From Artisan to Infrastructure

The louder market and the need for trust 0:00

When it comes to the news, the market is louder. The tools are faster, expectations are higher, and margins are tighter. So let's talk a little bit about that. You know, the market is louder. When you first started your practice, there were probably not that many people in your community doing what you were doing. And today, there's lots of things that kind of look like your practice that are getting sent to people in your community all the time. There's a lot more noise in the market. There's a lot more people talking about longevity and, you know, root cause and functional medicine and all of these different ideas and that sound a lot and, you know, tangential to kind of the work that you're doing.

And so, you know, we have to be be ready for that. The tools are faster. We're going to talk about AI. The expectations are higher. Again, we could talk about those kind of tools as well. And the margins are tighter. So how can we scale functional medicine with trust? How can we really deliver and do something that's truly effective for our patients and continue to grow our practice? Hello and welcome to the Evolution of Medicine podcast. I'm your host, James Maskell, and this week we are going to do something a little bit different.

I hope you've been enjoying the interviews that we've done over the last few weeks. There's been some incredible timing. The day that the podcast came out about metabolic psychiatry was the same day that there was an announcement from Health and Human Services about the power of food and mental illness talking about cases of schizophrenia and other mental illnesses that have been reversed and ultimately we are at the beginning of the science but as Dr Bernstein said on the podcast we are expecting a lot more a number of randomized control trials this year that are finished and are awaiting publication in that space and so it's super exciting to see that we are you know mirroring here on the podcast things that are happening in the bigger world.

Now We could do a whole session on the news, but what I really thought might be most useful is last week I gave a keynote at a conference and I want to talk a little bit about what that conference was and then I'm actually going to redeliver the keynote. I was about half an hour and the whole point of the session was a state of the functional medicine industry. And what it's going to take for us as Functional Medicine to go from pioneers to key infrastructure for health. And so that's what we're going to talk about.

Now, just to give it a little bit of context, I was giving a keynote at an event called Legacy. So Legacy was created by Seth Conger. He's been on the show before, but he had a very successful practice. He sold it. He's now the Chief Operating Officer of Freedom Practice Coaching. And about two and a half years ago, he brought me in to help him out with Legacy. And Legacy was a mastermind for clinics that were doing over a million dollars in revenue. And ultimately these were sort of graduates or potential graduates from Freedom Practice Coaching.

Many of them had come to Freedom Practice Coaching from me initially back in 2014 to 2016 when they were one of the major sponsors on the Functional Forum.

Introducing the keynote and Legacy conference context 3:04

So I've had an opportunity twice a year. In the winter we go to Mexico, then in the summer we've been to Spain, we've been to North Carolina, been to Tahoe. This summer we're going to Portugal. So if that sounds fun, feel free to get in touch. But ultimately what I wanted to share is this session because it went really well. We got an incredible amount of great feedback and I just think it's the most interesting and useful information right now if I'm a practitioner and how is the world changing and how should I be reacting to it.

So what I'm going to do is jump into it and then I'm going to share a little bit later what this is all leading to and you know just a sort of a just to give you a little bit of a heads up on where this is going, you know, I believe that ultimately we need to move towards clinics having repeatable, scalable infrastructure so that this can become the standard of care. And we'll talk about that a little bit later on and what I believe that infrastructure is. So what is the importance of this talk?

Ultimately, When it comes to the news, the market is louder, the tools are faster, expectations are higher, and margins are tighter. So let's talk a little bit about that. You know, the market is louder. What does that mean? When you first started your practice, there were probably not that many people in your community doing what you were doing. Right? And today there's lots of things that kind of look like your practice that are getting sent to people in your community all the time. So there's a lot more noise in the market.

There's a lot more people talking about longevity and, you know, root cause and functional medicine and all of these different ideas and that sound a lot, you know, tangential to kind of the work that you're doing. And so we have to be ready for that. The tools are faster. We're going to talk about AI. The expectations are higher. Again, we could talk about those kind of tools as well. And the margins are tighter. So how can we scale functional medicine with trust? How can we really deliver and do something that's truly effective for our patients and continue to grow our practice?

I started off by sort of going back 10 years, because again, when I got a lot of the practitioners that were there into freedom practice coaching, I would say when we started the Functional Forum back in 2014, our main job as practitioners was education. Right? That's why if you look back at the Evolution of Medicine book, if you look back at what we were doing there, teaching people how to run webinars, you know, freedom practice coaching was teaching people how to do dinner talks, how to run Facebook ads, how to put out flyers.

Ultimately, our job was education and information. Information is what created trust. And so practices were out there building trust through delivering information. However, when we look at today, talking about lifestyle is no longer differentiating. And I guess the point that I want to make is, I feel like we won the argument, right? I feel like we won the argument that lifestyle is, that should be the basis of all of medicine. Now, there's still big parts of medicine where they're not doing lifestyle.

But overall, I think the consumer is aware that they can participate in their health to whatever degree they participate into it. They're going to be healthier. To whatever degree they don't participate, they're going to be less healthy. But ultimately, that is kind of known. And it's not easy to build a business today when all you can do is delivering, is that argument of education. Thank you so much to all of our mission partners. We are really grateful for their support in bringing you the Evolution of Medicine podcast.

First of all, I want to say thanks to Fullscript coming up very soon, starting on the 23rd of February. We have the full script challenge, which is going to be a five day challenge to make it easier for you to run a successful practice, take advantage of all the awesome tools they have. You have to have a full script account to take the most advantage of it. And if you don't have one, go to goevomed.com slash full script. Sign up and we'll get you ready for the 23rd. True Neura, go evomed.com slash True Neura, get a demo.

We have got an unbelievable group of practitioners starting to build this network of clinics that are reversing cognitive decline and we really want you

From education to delivery in functional medicine 7:18

to be part of it. So go and visit us there. Big Boost Marketing is the place to go for practitioners who are looking to grow their practice, get new patients in, build new models of marketing systems. And so go and have a call with Uli over there. We've been working together for more than a decade. And then our last mission partner is Freedom Practice Coaching. And Freedom Practice Coaching is really making it easy for practitioners to build strong, sustainable practices. We've got a great partnership going with True Neuro where we have about a dozen clinicians that are working together to build these brain health practices and doing it really successfully.

So go to goevomed.com slash FPC and check in with one of the team there and see if it might be a fit for you. All right, back to the podcast. Now we have to win in delivery too. So that's what we're going to talk about today is how do we win in delivery. So I mentioned the market's noisier. Patients are talking about choosing between narratives, not doctors. And what I mean by this is like, you know, let's say Look at Moldco. I gave the example of Moldco. Many of you haven't heard of it, but Moldco was a company.

I actually found out yesterday who the practitioner of the original, of the founder of Moldco is. But essentially, Moldco, 40,000 people have signed up for Moldco. It's an end-to-end sort of telemedicine and testing solution. It's got the IP of Richie Shoemaker. So ultimately, you can argue whether or not you think that it is possible to reverse your mold toxicity through a telemedicine and testing service. And I'm definitely not saying 40,000 people have reversed their mold illness through Moldco, but they're good at selling and they know how to get people into the top of the funnel.

And so patients are choosing between narratives, like can this company, where I don't know who the doctor is, but I see that they have good marketing, or do I trust this local person in my town? So they're choosing between narratives. Do I need the doctor or can I use the platform? What does noise do? It creates confusion, it creates protocol hopping, and it creates doctor hopping. All of the doctors online, all sharing their protocol, all vying for celebrity, this is noise. And you're all experiencing it one way or the other.

The only moat that you can build, you can't build a moat with information. You can only build a moat with trust. People don't buy information anymore. They buy certainty, right? So in my last talk that I'd given back in July, I talked about the shift towards direct primary care, some of the law changes that were coming around that would incentivize building a direct primary care practice. Those laws exist right now by the way and hopefully if you're listening to this you're at least aware of that and you're aware that employers could now buy direct primary care.

What is direct primary care built on? It's built on the trust of relationship. because you know that this is gonna be your doctor. So you start a direct primary care practice, you sign up for 100 patients, they pay you 150 a month, and that's your panel, and you make 60 grand a month plus everything else, and that's your business. And maybe you can build a brand beyond that practitioner, and you can bring on another practitioner and build the brand. But ultimately, it's based on the relationship that you have with the patient.

And that is one way to certainly build trust. But how do we build trust at scale? And what I'm here to say today is I believe that there are two ways to create trust and that winning clinics will do both. So one way to deliver on trust is to be convenient. Convenience creates trust because you do what you're saying you're going to do. You follow through and you execute on what the patient is expecting. But over here, Connection also creates trust. That's why I've talked about this all the way through the functional forum, Evolution of Medicine.

I wrote a book on group visits. You know, I've talked about the practitioner-patient relationship.

Noise, competition, and the rise of AI health platforms 11:28

It's why I'm still here battling for functional medicine because functional medicine has at its core the patient-practitioner relationship. And so that's why I'm involved. So willing practices have to win at convenience and connection. And just as a sidebar, you know, on the sort of Maha movement, I think what you're seeing is that like, you know, what I see in the early days of maybe why Maha was unsuccessful is because it was rebels that were running the show. And it's hard to go from rebellion to infrastructure, right?

And we're kind of doing that in the functional medicine movement right now. Everyone who started a functional medicine practice was a bit of a rebel. You had to be to go outside the standard of care and start your own practice. Right. But ultimately what we're looking to do now is build infrastructure to actually become the standard of care that takes a different skill set. Now, one thing we have to talk about for a moment here is the competition, because ultimately, you know, if we look at when Functional Forum started 2014, until let's say a few years ago, None of the big players, well-resourced, well-executed players in functional medicine, or functional medicine-ish, they all went after employers.

They didn't go after consumers. So all of the innovation was pointed on employers, not patients. So let's give an example of that. You probably have all have heard of Virta Health. So Virta Health was a company, technology plus keto diet aimed at diabetes. So very successful in lots of ways, pretty significant company. Why did they go after employers? Because they know that there's at least a million employees at Walmart and let's say 5% of them have diabetes. And so they can sell their diabetes solution 50,000 people at a time, not one at a time.

Why is that? Because ultimately the cost per acquisition can be layered. This is why direct-to-consumer failed in that era, high cost of acquisition. If you are running a practice like Freedom Practice Coaching, and I was able to give some examples, you're running a practice where the lead funnel is you know, Facebook ad to webinar or Facebook ad to local dinner talk. And my feeling is that you actually have a lot of advantages if you're selling in that way, because you actually have an opportunity to be face to face with patients.

And I think that would bring the cost of acquisition down. But ultimately, the reason why those companies didn't go direct to consumers, you have high cost of acquisition. If you're selling something that's only a couple thousand dollars and you're spending a thousand dollars to acquire it, it doesn't turn into a great business. High churn and low trust. It takes a while to build trust in that space. But then things have changed. So one, telehealth is normalized. So you can sell across all 50 states and you're seeing that I don't know if you have an Instagram like I have an Instagram, but you're getting tons of commercials all the time from all kinds of services that probably sound a bit like your services, longevity centers, virtual clinics, so forth.

subscriptions are now expected, right? So telehealth normalized, subscriptions are now expected. So everything's a subscription and people are used to buying subscriptions. Direct primary care was very abnormal at the beginning and now is kind of normal because people are used to subscriptions. And ultimately what's changed now is that AI can explain everything. You don't need to sit there and explain everything because AI can explain what you want to say, you know, very well. So all of that has changed.

And so now what you see is that you have very sophisticated, very well funded companies going after the consumer. And that is a huge change because now you have very sexy competitors. And to give you an idea of one of those, I'm going to talk to you about this new ChatGPT Health. So I talked about it on my last solo episode, it was announced in January, still in beta, but I'm just going to read you now what is included in ChatGPT Health. So imagine a service, 800 million people use ChatGPT, you probably use it yourself, right?

So imagine a healthcare service that integrates Probably seamlessly because this is what they do a lot of technology one medical records for lab visits, visit summaries and clinical history. Why do you take such a long history in functional medicine? Because you don't have all their medical records. How would it feel to start every appointment with a new patient with their complete medical record? That is actually now possible and it is going to be part of GPT Health. Two, Apple Health for health and fitness data, including movement, sleep and activity patterns.

So Apple Health is a partner. Function is a partner for lab test insight, nutrition ideas, and takes action on your health. Mark Hyman and Function is now integrated as a Chachi BT and will be competing for your clinic. Four, MyFitnessPal for nutrition advice, macros and recipes. Five, Weight Watchers for GLP-1s, personalized meal plans, recipes and food guidance. All trails to help you find your next hike. Instacart to turn meal plans into shoppable lists. And Peloton for suggested workout classes or guided meditations.

Ladies and gentlemen, this is going to be good. This is going to be hard to be better than. Right? This is going to work. This is impressive. Right? There's a lot of cool stuff in here. What does this mean? You as a clinic now have to own meaning, integration and trust. One of the things that I've been speaking about for the last few months is the idea that the harder the case, the more longevity.

What winning clinics need: data, team, programs, and membership 17:28

Trying to convince practices to launch brain health cognitive decline programs because ultimately it's going to be a long time until chat GBT health can reverse cognitive decline. The only thing that has ever a reverse cognitive decline are functional medicine practices with an experienced doctor, a health coach, and probably a dietitian. That's the only thing that has ever done it. No drug has ever done it, but that combination has done it. So I think we should bet on that because I think that's going to have a lot more longevity.

I think if you focus on autoimmune disease, you can have that same longevity. Ultimately, the question is, when will it be possible for a patient to be able to do it themselves? And my judgment is that if you are selling to diabetics or pre-diabetics and doing some lifestyle medicine and a little bit of function recovery, That is not going to cut it because I think patients will be able to do it to themselves. Arguably they can do it to themselves right now. You know, if you had a patient sign up for Virta Health, that's going to be a great experience.

Whatever this is, it's going to be a great experience. So ultimately, you know, you have very, very sexy new competitors coming along and we have to be ready for that. I also want to talk a little bit about treatment companies. So I was totally wrong on these treatment companies when him and hers and Ro and these things came along that are essentially like, you have a symptom, you take a drug, you get a subscription. I didn't think it was going to work because like, I'm just so steeped in functional medicine.

And I was like, do people really want that? Well, yes, it turns out they do. Starts off with ED medication. Now it's GLP-1s. Everything is now available through that way. It's 50-state medicine. It's super easy. And think about examples like Kim's and hers. Why do they win? Speed, convenience, logistics. My recommendation, no clinic and functional medicine will be able to win at this game. They've already won. You will not be more convenient or speedy or organized or easier than hims and hers. They've really won at that game.

So what is the strategic shift? It's from artisan to infrastructure. Right? It's from rebel to infrastructure. It's really about building the infrastructure that, you know, allows your practice to be as convenient as him's and hers, but with the connection of you as the practitioner, your team, your other practitioners, other patients, all the things that we've been speaking about here for more than a decade at The Evolution of Medicine, particularly around connection. So what wins now? What is the winning formula?

I think the first thing is objective data. Can you prove what you're saying? And ultimately, you know, one of the reasons why, you know, if you look at the things that I'm involved in, you know, I talked at this event about Viability. Viability is a company that was sort of spun out of freedom practice coaching that does coaching, education and outcome tracking for the programs in in freedom practice coaching. Why is it great? A thousand people a month go through it. 40,000 people have gone through it.

They have objective data on weight loss and coming off medications and changes in lab data over all of these patients, tens of thousands of patients. And so you can use that as a clinic within the freedom practice coaching network. You could use that to your advantage because objective data is valuable. Why is it important? Why is this randomized controlled trial by Dr. Bredesen, Dr. Burke, Dr. Toops, Dr. Hasee. Why is that important? Because it's objective data. It's the first randomized controlled trial.

So if you don't have objective data in your practice, finding a way to cushion up with someone who does and be part of that network is valuable. And that's one of the reasons why we have practices that are using True Neural now. that are going out into the market and saying, hey, I'm mentored by Dr. Christine Burke because she's out there, she's got these outcomes and she's mentoring me and that's going to help me recreate these outcomes in you. So the first thing is data, that's the top of the tree.

You have to have a great team, right? So I think... We've been a part of the journey here at the Evolution of Medicine to create the practitioner coach dyad. When we started, Functional Medicine Coaching Academy didn't exist. Ultimately, Gabe, my partner at the Evolution of Medicine, I think was probably the first functional medicine coach. He started coaching at a functional medicine clinic in 2008. So that was the very beginning of that journey, one of the first anyway. So you have to have a great team.

Next week on the podcast, I'm going to interview Ashley Cough, and she's going to talk about why a dietitian is critical to that team too. So, you know, look at Dr. Burke's practice, look at the Cleveland Clinic, provider, health coach, dietitian. Then I think you need to have a program that delivers outcomes over the years about, you know, having programs that Seth Kong has come on here and talked about it about selling something that does something, right? Selling outcomes and ultimately having a program that delivers outcomes I think is critical and then a membership underneath.

So in freedom practice coaching, what the goal is for those clinics is to sell enough programs, get the outcome data, track the outcome data, and then move people who go through an initial three, six, nine, 12 month program into a membership. And the goal is to get the membership to a point where that pays for all of the costs of the clinic. And then essentially selling more programs is just gravy for the clinic. That's the goal of where they're trying to go. And I think that's really important.

So objective data. Stories can inspire, but data cuts through the noise, right? They're training people there to tell stories that get people to want to sign up. But it's data that cuts through the noise. So they can sell to the right brain and to the left brain and get people over their own objections. and into taking care of themselves. You need this great team. The Future Clinic is a team with a playbook. Front-end program. People don't buy care, they buy direction, they buy an outcome, and that's the opportunity there.

And then the back-end membership. The program changes lives, and then the membership funds stability. So what does the full-stack clinic look like? Data. at the front end to bring them in, team, program, membership, and then lastly, infrastructure. So how are you building trust at scale and what does infrastructure look like? Ultimately, the infrastructure has been a bit random. When I ran a clinic, what are the most two annoying parts of the infrastructure? It's supplements and it's labs.

Building infrastructure with Fullscript and the Future Proof Your Practice Challenge 24:18

One of the reasons why we recommended Fullscript and why we really helped Fullscript grow is because I had literally worked in a cupboard. And most of you who are listening to this know what I'm talking about. The cupboard in a clinic where all your supplements are, where you do your work, And ultimately, that's where the supplements get sent out from. When we started that clinic, we were doing one or two packages a day. And by two years in, we were doing 40 packages a day out of this cupboard with all the supplements.

The supplements kept on expanding because the practitioner would find new stuff that they liked. And ultimately, you know, I was clear when I came to do Functional Forum that we needed something like Fullscript. And so we sold Fullscript to a lot of people and most people in the industry use Fullscript now because, you know, it's much easier to run your logistics at scale. And, you know, ultimately, you know, we've seen the same thing for Rupert Health or Avexia Diagnostics, right? Places where they organize all of your labs together.

Now, still, we don't have yet a fully integrated system where everything fits together. You know, ultimately, you know, we're building that at True Neuro. And that is, you know, that is if you're interested in doing cognitive decline, they're a sponsor of the show. We'd love to have them here. I've talked a little bit about freedom practice coaching here. And if you're interested in joining a group of practices that are on the journey to build the model that we're talking about, you know, great, great, come to goevomed.com slash FPC, but to find about that.

But the big reveal and what I wanted to share here today is that we believe That full script, who has been our partner here for more than a decade, is on the edge of building a fully integrated infrastructure for delivering on whole person care. You're doing integrated medicine, you're doing functional medicine, whatever you're doing. Whole person care is here to stay. And ultimately, I'm super excited to share that in about a week's time, starting on the week of the 23rd, we are going to be running the Future Proof Your Practice Challenge in partnership with Fullscript.

What does that mean? It's free to sign up. You can go to goevomed.com slash challenge. And if you go there, you will see what we're up to. Ultimately, over five days in as little as 15 minutes, we're going to introduce you to some of the tools that Fullscript has been building to make a scalable program, to make a scalable infrastructure possible. So on day one, we're going to speak to Dr. Jeff Glad. He's the Chief Medical Officer. You know, it was Dr. Glad. In 2017, he spoke on the Functional Forum about using low-cost labs to create trust, especially for patients with, you know, high deductibles.

And, you know, Dr. Glad has been on this, you know, we've worked together very clearly and he's going to be sharing sort of like the vision and, you know, some of the key pieces. On day two, we're going to be speaking to Dr. Kate Kresge and talking about the labs. So, you know, Fullscript Labs exists. Rupa Labs is now part of Fullscript and she's going to be sharing, you know, how you can integrate all of your lab work and use it seamlessly through the Fullscript platform. On day three, we're going to be talking a little bit about education.

Where do you go to learn? Obviously, there's a huge educational component to what they're doing at Fullscript, especially now with all of the Rupa tools as well. So we're gonna be talking about applied clinical learning that supports practice growth. Day four, we're gonna be talking about wearables and integration into whole person care. But the big news is day five, and this is gonna be Fullscript launching a new service called Journeys. And Journeys is Fullscript's equivalent to Function Health.

but at the end of the funnel of getting those tests is not good luck. Let's watch our AI printout and go for it. It's actually your clinic. So you, as your clinic, you can have an alternative to function health, to superpower, to aura, to whoop, to lab core, all of these players that are selling labs direct to consumer. You can create your own panels and you can use that as the top of the funnel into your practice. This is prevention at scale. This is going to be a game changer for our industry.

And I'm super excited to bring this to market for the first time. So go to goevomed.com slash challenge, register for the five day challenge is going to be the 23rd to the 27th of February this month. Each lesson is 15 minutes, so you just need to take 15 minutes a day to learn about what you're going to learn about. You could go into your Fullscript account. You have to have a Fullscript account. If you don't have a Fullscript account, you can go to evomed.com slash Fullscript, get yourself an account, or you can just register for the Summit and we'll show you how to do it very easily.

But I believe that this is a transformational moment for our industry, because for the first time ever, There's a completely integrated layer that will allow arm medicine to become the standard of care. And you can continue to be the trusted resource in the middle of your community, making an impact, educating and executing on whole person care with convenience and connection. And that is what it's going to take for the clinic of the future to win. So I'm super excited about it. I'm so glad you're here.

So grateful for Fullscript for trusting me with this. You know, I've had this long relationship with them and I think there's some really exciting things, you know, coming in the future. Every quarter this year, we're going to do something innovative, something new. This is the first one for this quarter. Super excited about the rest of 2026. What a time to be alive. You know, I got into this industry 20 years ago because I wanted to see the transformation of medicine towards a root cause approach.

I believe it's the only way that we can turn medicine around. And now for the first time with some of these tools, I can see that it's not just possible, I think it's going to happen. I think it's going to happen in my lifetime. I think it's going to happen maybe even, you know, before all of my kids are fully grown. And that's my vision and my dream for my career. So I'm super grateful to you, all of you who listened to this podcast, who have supported me, you know, over the last 12 years in the way that we've supported you.

I'm super grateful to all of our partners and mission partners here at The Evolution of Medicine. And you can find out more about those on the website. And I will see you on the 23rd of February for an epic week that will be transformational to your practice and will help you build an organized infrastructure so that you can save tons of time and just get on with the uniquely human aspects of delivering care and delivering great medicine. So this has been the Evolution of Medicine podcast. This is season two, episode 16. I'm your host, James Maskell.

Join us in the full script challenge. Thanks so much for tuning in and we'll see you next time. So that was the podcast. What an epic session. And just a reminder that coming up in April, we will have version two of our Reversing Alzheimer's Summit and we're gonna have updates on some of the new studies from Dr. Bredesen and be charting a path forward for the reversal of Alzheimer's and cognitive decline. Thank you so much for tuning in to the Evolution of Medicine podcast. We'll be back again next week and thanks so much for tuning in and we'll see you next time.