The Natural Evolution Podcast

Season 3

Episode 4

S3E4 – The Missing Piece of Healthcare: Community & Groups Success with James Maskell

James Maskell is the author of The Community Cure and a pioneering entrepreneur in the functional medicine space. Originally working in economics, James started his company, HealCommunity, 16 years ago as a way to flatten the curve of ever-rising healthcare costs due to chronic illnesses.

In this episode you’ll learn more about how chronic illness heavily contributes to rising healthcare costs and how HealCommunity’s mission aims to change that in spite of functional medicine’s potential pitfalls. James speaks about the increased patient outcomes in group functional medicine and how to get insurance companies on board.

Find more information on HealCommunity here.

For more on functional medicine, follow James on Instagram, Twitter, and Facebook.

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About our Guest

James Maskell has spent the last decade innovating at the cross section of functional medicine and community. He grew up in an intentional community, and has lived in South Africa, UK and America. Originally trained in health economics, James is on a mission to flatten the curve of healthcare costs building companies and creating content along the way. A lively speaker and in demand impresario, James has spoken to audiences on six continents. He lives in Northern California with his wife and two daughters. He loves playing cricket, riding horses and plotting our survival on this planet and emergence into our potential.

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Podcast Transcript

Michael Roesslein:

We’re live. We are going to do a really fun episode today with my friend James Maskell. James, thanks for being here, man.

James Maskell:

Great to be with you, Michael. Thanks for having me back.

Michael Roesslein:

Yeah. Yeah. I always enjoy our conversations. And it seems that every time that we chat, you’ve got another new, brilliant idea in the works. So, before we jump into what that is, a lot of people listening to this are probably familiar with you and your work, or at least some iterations of it in the past, but I’ll give a little introduction so we can formally introduce and get started. James is a health entrepreneur who’s real mission is to bring lifestyle medicine and functional medicine and functional health to the masses. There’s been a huge increase in awareness and even access to some degree largely because of work that he’s done over the last decade, but there’s still millions of people who don’t have access to that type of coaching or care or help or support. And through the last decade since I’ve been familiar with his work, it’s evolved to find newer and more effective ways to accomplish that goal.

And you may know him from being the founder of Evolution of Medicine or the Functional Forums, if you’re a health practitioner out there, that have been going on for probably well over a decade now. He was also involved as a founder on Knew Health, which is a functional medicine based insurance alternative. And now all of his attention and efforts are focused towards a really exciting new organization or project called HealCommunity, and that’s what we’re going to talk about today, is what that is and what it can provide, whether you’re a health practitioner out there hearing this or someone who’s looking for the right type of care and don’t really know how to access it or where to find it, or even if you’re in the insurance industry or within the conventional medicine system. And I don’t say that often, probably never, probably not even one time on any interview or podcast I’ve ever done, but we’d like to reach you folks too. And this is more of a collaborative effort than I’ve ever seen. So, that was kind of all over the place, but you’re a difficult person to summarize.

James Maskell:

Well, that was pretty good.

Michael Roesslein:

Awesome. Sorry.

James Maskell:

You code it pretty well. I mean, the mission is always the same, right? The mission as I started off 16 years ago to try and understand was, what is causing this exponential increase in the cost of healthcare, right? Which I have a degree in health economics. What is causing that? Is there a way to arrest that curve? And then if you can arrest that curve, then go do it. Because ultimately if we don’t in my lifetime, nevermind my kid’s lifetime, everything runs out of money, right? The UK where I grew up, single payer healthcare system paid for by the government, US, whatever this hodgepodge system we have in America, but both have the same curve. And that curve is an unsustainable exponential increase in the cost of care, driven by lifestyle, driven chronic illness, and large sways of the population being chronically ill.

And ultimately the first part of it was really understanding, is there a way back for individual people? Can you reverse a chronic illness? And the answer is clearly yes. And that’s why the goal of the Functional Forum was to spread that knowledge, make it less friction for doctors to want to participate in it, make it cool and aspirational to be a functional medicine doctor. And then that worked pretty well. We got thousands of new doctors. Right now, which there wasn’t 10 years ago, there’s a functional medicine doctor in every little town in America. And I’m super proud that we were able to facilitate that. But about three years ago, I had an opportunity to take a step back and just realize, that’s not it. Even if we take that plan to its logical conclusion, one, it doesn’t end up solving the biggest problems that really underpin that exponential curve.

It doesn’t help poor people. And ultimately most people don’t get really helped by that solution. And we can get into more of why that is. But also if I go to the UK where I grew up, they have an incredible health system with equal access, with no direct cost at the moment. The NHS is a jewel. And ultimately in America, if you apply my model to England you end up destroying that system. And I didn’t want to be a part of that. My mother had got great value out of it. And I think that a system that is equitable and accessible like that is an optimal system. And so I wanted to really rethink the whole thing based on what I’d learned in the previous decade, but to try and create something that could reduce the friction even more and make it easy for everyone to get access to a type of care that would give them the opportunity to reverse their chronic illness and live a life of health and happiness.

Michael Roesslein:

Which is, I think, the goal of everybody that’s involved in the functional medicine world or in the natural health world. If you said that you’d get 100 out of 100 people saying yes, and you probably wouldn’t get very many people with ideas on how to make it happen. So, something you said in there I want to hit before we get into what you’re doing now, because you said, “There’s thousands more functional doctors now and every town has one, but that doesn’t help everyone.” And I’m curious if you want to expand on that a little bit. Where are the failings of that functional medicine growing? It’s great, but it doesn’t address a lot of things en masse, I guess. And is it an access question? Where’s the roadblock there from achieving the ultimate goal?

James Maskell:

Well, the ultimate roadblock is that if you spend two hours at the beginning of a relationship with a new doctor with that doctor, automatically there’s a barrier that is very hard to overcome, right? So, some clinics have been able to overcome it by doing, let’s say, a membership practice at 80 or $100 a month. And that gives a large percentage of access in America because employers can pay that direct primary care fee or individuals can pay it. And you could afford that if you were chronically ill to about, let’s say, the 60th percentile in America, right? 50th, 60th percentile could pay some sort of fee outside of their insurance to get that kind of care. But still it’s hard for a doctor to execute on that. And there’s all kinds of operational risk with moving to that kind of model.

Most functional doctors end up going down a route where it’s a few thousand dollars to participate with them so that they can deliver the care that they want to give. Because they’re burnt out from being in the system. And so they just want to optimize the care that they want to deliver, and the best way to do that is to have someone pay you five grand and you to deliver care over the year and not to have the artificial barriers put on by insurance. And so yeah, there are people who will pay five grand to start the process of reversing a chronic illness. But what’s really in the way of that is that initial appointment. Because if you multiply the most expensive provider by the two hour intake, it’s very difficult to work that out in a way that can be accessible to most people.

And what I also came to realize, Michael, is that I’m not sure if that’s actually that good a plan clinically. Because from my experience and being in this all this time is that one, that is a super overwhelming experience for everyone involved, the patient particularly. They can’t concentrate for two hours. And what I heard time and time again from speaking to people in and around the industry and also patients is that it was just an overwhelming number of new things to do. Obviously a part of the reason why they were sitting in that office is because they had come to the realization that behavior change was necessary for them, that some of their behaviors were causing their chronic illness. Whether that be the way they dealt with their stress, the way they sleep, the way they eat, the way they move. They had come to that conclusion, otherwise they wouldn’t have been in the functional medicine doctor’s office.

But the list of new things that they had to do was so massive and so egregious and so unlikely, right? That actually that two hours wasn’t really that helpful. Yes, it was nice to have someone validate the fact that there was an etiology to the chronic illness and it had moved along, but ultimately they just left with this huge protocol, a bag full of supplements, another list of lifestyle changes, and they got home and just felt a new level of shame and embarrassment that this was another thing that they weren’t going to be able to do. And that was happening in my estimation more often than not, right? I think the doctors would like to think that they were the heroes of the story and coming up with the epic protocol.

But I heard it enough times to think, “Maybe this is actually what’s normal and it’s only a very small percentage of the population that have a certain personality type that can just jump into it, push their way through this new protocol, facilitate behavior change in themselves, and get out on the other side.” And I’m sure every practitioner’s testimonial list was filled with those people. But what about these other people that really didn’t have the intrinsic motivation to get it done? And so that was a big piece. And then the financial piece. I think we had helped clinics to find new models.

But one of the things that we had been very anti was insurance. Because the insurance system up until 2021, and still a bit to this day, super unpredictable foundation to build a business on. Lots of nefarious things going down. A very nefarious system, all be told. But ultimately I just realized that unless we were able to build a way of doing this care that solved both of those two big problems, the functional medicine movement would not be functional, wouldn’t actually function to serve the purpose, which is to keep people well. And so I wanted to rethink from first principles what care would have to look in order to be accessible and in order to work in most people.

Michael Roesslein:

Yeah. I think two things. When you said $5,000 entry fee, I think your 60th percentile goes down to about five percentile. And then also before I switched over to just doing larger scale educational stuff, I worked with clients for about six years. And I’ve told this story a lot of times on interviews, but in those six years of working with clients, I had one client ever, the whole time, who went home, did every single thing that I had recommended, took every single supplement that I’d recommended, changed their diet completely, started doing the exercise program, did all the things to a T, would’ve got 100 out of 100 on a test, and they had amazing results and they were a raving testimonial. I had one. Literally one. Now there’s a gradient. And then I learned eventually, “Hey, don’t even give them this many things because it’s too overwhelming and people fail.”

But if you’re out there and you work with people and you’re being honest with yourself, you know that everything he said is true, that you get your people who manage to do it. And there’s a million reasons why people can’t do a thousand things when they go home. We could get into whole reasons behind psychology, but it’s not feasible. And so that all makes total sense. And everybody that’s listening has been through the ringer with the insurance industry. So, they understand that too. We were just talking before we went on air. I saw you in San Francisco at an event that you hosted when you had put out your most recent, because James has done some writing, but your book The Community Cure. And so the model we were just describing with the functional medicine doctor and the individual going through the two hours and getting the protocol and all that stuff, that’s an individual experience.

That’s the practitioner and the individual. They’re given their protocol, their diet, their supplements, all their things. And then they’re to go home and do this thing. And your book, The Community Care, and more so what I learned when I was there listening to you talk and the guests that you had, is you did a great job of backing up your idea with statistics. I was pretty blown away by the outcome differences and the positive effects just in general of people doing something in a group and having support in a group and to group model versus an individual one-on-one. Or actually it’s, once you leave the doctor’s office, even if you’re with a functional provider, it’s one-on-zero. There is no other one. You’re just doing it. And the effect of connection and community and groups, even if what they’re doing… Because the organization that was there in the Bay Area that I’d introduced you to, the people over there with Kermit and Elizabeth doing… What’s the name of it?

James Maskell:

Yeah. It’s called…. I-

Michael Roesslein:

Wellness.

James Maskell:

… featured them in the book. Yeah. So, it’s Open Source Wellness. Yeah.

Michael Roesslein:

Open Source Wellness. When they were telling me what they were doing, and this is a community group where people can go and they get together, I think it was weekly, and they would do different activities based around health, it wasn’t even things that I would’ve thought. They’re like, “Well, that week we sang and we ate dinner together and we told stories.” It wasn’t even, “We went and we learned specifically about nutrition,” or, “We did this exercise program.” It was purely just creating a supportive group environment. And then the statistics they had behind their outcomes of these people were incredible. And so what gave you the idea for that book and what did you learn along the way of writing it?

James Maskell:

Well, actually, so I’d first heard about the functional medicine group three months before the ever first Functional Forum. So, October, 2013, I’d gone to a conference and I’d heard Dr. Sherpa Shaxsenna talk about running this group model. And her group model was the very first version, which was a one-off group, right? So, rather than having 16 patients in the afternoon who all have diabetes and we’re going to see them all for five minutes each, why not just get them in a room and do a whole bigger experience and still bill their insurance, but they get a two-hour visit and they just get way more value. So, I’d heard about that. And so during the Functional Forum over the years, we had featured some people who were doing interesting group models and we talked about community and the whole theme was community.

And then, yeah, so part of that going back to first principles was I wanted to really look at, what is a model of functional medicine that could solve those two big problems, access and affordability? And does the person actually execute the protocol? And as that had evolved I had start to come across, “Okay. The Cleveland Clinic Center for Functional Medicine. Now, if you want to see Mark Hyman, you have to go through this 10-week, two-hour a week group.” Because they recognize that half the people would get magically better without ever having seen the doctor, because there was a multi-week experience. And Open Source Wellness-

Michael Roesslein:

Magically.

James Maskell:

Right? Yeah. Multi-week experience, right? Ultimately you are still taking advantage of the efficiency of delivery of information, but actually information delivery is not the most important thing. It’s the togetherness and the community and recreating new friendship groups. And through that book, what I tried to do was to bring together all the examples, from Ornish to Jim Gordon to the Cleveland Clinic to CenteringPregnancy. And essentially with my book, the goal was if I gave it to an administrator of a health system, would they read it and go, “Wow, we should really be doing these functional medicine groups”? And we could infiltrate into the system. So, that was the plan in January 2020 when I saw you last. And then obviously COVID happened, right? So, straight away, not only is the whole of group medicine destroyed overnight, right? Alcoholics Anonymous, other group-

Michael Roesslein:

Anything. Anything that involved-

James Maskell:

Anything that was involved sitting in a room together is done. And ultimately, I just realized at that moment I knew probably more about group medicine than anyone on the planet because I’d just researched that book and I realized that telemedicine was going to go from now a nice-to-have to the new standard of care. And so I was like, “I want to start to do some experiments with virtual group care and see what’s possible.| Because there were benefits that arose to telemedicine that people didn’t expect when telemedicine started, right? And I wanted to look and see what those were. So, essentially at that moment we started a new venture. And the first question was, what is the optimal starting point for a functional medicine relationship?

Someone who’s never done any lifestyle changes. They’ve just taken a few drugs. They’ve got either pre-chronic illness or they’ve got chronic illness. What’s the best starting point for then? And my thesis was, it looked a lot more like being in a group of supportive people that are all going through the same thing, learning and working together, and less like, “I’m here to dump my whole information about leaky gut on you,” right? Which is basically the standard of care in functional medicine. So, I hired a coach, she’s a nurse coach, and started a business to essentially deliver an episode of care. So, we took different pieces from all the different things that I’d seen out there. We created this 12-week episode of care. Immune health was hot the summer of 2020 for some reason. And so we called it the Immune Collaborative.

Michael Roesslein:

Everybody knows a hell of a lot more about virology and immune health right now than they did two years ago, somehow.

James Maskell:

Totally. Yeah. So, we created a program called the Immune Collaborative and we sold, I think, 30 people into it and we ran two groups of 15 and we started to learn a lot about the virtual group environment. And one of the things that we learned straight away is that there’s probably no doubt in anyone’s mind that if we sat 15 people in a room together, or we had a 15 person Zoom, equal length, equal content, the in-person is definitely better, right? There’s going to be a lot of benefits to that. However, if you take that example of Open Source Wellness where they met every week for 16 weeks and yes, okay, Tuesday night they always met and that was their night. The question is, “Could you nudge their health on Wednesday morning or Thursday morning or Saturday morning or Sunday night?”

What we started to see was there was a benefit to an assumed virtual relationship because it meant that if you had a meeting on a Tuesday night and you said, “Hey, tomorrow morning I’m going to send you guys all a video and I’m going to put it in the chat, and I really want you to watch it because it’s super relevant to what we’re saying,” everyone watched the video and then there was communication back and forth. So, in a certain way you were actually getting full spectrum attention to health really for the first time. And that was something that was really interesting to me because I realized that even if a year between appointments has no chance of making health then three months has no chance of making health and even one month or a week, you need to be in it every day.

And now there was a structure where you could be here every day. So, we learned a few more things than that. We definitely learned that less is more. We learned that most people are so overwhelmed by the state of life that they need some time just to relax before you can get into changing a lot of stuff, whatever that is. Changing the diet, changing the stress, whatever. So, that was last year. And then in a moment of clarity, it was the second half of the year, I think it was September, and there’s a clinic just down the road from me in Sacramento and I’d got to know the physician there. And she had a unique practice in that she had functional medicine, she was trained, she had three PAs trained, but they only took insurance and they’d only ever taken insurance. And I had met her and we’d become friends since I moved to Sacramento.

And so one day I just went into her office and I said, “Hey, look, we’ve developed this 12-week virtual episode of care run by coaches. I’ve done some research and I think we could have a new, innovative business model where essentially we become an extension of your care team, right? So, rather than you hiring a health coach who sits in the office and does one-on-one, this thing will be an extension of your team. So, now you have one doctor, three PAs, your whole internal staff, front desk and medical billers, but we’ll just be this care extension. You prescribe patients into this. You bill the insurance for it, and we’ll split the money. We’ll just charge you a certain amount and it’ll be about half the amount that you’ll make and let’s see what happens.”

And she was all in because she knew that health coaching was powerful. They’d never found a way to make it pay in insurance. And she knew from being a yoga teacher for a long time that it was those micro implements of health that were really powerful. And she just trusted me. We’d built relationship for enough time. She was like, “Okay, I trust that this’ll work.” That was October 2020. And we ran it and she recruited 60-odd people into the group. We made four groups and we worked out straightaway that this was a slam dunk. This was an epic win. We had essentially solved the access issue because people really didn’t have to pay to be in. Maybe there was a co-pay here and there, but ultimately the insurance was paying for it.

We started in October too, so everyone’s deductible was kind of replenished if you were chronically ill. And the people, the patients loved it. I mean, it was the most disconnected moment in the history of the world, right? So, having something that reconnects was obviously going to be there. But doing those videos. And in December, we got all the groups together. We had people share their experience. So often when you see people talking about their experience in health programs, the person who’s telling you what an amazing experience they had is basically a supermodel, right? They’re Instagram ready, like, “Oh, I did this and now I lost this.” And you look at them and you’re like, “I know you are not a normal person. I know what normal people look like. I go to Trader Joe’s. This is not you.”

This, Michael, was normal people. This was 57-year-old women, overweight, not many friends, having a cathartic experience by building new friendships, taking easy steps towards health, being supported by a coach who is more like them than the health coaching thing that you see in Instagram where everyone’s an ex-model turned whatever. And it was just real people having real health experiences. And it was amazing. And right then I was like, “Okay, this could be it. This could be the way.” And I mean, that’s the beginning of the story that takes us to where we are today a year and a bit later, where I think what we’re standing on ism in my estimation of 16 years of doing this, for the first time I feel like if I took this project to its natural conclusion, it could solve the thing that I’d set out to solve, which is how do you flatten the curve of healthcare costs?

How do you keep the majority of the population healthy? And it all comes back to the thesis in the back of my book, which is that there is a missing layer of care in healthcare that used to be community. It used to be elders and friends and the shaman and the whatever. And that missing layer is designed to keep people healthy and it sits between people and the healthcare system. And ultimately this delivery system now can scale to be that missing layer. And when that missing layer is deployed, people are just healthy as a norm of being around other people that are healthy, having an environment that supports health, and are working together to make slow but incremental improvements in their health that over a six-month episode of care can be dramatic outcomes with anxiety, depression, fatigue, pain, all the things that are hard to move in one-on-one medicine.

Michael Roesslein:

Brilliant. And there’s so much that could jump off there. I have a couple questions. One is, how large are these groups generally of people? What have you found is the sweet spot for a group?

James Maskell:

Yeah. We like 20. We get about 15% attrition over the length of the group, and 16 is our magic number where we feel like it’s not too big, that you could be anonymous, but not too small that you are too vulnerable too early. So, we like to recruit 20 and then we like to have 17 by the end of it, and that’s been a good number for us.

Michael Roesslein:

Cool. Yeah. That makes sense. Because it gets too big you lose, I think, some of the effect of group, because people can just kind of slink off into the distance. And then my other question is, how did you get insurance to pay for that? And I guess just that. Because you said that clinic in Sacramento where you beta tested this, they were functional and they’d worked with insurance, which that’s a question aside that I don’t know how they worked, but-

James Maskell:

Just very short visits. I mean, that’s all I can say.

Michael Roesslein:

You said they prescribe. The doctors that are within the system using insurance and using government, I mean, I guess this would work with Medicare and things like that too eventually or hopefully, they can prescribe this as part of the care. But do things like this often… Well, I guess there’s never really been anything like this, but the insurance companies are on board with…

James Maskell:

Well, look, there’s a few things that changed dramatically that made this possible where it was never possible before. The biggest thing in 2020 you got what’s called telemedicine parity, which means for the first time telemedicine was reimbursed at the same rate as in-person appointments. So, until that happened you couldn’t really have done this because you could never get the same payment. So, that’s one big thing that changed. And then just after we magically, after we did this three-month thing from October to December 2020, 2021 was the biggest shift in coding in 30 years. And some of the subtle shifts in there, there are some obvious shifts that everyone heard about in the industry, but there were some subtle shifts too. And those subtle shifts allowed us to create a program that was billable to insurance.

And for the insurance company, it just looks like this doctor is doing a slightly higher number of visits with a certain chronically ill population. So, it’s kind of boring to them. It doesn’t trigger the algorithms. And it does work on Medicare. Medicaid we’re still working on because, again, it’s a bit lower. And I think maybe by the end of this year we’ll be able to do Medicaid. But certainly commercial insurance. Workers Comp works. So, we’ve had some interesting groups coming through with that. So, yeah, it’s really about learning what insurance is. We just did a deep dive. We spent a lot of money on [inaudible 00:29:07]-

Michael Roesslein:

Recoup and understanding how to language things, how to put things, how to present it.

James Maskell:

Yeah. How to organize it. There’s some subtlety to it, which is probably too boring for your audience. But it took some work to finagle it, but ultimately what we’ve created is something that it’s a bolt-on to a clinic. So, we bolt-on this virtual group, six-month episode of care. The care of the clinic is now extended to these coaches. And essentially it not only is clinically optimal to put people who have these kind of chronic conditions and a hard time making behavior changes to these groups, it’s actually more profitable than prescribing a drug. Because they keep a percentage of the money. So, the way that we’ve worked out the model is that the clinic is making more money by prescribing people into the groups and that’s part of what’s reducing the friction to get people in there. And so, yeah.

Michael Roesslein:

Well, it increases the value of what they’re providing as well as a service as a clinic. It improves outcomes and increases revenue to the clinic at the same time, all while costing the individuals not very much money, if any at all, if it’s going through insurance and Medicare and things like that.

James Maskell:

Yeah. Medicare. Medicare costs people zero. If they have commercial insurance, it depends on the plan. It depends on the pay rate. It depends on a few things. But in general, it’s been-

Michael Roesslein:

But it’s within the system. That’s what I’m getting at. It’s within the system. I mean, I think the biggest frustration that I’ve heard voiced from everyone is that they have to pay into the system and insurance premiums are no joke in the US and deductibles and all these things and all this stuff that everybody has to pay and they’re paying this and this and this and what they find out when they really go down the rabbit hole of creating health and what that means and what wellness is, is that most of the help that they’re going to get, whether it’s from a doctor or coaches or lab testing or anything, is outside of that system that they’re already paying for. So, then they’re paying for that and that does nothing.

And then they have the new bill that’s paying for all of this, which then everything becomes, again, you’re looking at your percentile going from 60 to 30 to 20 to 10 to five. And so it’s within that system that they’re already paying into that already is being supported by the insurance or the Medicare. So, it’s brilliant. And from the practitioners side, what are you seeing thus far when these things are engaged in clinics, like outcomes for patients versus… The doctors who have been the guinea pigs with this, what are they seeing? What’s the feedback or what’s going on?

James Maskell:

Yeah. Well, the good news is we track all the outcomes. I mean, this has been a pet peeve of mine for the whole time I’ve been in functional medicine, is that no one tracks their outcomes. And part of that is because the nature of the delivery in individualized medicine is such that the protocol isn’t the same for all the people. Well, in this one, the protocol actually is the same for everyone because over the six months it can be just dedicating one month to each of the foundations of care. It’s functional medicine in the way that it’s a lifestyle first, root core, systems biology approach. It’s not functional medicine in the way that you might think about it or other people might think about it with like, we’re not doing supplements. We’re not doing labs.

We’re really focused on the lifestyle behaviors, but through that functional medicine lens. Yeah. So, 75%, three-quarters of the people who have either depression or high levels of fatigue experience a noticeable decrease over the six months. Anxiety, it’s about 60%. Sleep, it’s over 70%. Pain, it’s over 60%. I mean, we’re talking about a full spectrum bio psychosocial intervention. We’re talking about not just building new friendships and having new connections and being connected to people in the group and the coach and your progress partner, which is a peer partner, but also now having the structure to actually do these healthy behaviors consistently every day. And that combination is incredible. And so every time we edit the groups and change the way that they run, we just keep ratcheting up the outcomes.

And the goal is, can we create a structure where we get so good at understanding the underlying bioinformatics of what’s happening that ultimately we can optimize towards creating a container that everyone gets better every time? That’s the goal. And we’re already on the way to doing that. The data link, now that we’re building our own technology, is capturing enough data that can be optimized. And in AI and machine learning, there’s a lot of weird end points that we’re optimizing towards, right? Whether that be in the financial services or defense or neurolink or whatever, to optimize something towards having a structure where groups of people can come in and be nudged towards getting themselves and their friends in that new community healthy, I’m excited to see what the answers are down that rabbit hole. Because ultimately I’m not sure if anyone else is optimizing for that, but we are. And already we’re seeing that some theses that we have about what creates health either being borne out or rejected based on how we change things and then what that leads to in the outcomes.

Michael Roesslein:

It’s incredible, and it’s something that every doctor out there should be excited about adding into their practice, because it’s going to improve your patient outcomes. It’s going to increase the revenue stream for your practice. I mean, as much as doctors wish they could, even the best ones, you can’t provide this to people. It’s something one person just can’t provide. It’s part of the format of it itself. The group itself, the support itself, the community itself is part of the medicine. It’s not something that even the best practitioner in the world could possibly do. So-

James Maskell:

Let me just add to that one thing, Michael. As a practice management coach, I guess, for years before, for a decade before, what I recognize is the operational risk has always been on the doctors to make whatever new idea they have happen. And as someone who helped 1000 doctors switch to functional medicine over the last year, last decade, what I came to recognize is there’s even more operational risk associated with going to a group model because there’s so many new unknowns and so much is uncomfortable, and actually the doctor is awful at doing the groups in general. It takes a Jeff Gala or a Sherpa Shaxsenna training in humility to be able to get to a point where they can actually not be an expert and not have all the answers and not tell people what to do and not overeducate, and actually facilitate peer-to-peer delivery of value by shifting from being an expert to being a facilitator.

And that’s a very difficult clinical leap. And the operationalizing, if you go to Jeff Gala’s group visit conference and you learn about it, what you learn straightaway is that it’s the front desk people who hate this, because now they’re forced to do something totally new and they don’t understand it and whatever. So, we were just like, “We’ll just take on all that ourselves. If Janice forgets, it’s like, “Hey, Janice, the event’s starting. Why aren’t you coming on the Zoom?” We’ll call Janice. If Janice doesn’t know how to use Zoom, we’ll help Janet with Zoom, right? We’ll take on all of that operational risk because we can automate it and we can do it better than you anyway.

And so the front desk person and the office manager, and now that we’re getting into health systems, I’m having conversations with the money guys inside health systems that have always rejected integrative and functional medicine. And now they’re like, “This seems pretty cool. I can’t see any downside. There’s no upfront costs. We only pay you if we get paid. Let’s give it a go.” And that’s what I’m most excited about today is that we are making pathways beyond conventional medicine doctors, which is super exciting anyway, and into the belly of the beast, conventional medicine delivered at scale through health systems. And there’s an increasing appetite for things like this.

Michael Roesslein:

Kudos, man. That’s all I got. I got nothing else other than superlatives to say about what a brilliant idea all of it is. And to see it enacted is something. Honestly, I understand the size and the scope of the systems that you’re trying to infiltrate and get into and align with, and it’s a big beast to get in there. And this could change the game in ways that, I mean, it’ll be fun to watch to see. But if people want to learn more, whether they’re a doctor or… I mean, I guess, what are the next steps for individuals? Right now it’s for doctors, clinics or health systems or people that are involved in hospitals. Anybody on that side of the thing goes to the website and they can connect with you there, is that the best?

James Maskell:

Yeah. It’s B2B right now. We’re not doing any consumer-facing things. So, the best thing that could happen is if you’re inspired by this, the website I think is getting better all the time and it’s a good billboard for what we do. I would bet that there’s listeners out there who have been frustrated that it’s been very difficult to get through to their conventional doctor. Or why doesn’t this group get it? Why doesn’t this all happen? And ultimately I would say that we’re living in a new world. First of all, those organizations have come to realize over COVID that they don’t really know anything about creating healthy humans and that we have a huge comorbidity problem that is not just something that will affect their patient’s health in 10 years, and maybe their 70 to 80 won’t be as healthy but in general their life expectancy will be not that different.

When the virus comes along, it creates something that was chronic to be acute. So, everyone’s really tuned into this now. And so I would say if you are listening to this, every conversation I have with a conventional doctor, whether that’s primary care, family medicine, or the specialties… Right now we’re working with gastro, rheumatology. We’re working with psychiatry. We’re working with OB-GYN, pain.In all of these cases, the lifestyle, chronic inflammation, stress, all of those things clearly play a role. And so now would be the time to ask your doctor if your community might be right for them. And if you could be a bridge to connecting us to that, that would be a great gift.

And I promise you that at some point in the future, there will be an entry point for just people who get this and say, “I want this. Count me in.” It’s just that, for the next couple years we got so much to do to get to scale and make it so that by the time real humans can sign up for it, the experience is so rich and beautiful that you would never go anywhere else again for your healthcare. I mean, it’s where we’re headed. But right now we are solving such big problems for the healthcare system itself because they don’t know how to do it. The technology that’s required to organize and automate the whole thing is sophisticated. We’ve spent a million dollars on it already and we want to keep spending more to make it great.

So, if you’re listening to this, if you could be a bridge in any way to any kind of health system, the only thing that’s a requirement is they take insurance. The functional medicine doctor who takes cash, people who go to those doctors don’t really want to pay to be in what looks a bit like Alcoholics Anonymous. They want the doctor’s time to fix them. They’re still in that. But the rest of medicine, the whole of Blue Ocean, I’m having conversations with those people every day. And it’s really joyous because it’s the first time where I feel like the convergence of factors has arrived to help them say, “Yeah, that sounds good. Let’s do it,” rather than, “Well, where’s the science?” or, “How will I make money?” or all these friction points that have existed.

And also to be clear, Michael, this isn’t the functional medicine that you get in those doctor’s office. I’ve, in the last year, had my own functional medicine thing that I’ve gone through. And I’ve really benefited from paying a local doctor a couple thousand dollars to do some lab tests on me to uncover the root cause of a chronic illness that didn’t go away even though my lifestyle got incrementally better over a decade. So, there is still room for the functional medicine doctor doing the thing. But the way to visualize-

Michael Roesslein:

And you’re talking foundational health practices, foundational lifestyle modifications, foundational things that are going to push the needle forward for most people in most situations.

James Maskell:

Correct.

Michael Roesslein:

Right?

James Maskell:

And poor people, especially.

Michael Roesslein:

Yeah. I mean, because I mean as much as we want to think otherwise, functional medicine isn’t accessible to most people. The care that you had is not accessible to a lot of people. So, this is foundational lifestyle practices that anybody can do, that anybody can access, that will move the needle with most conditions for most people. Even as you’re seeing now, and it’s not even refined yet. You’re still in the beginnings of this and those statistics you’re putting out of 60% of this and 70% with this, that beats any of the pharmaceuticals out there. And most practitioners probably wouldn’t admit this, but it beats the results with most health practitioners too. So, it’s brilliant. And the website we’re referencing is healcommunity.com. And yeah, right now it’s, you said, business to business, but having an entry point in the future would be great.

But like you said, if people out there are listening and you have access to a doctor, to a medical system, to anybody within that model, reach out to them, let them know about it, introduce them to James, get them on the website, get them filling out contact stuff. And if you are in the system out there listening, take this as your sign that it’s time to enact something like this in your practice. So, I’m excited for it. I’m just excited for you. I know how hard you’ve worked for how long and tried so many different… It’s like you knew what the thing was that you wanted to happen and it’s been putting different square pegs in round holes and doing different kinds of things that move the needle. But it feels like, between what you’ve figured out along the way, combined with what happened with COVID and with all this stuff shifting the view, you mentioned that people now realize even within the conventional system, that these comorbidities and these chronic health conditions are no longer something that’s going to affect your patient in 15 years.

There’s something that will change the outcome of almost an inevitable occurrence that’s going to happen now. It’s something now. It changed the chronic to the acute, almost. It’s lifted urgency. And we’ve now seen that there’s undeniable evidence that those with less of these comorbidities are having more positive outcomes with that situation. So, it’s brilliant timing. It’s a brilliant model. Go to the site. Get signed up. Get checking things out. Follow along. Check out the book too. Because the book, I mean, we didn’t get too much into some of the studies that you found in the book or the research or the evidence, but there’s a lot of really cool… It’s a fun book. It’s fun to read because it’s inspiring to show what groups and community can really do. So, cheers, man. I’m excited for this. I’m excited for you.

James Maskell:

Yeah. [inaudible 00:45:30] for being along the journey too. I have to say, going and being… I saw Jeff Gala do his thing at a conference. But I went to Open Source Wellness. On your advice, I met those guys and I sat in there and I went to one of those events. And it was really a powerful experience for me to witness what was possible, to witness the different types of people in a room having harmony where harmony was not there before. So, that introduction was very powerful for me and those guys are awesome and I’m super excited to follow their journey and their path. But I just want to say thank you for that. Because that really brought it into my body for me in what we actually did and how we connected there. It was really, really powerful. So, thank you for your help along the way. And yeah, great to be here with your community and excited to keep following your exploits in Italy.

Michael Roesslein:

Yeah. We’ll see. We’ll move into a new health system once you’ve mastered the one over there. I’ll be able to speak Italian by then. So, I’ll get into some rooms and get them creating groups. But this culture is one that you can use as an example of the power of community and groups as well. And it’s referenced a lot in those speaks. So, yeah, man, thank you. Congratulations on getting this going. And keep it up. I’ll be watching. We’ll be cheering you on and sending people your way as much as we can.

James Maskell:

Thanks, Michael. Thank you, everyone.