share. Let me share it. And I've got all these people listening, so let me share it. And ultimately what we realized is like, we got to bring that back because actually one person in a, in a. Instead of a lecture on nutrition, having one person share care, why it's hard for them to make digestive changes in their diet, is so much more powerful for the rest of the group, because then they're like, oh, that's me. And we have a little thing that we do where if someone says something that you resonate with, and I stole this from my men's group because it's just really powerful, you put your hand up. And so imagine if you're telling a story and you're being vulnerable and eight other people put their hand up like that. That normally gets the waterworks going because you finally feel heard, you feel seen, you realize you're not crazy, and that's the safety that most people are not living with.

Amazing. James, I know it's your 14th wedding anniversary today, and you are such a dedicated human being to your craft, to your vision, to your passion. Definitely shows. And I really love kind of walking this path with you to make the world a healthier, happier, more whole place. And it's inspiring to see, see how you continue to innovate, continue to, you know, just keep refining what you're doing and making it more accessible and available to people. So appreciate you so much for being ahead of the curve and kind of riding that wave of what's possible. What would you like to say to practitioners who are listening? The stage is yours.

Yeah, so I would say I used to think that switching to an all cash model was like the premium thing that you could, you could do. And I would just say that what I'm seeing is now the sort of most elevated business model is for any clinician, is to have a wider funnel at the top of your business. And that wide funnel is insurance. Now, I'm not saying that you have to see insurance patients. I'm just saying that you have a funnel where someone can see insurance patients and create a heart connection into your business through the energy that you have in your practice, through the energy of the people you hire, through the kind of care that you provide. But ultimately, you know, by, by taking people in, in who have insurance, you're creating massive access. You know, you can work with people in a range of range of different, you know, socioeconomic groups. And then, you know, you can run them through our groups and we can partner with you to do that in a profitable way. And then ultimately, in that process, patients can realize, oh, what does Dr. Smith do? Oh, I never heard of any of these things. I never heard of a Genova test. I never heard of an oat test. I never understood what supplements could really do. And so ultimately, what that creates is a nice funnel for your, you know, high ticket cash business, if that's what you choose to make. And you know, having had a, had a, having had a business for years where we help doctors make the transition to cash, the number one thing that people struggle with is getting enough patients through the door once they make that transition. And so I think having this funnel, you know, is a good way to connect with new people in the clinics and ultimately take them to the same place, but just to help a lot of people along the way. So that's the first thing. And then the second thing I think is that, you know, we're at a moment right now where I want to finish with this. Health systems realize that they're losing people to functional medicine. Doctors, right? They are, they are sitting in boardrooms and realizing that people are leaving. And when they ask them why they're leaving is because like, like you don't understand nutrition, you don't understand brain, you don't understand health, you're not delivering health. And I think this might be the sort of the inflection point for the whole industry where now there's so much pent up consumer demand through all the work that we've all done for all this time that the systems themselves are realizing are humble enough to realize we're losing now and we need to work out what this is. And so I would say I am having the most interesting, exciting conversations with leadership in hospitals and health systems who are like, we need to work out how to do this now for even just the most selfish financial reasons. But you know, how interesting is it that we can live in a world where the right thing happens for whatever reasons they happen. And ultimately, like my mother always said, the truth will out and the truth is out. And people want, people want to know what we know, know. And so there are new opportunities for everyone in our community to lead in this area. And so, you know, I'd love to meet you, you know, and we'd love to meet you at Heal Community if you feel inspired to be part of the movement. I think that if you're going on your journey, you know, along with Sachin, you're in great hands. But the, the range of opportunities that's available to doctors and practitioners that know what's up is wider than ever before. And so I just love everyone to just think big, go big, plan big. And I think we've got a real shot at making an exponential shift in medicine in the next five years.

I love it. I love it. Thank you my friend. Have an amazing, amazing rest of your day and keep up the inspiring work. I know this is number three for us. I know there's going to be number four, five and six coming up in the next few months or years. And again, keep. Keep inspiring. You're doing a great job.

Thanks, Sachin.

Thank you.