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Rethinking The Era Of Prescribing Supplements​

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Cheng-Huai Ruan, M.D.

Everybody, today we have Dr. Alex Keller with me today. He’s a good friend of mine, and we’re gonna be talking about something that’s super cool. And I’m gonna take a blast from the past and just talk about my introduction with what Alex has got going on back in 2013. So Dr. Keller serves as a medical director at this company called Fullscript I’ve been working with for a few years now, and oversees, a 20-plus member of integrative medical advisory team. And he’s led the establishment at Fullscript in technical integrations and all sorts of different things that I have no idea about. 

But that’s why he’s on today, because he’s really helped pave the way in terms of automating things that is really difficult to do. And that’s what this summit is all about. And looking at what Fullscript has done really over the last year has really kind of opened my eyes into seeing what practicing medicine is really all about, which is communication and over-delivery of value. That’s what we wanna do. We’re gonna overdeliver value to our patients, but at the same time, have it be a sustainable and a thriving and a replicatable business. And we really wanna connect that business part and the medicine part. So there’s no one than Dr. Keller to kind of talk about it. So Alex, thanks for coming on. Thanks for taking the time out of your day to come on with me.

 

Alex Keller, ND, CISSN

My pleasure, Cheng. Thanks for having me. I don’t know what you’re talking about, that I know more about technical integrations than you. I feel like every time we chat, you’re teaching me something new. But thanks for the kind words.

 

Cheng-Huai Ruan, M.D.

Yeah, no problem. I mean you’re currently, I think you’re currently completing your Executive MBA, right, through the School of Business, the Quantic School of Business?

 

Alex Keller, ND, CISSN

Yeah, this is a really cool new business school that’s fully virtual. It’s incredibly advanced in the networking that you can do online. I’ve had lots of friends who’ve been through traditional MBAs, but they don’t describe it all like this. So yeah, that’s something I’m doing on the side right now.

 

Cheng-Huai Ruan, M.D.

No, that’s wonderful. And part of your interest is also like renewable energy, right?

 

Alex Keller, ND, CISSN

That’s the field that I worked in before medicine actually. So I–

 

Cheng-Huai Ruan, M.D.

Oh, great.

 

Alex Keller, ND, CISSN

I spent a few years in that sector working in something called biogas, we did solar as well. And it taught me a lot about systems, project coordination, programs, all of this, but also on the side, learning about the fragility of our environment and the necessity to think about that when it relates to medicine as well. So that was part of my motivation to get into this kind of medicine.

 

Cheng-Huai Ruan, M.D.

Wow no, that’s wonderful. You know, I think, when we think about medicine currently, and especially we’re in this pandemic era you know, I would like to call this pandemic one day, but we’re in this pandemic era. And I think we’ve learned a lot over the last year, ever since late 2019, early 2020, is that things change, man, especially in medicine, right? And when things change and you have a lot of systems that you kind of automated and it can really disrupt, but, I mean here’s the problem. When all that stuff happened, a lot of our patients went downhill. I mean, their blood sugar was going up, A1c was going up. We had major cardiac events during this time, a lot of stressors during this time. And I think that chronic disease is something that has been laid to the sidelines while COVID’s going on. 

But, I mean, it’s not like it stops. It’s there, right? And it’s really alarming how the rates of chronic disease are going up. And so, you know, part of the reason I’m asking you to come on to kind of discuss this is because we have an opportunity to communicate with the patients on a higher level, why? It’s because well, since the pandemic, a lot of our patients are asking, giving me articles. Should I take vitamin D? Should I take N-acetylcysteine, should I take you know, this and that, and from a mass practice in medicine, it is really hard to do, just to give blanket statements. 

So what we’ve been doing with your company with Fullscript is actually start putting some protocols on there and so it’s allow us to have an easier conversation with our patients. But my question to you is that right now, patients are talking about supplements and more natural way of doing things, right? But it’s really hard for my physician colleagues to just jump on board and say, take this supplement, and then they’re like, where do I get it? And they’re like well, I don’t know, you can get it at CVS or something like that. But I feel like there’s a lot of my friends that are doing that right now. So tell me what you think can sort of solve this problem.

 

Alex Keller, ND, CISSN

Yeah, so many great points and questions. I wanted to touch on one thing quickly, though, that you said that the chronic care has been put to the side, and I fully agree that, you know, we’ve had to prioritize the acute situation more, but one positive or silver lining that’s come out of this is that the association to COVID risk and comorbidities has gotten a lot more attention to the point where we’re now seeing that many more practitioners are looking to deal with prevention and to address these comorbidities before something like this happens again. So there’s, I think a massive shift happening right now where people are aware to the fact we can’t let chronic disease, let the fire of chronic disease get this hot, otherwise it’s going to cause disasters like we’ve just seen. 

And, you know, we were talking just before we got on here that right now, 60% of US adults are dealing with at least one chronic disease. That’s an incredible amount when you think about it, right? How can six in 10 people be dealing with a chronic disease right now? It’s insane or three in five. So, you know, we’re at this moment, I think in history and especially medical history where we have to reflect on how we’ve let things get to this point, and we have to start thinking about how can we reverse the biological clock on chronic disease, if you will, and start focusing on these things. 

So consumers are already doing this, right? There’s been an incredible spike in awareness and in consumption of preventative and wellness types of products in the last year. So I was looking up a study here. I couldn’t see exactly who it’s from, but three in 10 Americans increased supplement use since the onset of the pandemic. Whoa right up like, so six in 10 are dealing with a chronic disease and three in 10 increase their supplement use because they’re looking for alternative ways to either support their immunity and health or to deal with their general health to try to be healthier and hopefully prevent something like this from happening again.

 

Cheng-Huai Ruan, M.D.

I think humans by nature want to be empowered, right? So I think what the pandemic presented as a seemingless uncontrolled virus that’s really out there, but then the human curiosity is like, hey, what can I do for myself? So naturally, yes, you’re right. The consumer’s already doing this, right? And what I find is that a lot of patients talk to their doctors, doctors like, well, you know, I don’t know what you should be taking, but here’s some pharmaceuticals I can prescribe to you because that’s what medicine has been, traditionally. 

You know, I can prescribe, you know, medicine X to the pharmacy and then, maybe Walgreens or CVS will text them on their little thing, hey, your prescription’s ready to pick up and go pick it up and then that’s that. So that’s been sort of like the simplicity of what, prescriptions are. I put in some, like my electronic medical record, it goes through, it tells dosing, refills and all this stuff like that. Which is funny because when EMR is first started, it was a pain in the button and actually still pain in the butt, but now people kind of expect it. So how do you think doctors should really address when their patients are asking them about, vitamin D or N-acetylcysteine or vitamin C and stuff like that? And how do you think that doctors can execute on providing that information and then deliver value to the patient in that way that has not traditionally been delivered before?

 

Alex Keller, ND, CISSN

Yeah, so there’s kind of two points here. One is, how do you educate the patient that this is a safe intervention, that it will be effective in either preventing or in treating whatever it is that they’re concerned about. So you know, you have to do some educating and if you yourself are not educated to provide those details, then we’ve learned since Fullscript to have all of those details available handouts, reference documents regarding specific ingredients that you can use. And as a result, get the patient on board this treatment plan in the first place. 

And then that’s a big step in getting an adherent to whatever treatment plan you provide them. And then the second part of that is how do you actually deliver that efficiently in practice? And that’s the point of our platform is we’re essentially an e-prescribing platform for supplements or more broadly for the integrative treatment plan if there’s other components that you want to plug into your treatment plan. And then when you use our platform, which is integrated into numerous CMRs, and we’re continually integrating with more, then after the treatment plan has been delivered to the patient, they purchase the products. Then our job is to keep them on track with that treatment plan. 

So you now you’ve got this platform in the background, that’s kind of acting like a health coach or a patient care coordinator, and actually keeping the patients engaged with their treatment plan and keeping them informed. We provide them ongoing education about wellness, things like sleep and breathing and certain dietary things, just to make sure that they’re continually engaged with their wellness, such that when they see you intermittently, they always want more information and you can, it’s essentially setting them up for your next visit so that you can continue them down this path.

 

Cheng-Huai Ruan, M.D.

Right, and you know, for the doctors out there listening, sometimes like prescribing supplements is sort of the gray zone, and I guess it’s honestly, it’s really easy to go into my EMR and prescribe, dexamethasone and send to this pharmacy and this date. And so I think that when we started with Fullscript many, many years ago, and even over the last year, what we’ve noticed is the quality of the conversation with our patients actually becoming better because there is education that’s behind there. And because there is a perceived higher value whenever a vendor company goes out and takes the extra mile for the patient, which is why we’re even talking today. 

And so, and a lot of companies on the summit actually do that is to go out of the way to over-deliver that value to make us the physicians look very good and it’s very easy to do so. And so I think that since the pandemic, we’ve really truly value the communication and the connection with the patients on a much higher level. I think Fullscript is really allowed to deliver that as well. So let me just kind of put this in a way, if I was back into my 2013 self, when I first started with Fullscript, one of my issues is that, I fear that patients are gonna ask me about, different supplements and different things that I really couldn’t answer, but what it seems like, and what I’ve noticed is that Fullscript actually provides a lot of that discussion with the patients already, is that true?

 

Alex Keller, ND, CISSN

Yeah, just to be clear, we tread lightly in this regard because we don’t want to step on our practitioner’s toes right so you don’t always know exactly what’s being discussed, but what we do provide is a very robust blog to begin with where patients can go through and refer to highly referenced articles. So everything that we provide is very evidence-based, very rigorous the reference such that we’re on the verge of getting HONcode certification, which is this certification that essentially audits your content and make sure that it’s medically trustworthy. So there’s that, there’s a library of patient handouts that you can use to reinforce your treatment plans, protocols, ingredient reviews. So we try to create a whole bunch of content to allow you to support your treatment plan or allow patients to become more literate in this kind of medicine.

 

Cheng-Huai Ruan, M.D.

Are those shareable, like this content. So I can just grab this from the Fullscript site and then provide it to the patients, like a link that’s shareable, or how does that work?

 

Alex Keller, ND, CISSN

You’re just teeing me up here, I love it So a lot of our content is on our site. And then when you sign up for Fullscript, there is a library within the app of all of these patient handouts. We have guides, we have one page handouts, for ingredients, we have little things like goal setting templates, all that beautifully designed by our onsite creative team. And everything is made to create a very good experience, a rich experience that you don’t typically receive in medicine. I mean, when you’re dealing with pharmaceuticals and pharmacies and the traditional EMRs, things are not a great experience and we’re not really considering the patient experience in most of this. 

It’s usually very rudimentary and meant to just convey a very specific message. People want more now, nowadays, they want experience. They want agents who are reaching out to them, making sure they’re okay. They want somewhere where they can text and chat if they have a question. Hey, my product is not tasting very good. Do you think I can consider an alternative, and within seconds, there’s an agent there saying, yeah, let me get in touch with your practitioner or let me help you with this depending on what you prefer and going from there. So we’ve created all these customer experiences that you wouldn’t otherwise get if you’re sending someone to Amazon or to Costco to purchase product. If you keep it in-house within your ecosystem that you control, you get much more value out of it, like you were saying. So that’s our job is to create that value and make you seem like the star, because you chose to use a service like ours.

 

Cheng-Huai Ruan, M.D.

Yeah, you’re right. Consumer experience is sort of everything, especially in this modern day, right?

 

Alex Keller, ND, CISSN

Yeah, it kind of works, exactly.

 

Cheng-Huai Ruan, M.D.

Yeah, yeah, and even beyond e-commerce, I think that whenever, and this happens a lot, but especially during the pandemic, is that whenever there’s a time of uncertainty, like with the pandemic and stuff like that, practitioners get loaded with questions. Just see my inbox on a daily basis. And I think that anything to alleviate that is gonna be much better. And so, I personally answered a lot of questions within the Fullscript platform. ‘Cause I had a patient asked me today, “I just got exposed to COVID and what do I do, what’s your recommended protocols?” So I kind of responded just within the Fullscript platform. And so she was able to, get my recommendations through the platform, through our family, and it turned out to be really, really easy. So that automation is very valued because normally I would just talk to my medical assistant and say, hey, this is what I recommend . 

The medical assistant would say, “hey, I’m gonna email you this.” If they catch him at the phone number that they’re able to reach them at that specific time. So there’s multiple steps in the standard operating process, right, that then if delivered the value and you wanna decrease as many steps in between as possible. And that’s our goal at Texas Center for Lifestyle Medicine. How can we decrease the number of steps to get to the end value and how do we decrease the pain points of everyone? And I think you know, like you said, the e-prescription of supplements is so dang important. And if that allows my patients to have a really good experience, to have over delivery of care, that’s what truly matters, you know?

 

Alex Keller, ND, CISSN

Well, the expectations from consumers is elevating day by day, right? We as practitioners, we’re, I wouldn’t say threatened, but there is some degree of threat with consumers being able to self-diagnose and self-treat relatively easily nowadays. You know, there’s quizzes and there’s blood tests and there’s genetic tests and all sorts of things that you can do automatically yourself. And this is something we’re acutely aware of and discussing internally at Fullscript is how can we be a tool that helps protect and shield the practitioner patient relationship. So that patients don’t just go out and do this kind of thing themselves, because that’s harmful for patients and it’s not going to be good for healthcare in the long-term if that happens.

 

Cheng-Huai Ruan, M.D.

Let’s elaborate on that was so super interesting. You’re right, there’s a lot of self-diagnosis going on. And I feel like it delays the progress of a lot of our patients when they’re coming with 13,000 different things. Not that they don’t matter, but patients don’t necessarily know how to organize that process because they read on this blog and this blog, and then this doctor said that, and this doctor said that and they want you to kind of like make sense of it, right?. So let’s talk about that for a second. 

So especially since the pandemic, this is going on, and this is not gonna stop, man, this is gonna keep, the fire just got lit, and then, you know, this year maybe COVID-19, next year, maybe something else completely different, and I think we’re in that really strange transition in medicine where now we’re going on to telemedicine platform, right? And now we’re talking about supplements, we’re talking about what you can do for your health. And then nobody trusts what the government has to say. It seems like it’s a lot of our patients, and I think, for practitioners, we’re just kind of stuck in the middle, almost reacting and observing this, and it really burns us out. It really burns a lot of practitioners out in doing this. So you’re talking about how you kind of wanna approach this internally. How do you see the future of that playing out?

 

Alex Keller, ND, CISSN

Yeah, it’s a great question. I think it really depends on how each individual practitioner practices, right? So for you Cheng, you’re already very automated and very aware of all of these touch points that are necessary for keeping patients engaged. So our job in that case is relatively light, we compliment everything you do. Then there’s other practices coming into this space, that may be solo or in a small type of practice where they haven’t automated a lot of things. And our goal at that point is to figure out how much can we do to help provide you a turn key experience in this space? Because a lot of people don’t realize is truly practicing integrative medicine is hard, it’s complicated, there’s so many different things you need to consider .

From all the assessment components to the diagnosis itself, to the treatment, to the maintenance of treatment. I mean, this isn’t just, you have a symptom, here’s the drug. This is, you have 10 symptoms, you have three underlying conditions. You have, you know, all these different things you need to consider for treatment. Like you said, you’re probably coming in with a whole bunch of information products to begin with. And then after you’ve cleaned all that up and put them on a treatment plan that you believe in, now you have to maintain that adherence and behavioral change over the longterm. 

And if you don’t have a system in place to make sure that people are sticking to their plans, they’re gonna come and go very, very quickly. and such that we found in integrative medicine, but generally medicine across the board, adherence is at best 50%. So if we can improve that even by 10 or 20%, that’s a significant impact on healthcare in general. And for anybody who’s not currently practicing integrative medicine and coming into this space, it only gets harder, not easier to keep people fully engaged and understanding what all the pieces are. So we definitely need automation, and that’s where we see our platform coming in, especially at the treatment plan, and what happens after is how can we help with all those components?

 

Cheng-Huai Ruan, M.D.

Yeah, and you’re right. It’s global medicine, not just integrative medicine that we’re kind of experiencing the shift towards the adherence is gonna be a lot less. And I think that has to do with the feeling of uncertainty, right? And so if there’s no process that automates, hey, how you doing? Then people get really distracted. You lose your patients, you lose them to follow up. And then they come in a year later, it was like, hey, you know, we’d never talked about X, Y, and Z. Well, it’s been a year and a half. So I think that everyone has tasted this bitterness. And it’s so hard to just say, well, you know, let’s just pick up the ball and keep going, but that’s why automation is so important. That’s the whole reason for the summit. You wanna automate the patient experience. And I think doctors kind of forget that we’re in the service industry. 

That we’re in a environment where our job is to teach. The word doctor means, it comes from a Latin word, to teach. So we gotta be able to teach our patients to manage different things, but especially right now. That level of uncertainty is at unprecedented Heights. It ain’t going anywhere. So we really have to make sure things are rolling smoothly, I kind of wanna compare something real quick, ’cause I have a long history of having relationships with compounding pharmacies because these compounding pharmacies are usually individual owned, not the major chains. They reach out and they talk to the patients when I prescribe a drug that may be compound and stuff like that, though their staff will make sure that, hey, you know, we’ve got this prescription, did you get it? And then they’ll follow up on a patient. So that experience has been pretty good. And what it seems like is that experience is now translating into what you guys have on the supplement side. So describe how did you guys even come up with, what’s the story behind Fullscript? How did you even come up to where you are right now?

 

Alex Keller, ND, CISSN

Oh, okay yeah, So we’ll, let’s go back in time. About the time that you were starting to practice like this. So Fullscript is now 10 years old. If you go, we merged with another company called Natural Partners in 2018. So that’s 25 years, but the model of Fullscript is really only 10 years old. And it was born out of one of our co-founders, who was a developer. His partner was an integrative practitioner and she at the time was just starting a clinic and she had to buy a whole bunch of products to stock in office because there was nowhere that you could send your patient to purchase these kinds of products. And we’re talking the professional types of products that are not easily found in retail settings.

And so she was stocking her inventory and one day over dinner, she said, I’m so stressed with dealing with all of this. I’m not a purchasing expert, I’m a practitioner, I’m a doctor, I don’t wanna deal with this. And so he said, well, what if I created a platform where we had a catalog in the background, and you could just tell your patients to go do some sort of interface and they buy the products and then we ship them, would that work? Sounds so simple, but there’s literally nothing like that. So he and his co-founder built the platform as it is now. And over time, it evolved into being more of a refined prescribing experience. 

So that was essentially the first eight to nine years and then two years ago, we started realizing that adherence is a significant problem that we can solve. We had solved the challenge of people stocking products in their office and all of the problems that go with that. So great, that part we solidified. But what happens after that treatment plan is delivered to the patient. That’s now the spot that we want to focus on. So we spent eight months doing a comprehensive research paper that’s now PubMed indexed, and it was all focused on kind of the big picture of treatment adherence in this space. And what we realized from that is aside from all of the things that we can do as practitioners to try to improve adherence, a lot of what’s necessary are human touch points after the fact. So automation you can do through through platforms like ours and various others, and obviously you’re talking all about that here, but the human portion of it is still so necessary. 

And again, you know this because you built your clinic model with all sorts of human contacts along the way, right? Such that I think last time we spoke, you said your health coach team or your patient care coordinator team is kind of at the center and you’re now on the periphery. And I just love that because it’s taking the doctors a little bit out of the center and putting the patients with the high touch health coach or care coordinator staff in the middle. And we the doctors are just there to help guide and make sure everything is okay. So that’s where we felt, okay, as a platform, if we’re managing what people are recommending and product wise, and then what people are purchasing, we can also reinforce that people stay on this type of plan with our human staff. 

So we have a large CS team that caters to the thousands of interactions that we have every day. And we thought, okay, let’s take a portion of that, and just test out here what it would look like if we had these CS team members proactively reach out to patients who haven’t filled a treatment plan yet. So we started doing that. And what we found so far is the vast majority of the time, people either didn’t get the communication. So they didn’t get the email, or they didn’t get the notice because it was blocked or something, and they were glad that we reached out. 

They didn’t know how to open it because maybe they’re technologically not as savvy. They had questions about the products, but they couldn’t get in touch with their practitioner and they just need those questions answered. So you kinda see the picture here that the vast majority of the time, it’s not because they didn’t wanna follow the treatment plan, it’s because something else got in the way. And if we didn’t follow up, they would have fallen off. They would have become disengaged, maybe not come back to see you again. So this really speaks to the fact that we need to maintain that human contact between visits as much as possible. And it’s not always easy for clinics to do that if they don’t have a system built like yours. So that’s another component now that we’re trying to solve and it seems to be proving itself pretty quickly.

 

Cheng-Huai Ruan, M.D.

Yeah, so this is what hospitals do. You know, if someone is an inpatient, they get discharged and the hospital gets penalized, they have to foot the whole bill if the patient bounces back within 30 days, especially if they’re on a government plan. And so huge incentives for hospitals to make sure the patient stays as an outpatient. So they’ll have multiple touch points, follow-ups, nurse practitioners, physiotherapists to make sure the patient’s actually okay. And then the hospital team actually follows with the physicians and saying hey, you’re the primary care doc. 

We just made contact with your patient. This is how they’re doing. And I get to make sure that I follow with the patients too. And so, and that’s beautiful. And I wish that happened when I prescribe a pharmaceutical drug, but it doesn’t. But so what we did is internally, we created outreach based on that through different platforms. But it is expensive to do. Is it expensive it’s very difficult to do de novo within a smaller medical practice or even a medium sized medical practice. It’s very difficult to do because the allocation resources is just not there. When a lot of doctors are just kinda like already burnt out with documentation and notes on the stuff like that, the last thing you wanna do is kind of develop the system. 

So that’s why I really appreciate about what you guys are doing, but your story of how Fullscript developed to what it is today and over the last two years has been very interesting because, just from the outside, looking in Alex, from a physician standpoint is I’ve always considered companies kind of staying in their role because Fullscript is a eScribing settlement platform, and then now there’s like humans delivering value to the patients. So I consider that an over delivery for what you guys got going on. But that must mean that we kinda see the future very similarly, is that whichever company develops the best human experience that supports the physicians. That makes sure that the patient’s always gonna be patient centric. And so it’s like a try when it’s a win-win-win. so I really appreciate what you guys are doing.

 

Alex Keller, ND, CISSN

Yeah if I can make two quick points, you know this research also pointed out that, to what you were saying up to 70% of hospital readmissions are due to patients not following their medication plan. So imagine we could provide the service on the pharmaceutical side, you might be preventing up to 70% of all hospital readmissions. That’s just staggering. Think the other thing to point out, this is not a sales pitch at all, but I think, the fortune in how we’ve landed on our business model is that, the way when you sign up for an account, you can make up to 35% on the sale of a product. if you so wish. You can also sign up for no margin account and make no margin on the product or on the sale of the product and not necessarily be affiliated with the sale of the product. 

Some practitioners just choose to do it because they don’t want to be affiliated with the sale. But the platform itself is free, there’s no cost for this. And if you want to have our team do the proactive outreach that we just talked about, the only thing that we’re collecting back at this point is a portion of your margin. We’re not charging you extra for anything right so the benefit here is that, you’re not paying up front for this. So for anybody getting into this space, again it’s a turnkey solution that requires no upfront investment. I don’t know how many platforms you can say that about because most software platforms nowadays require some sort of a SaaS membership. A software as a service membership. 

And we don’t have that, so there’s a real benefit here too, for if you’re not into supplements yet, and you don’t really know how you get started in this. You can use our platform for free just to play around at first. And if we integrate with your EMR, great you can now play around with that experience too, until you’re familiar and comfortable with it, and then you can get going. And then at that point, if you want our value team to do that proactive outreach, and then you can, you can opt in for that as well. So it’s kind of a no brainer. It’s very easy to do this.

 

Cheng-Huai Ruan, M.D.

Yeah that’s a great interlude. And you know what, let me ask you this. What type of practitioner should really use Fullscrupt?

 

Alex Keller, ND, CISSN

Great question, I mean, we have all kinds, but the vast majority of our users right now are medical doctors, naturopathic doctors, and chiropractic doctors. So typically the practitioners who tend to recommend a product as part of the treatment plan. And I say it deliberately like that because it could be a pharmaceutical product or it could be a supplement product or any product for that matter. But those three are the ones that tend to do that the most often. So those are the three most common, but if you’re not a nurse practitioner, if you’re a registered dietician, if you’re any kind of practitioner, then you can use this platform.

 

Cheng-Huai Ruan, M.D.

That’s great so I think a lot of issues that I come across when I first started the platform is now also a part of a practice and I have partners and it will be really difficult to keep, you know, supplements and stuff in the house. And I think coming from an old traditional, conventional practice, it was sort of a no-no amongst the partners, right. And so tell me if there’s a need to keep supplements in tow with Fullstrip or is it just, you can just directly use Fullscript as, like almost like a pharmacy?

 

Alex Keller, ND, CISSN

No, there’s no need we do offer a wholesale option as well, and everything is integrated once. You have one account and you can either purchase wholesale, if you wanna keep certain products in your office, some people opt to do that for very high volume products that they know are gonna move, but that’s fine. And then we have a, what we call direct to patient. So you use our software, like any prescribing platform, the patient receives notification on the other side, and they then log in, they purchase the products, everything ships directly to them from our warehouses. And it’s all taken care of like that. And then do you have automated refill reminders and everything else that we’ve talked about?

 

Cheng-Huai Ruan, M.D.

What about like HSA or flex accounts, can patients use those?

 

Alex Keller, ND, CISSN

Yes, yeah. Yeah, you’re again, you’re teeing me up here and thank you. They, so HSE, we are HSA and FFSA LSA all of the the options qualified, And we actually, we typically, at the end of the year, we send a notice out to all patients to remind them if they have such accounts that they should use those dollars before the end of the year, so–

 

Cheng-Huai Ruan, M.D.

Oh wow I didn’t know that.

 

Alex Keller, ND, CISSN

But I think about that, yeah, exactly. So as a practitioner, if you’re collecting revenue, those are the kinds of things that we’re doing in the background to just keep driving patients to you so that they’re reminded to purchase products if they need to.

 

Cheng-Huai Ruan, M.D.

Well, that’s really good because, you know, that’s another level of delivering value. That’s generally outside of the traditional medical care, but it’s saying that hey, we care, right. And it really helps that that gets tied to the practices, which is great. So have your practitioner kind of listening to this, the link is below if you wanna try out Fullscript, it’s pretty much risk-free. And I literally did it one day in 2013 because a patient asked me about vitamin D and how the patient literally gave me an article on how, you know, D3 is better than D2. So I went down this sort of this rabbit hole, and that’s really how it started with Fullscript. And then after that, I just didn’t stop. So, but that was a while ago. And I think that, you know, on this discussion of providing value to the patients, all right, just from a doctor standpoint, I think we’re trained like this in medical school, I’m seriously trained medical doctor, MD went to residency and the way that we’re trained is that there’s several ways we deliver value. 

We deliver value to the patient’s education. We deliver value in the way of a prescription. And then we deliver value in the way of coordinating care, if you will, right? But the average primary care visit in this United States is seven and a half minutes, by the way, and so in that seven and a half minutes, you can deliver only one of those values pretty efficiently. And that’s generally with a prescription of a medicine. And I think, we’re in a time where that’s gonna go very sour. The longer people are really wanting to take charge of their health in the near future. And I think that mentality accelerated 15 years with coronavirus, I really do, you know so I think that with platforms like yourself with Fullscript, where there is a, almost an obsession to kind of deliver value to the patients, I mean, it’s gonna be a big win. 

And for those of you out there listening to this, just from a business standpoint, and this is my view, whenever you’re doing a business, especially if it’s a startup business in private practices and stuff like that, you have to keep understanding, you have to keep listening to the patients or the clients. And so I actually got this from Tillman Fertitta’s book, it’s called “Shut Up and Listen.” And I thought the books about shut up and listen to him. But actually it’s about shut up and listen to what the consumer wants, right? And there’s one thing, Alex that I’ll never leave my head is his, is Tilman’s example cause he owns a lot of steak restaurants and stuff like that of breakfast at 2:00 PM. 

And so a lot of places, for example, if a consumer walks into the door into a restaurant, a patron, if you will, and then they order, try to order breakfast at 2:00 PM. A lot of restaurants say, oh, sorry, we don’t serve past X, Y, and Z anymore, you know. And so from a business perspective it’s almost a little bit daunting because you’re letting the clients down, but why not offer that service, if there’s additional cost to put that into the costs, you know, additional $2 whatever into the cost of the meal. And then that that type of mentality within a company in a corporation is actually can be very viral. It means that now that people understand that we wanna be able to over deliver. 

So if I take that breakfast at 2:00 PM, example into the medical setting, is that right now we’re doing prescription refills and referrals to other practitioners and stuff like that. And if they want that breakfast at 2:00 PM, meaning that they wanna know what they should be taking vitamin D and stuff like that, right. We should be able to adjust our fixed costs to accommodate for the patient, deliver the value to them, right and then that makes the whole world go around because at the end of the day, we’re not, we’re not here to practice medicine, the way that we’re trained, we’re out here to practice medicine, using the things that we were trained but also adapt into situational changes, which is exactly what’s going on in during the COVID pandemic and all this stuff right now.

 

Alex Keller, ND, CISSN

Totally, you’re funny you just reminded me of a funny experience when I was in college, I was working at a restaurant called The Keg. I’m up here in Canada and The Keg is the best known steakhouse chain across Canada. And they thrived on that kind of mentality where no matter what the customer asked for, we just did it. And early on, I remember somebody ordered a peanut butter and jelly sandwich at a steak house. And my manager said, “You go to the store and you buy peanut butter and we’re gonna make this peanut butter jelly sandwich.” And I said “Yes sir.” And out the door I went and I got the peanut butter. We made the sandwich. And that’s the philosophy that that restaurant took 99.9% of people came in for the stakes but that 0.1% that came in for the peanut butter and jelly sandwich. 

That’s the viral customer that would now leave a review and say, I’m so grateful that you make my child a peanut butter and jelly sandwich when no other restaurant would do that. So I completely completely agree when we’re in healthcare, especially this kind of healthcare where there’s lots of competition out there and great user experiences. We have to step it up. We need to provide a really solid overall end to end user experience for our patients and then they’ll love you. And then there’ll be loyalty, and you will thrive as a practitioner and you will enjoy every day of your practice because your patients are so happy with your care, is such a difference if you are restrictive to how you treat your patients and the type of energy that you get in return.

 

Cheng-Huai Ruan, M.D.

Wow that’s really congruent with what I just said. This is perfect, The keg, huh? Try that. is that restaurant just in Canada or no?

 

Alex Keller, ND, CISSN

I think it’s survived so far. You know, it’s one of those that, that has been pretty resilient through all this.

 

Cheng-Huai Ruan, M.D.

Oh, that’s great, that’s great.

 

Alex Keller, ND, CISSN

And Cheng I want to mention one last thing, if you don’t mind. You know, when I, so I went through naturopathic training and for people who don’t know about naturopathic training nowadays, I feel naturopathic gets somewhat of a bad rap, but most of the modern MD training is actually very evidence-based. And so we come out of school, these doctors who are probably most trained in the supplement and nutrition space. And so we have that advantage to begin with. And I have to say, even with that training, I came out and still felt like I knew nothing in this regard. And I was constantly looking for resources on how to guide decision-making when I was looking for you know, I’ve got a patient with this condition in front of me. 

What’s the appropriate supplement and what dosage and where do we even start that’s me with my training. So I can imagine if you’re going through conventional training where you don’t learn a lot of these details, where do you even begin? So this is a big part of another problem we’re trying to solve, which is before the treatment. And that’s giving you tools to make better decisions when using supplements. So we’ve built very rigorously evidence-based protocols that are now embedded into our app so that you can use them for reference when building a treatment plan. 

And we are building a library of ingredient references so that you can see if, let’s say a patient asks you for vitamin D3, like you said, you can go and cross-reference, if vitamin D3 is actually appropriate for what they’re asking for, what you’re considering and at what dosage and maybe what formulation or whatever you should be thinking about that, there’s a lot of nuances in this space when you’re dealing with supplements, you know, like different types of ingredients, the dosages, the forms, how you’re prescribing them is it liquid, is it capsule? We’re trying to simplify all of that to make it really easy to use these kinds of products, because it’s not easy, but we think we can make it easy for you so that it’s easier to come into this place.

 

Cheng-Huai Ruan, M.D.

So you’re like the Wikipedia of supplements? That’s great. It’s very hard and even in, you know, in traditional MD conventional training is that, you know, when I finished residency in 2012, and by 2013, the American Heart Association changed their guidelines. American College of Endocrinology changed their guidelines and then asthma and COPD for chest changed their things. And everything was different within about two years, you know, I think guidelines changed all the time. And then I think things change all the time. And it’s really hard it’s really difficult for, practitioners to really keep up with the times. And so I appreciate that, you know, when I’m trying to research supplements is not as laborious if you have guys have a library that’s kind of already has the resources and the references that are there. So that makes it a just a whole lot easier but–

 

Alex Keller, ND, CISSN

UpToDate, do you know UpToDate?

 

Cheng-Huai Ruan, M.D.

Yeah, yeah. I use UpToDate every day, yeah absolutely. And so, and patients are always more researched than we are, it seems a lot of times when they come in. And so it’s really nice to have that library, right. So I’m gonna just start closing it out a little bit. We’ve talked for a while now and it’s been great. And so I wanna ask you a question that I usually ask a lot of my interviewers. So even with Fullscript awhile and what I wanna ask you is let’s go back maybe three, maybe four years. What did you wish you know, three to four years ago about this industry that could have helped you get forward a lot faster?

 

Alex Keller, ND, CISSN

Oh my that’s a good question.

 

Cheng-Huai Ruan, M.D.

I like to stimulate the brain a little bit you know,

 

Alex Keller, ND, CISSN

Funny enough, I started at Fullscript four years ago and we were still a kind of a fledgling startup at that point. So lots has changed. What do I wish I would have known about this industry? You know what, here’s a, maybe a timely answer to that is I wish I had known that COVID was coming because if I had, I could’ve created a lot more resources and maybe prevented a lot, not prevented COVID obviously but allowed for a much easier transition for people to adopt this kind of medicine earlier, as in preventatively and saying, hey, you know, if we don’t start changing the way we do things and addressing the 60% of chronic disease. Maybe we could have done something earlier, but yeah.

 

Cheng-Huai Ruan, M.D.

Yeah you know I see prevention as two aspects. I see prevention through medicine, but I also see a fear prevention. And I think that, yeah, I think part of practicing this medicine is that well we’re in the business of preventing fear as well. We’re in the business of creating certainty, you know, as physicians. So any sort of device or software, and especially if it’s free to use and that’s able to allow us to create some level of certainty based on the roles that we have is gonna be absolute powerful but that’s a great answer. Yeah I also wish any COVID was coming.

 

Alex Keller, ND, CISSN

I think we all do, but God, I love that point about fear prevention because it’s so true and like, just as a small example, our company now has 500 plus people. And so myself and our Chief Medical Officer, Jeff Glad we spent a lot of the past year doing internal presentations to our staff to quell the fear that they had about this entire situation. And not to mention obviously the patients that we all work with and everything, but it was so, you know, with patients, they’re dealing, they’re coming to us with health concerns anyways, but we’re dealing with a staff of this size and seeing the fear that they’re dealing with, it kind of puts in perspective how mass fear can really control the larger public. And you’re right, if they feel empowered in their health, there’s so much less fear for them to be had in this kind of a situation. So a hundred percent agree with you.

 

Cheng-Huai Ruan, M.D.

Yeah so that’s you know, I think everything that we do that we wanna be able to make sure that it’s always patient centric, you know, business can’t be a business without satisfying the clients. So, you know, medical business can be a business without creating a really good experiences for our patients. You know, it’s not about prescriptions, it’s not about practicing just good medicine it’s about communications, it’s about the human touch points. And so that’s something that I really appreciate. So thanks for coming along, man, it’s been such a fun discussion. We’re gonna have a follow-up discussion as well of something called the treatment plus program that we’ll discuss on another video, but let’s have the people who were interested in just checking out Fullscript is there’s really no risk. 

The link is with this description and the video click on it, just literally just check out the platform is actually really fun and easy to use so much so that most of the practitioners within my practice, they could just tell the medical assistant, just go on and send us to the patient, but it’s faster and easier for them to do it themselves. They all do themselves and it’s pretty cool. So I, myself included and I hate doing work that requires a lot of, there’s just a lot of ease to it. But go ahead and just check it out and just literally click on the link and just check it out and just take a look and gander, you know, surf around and then have fun with it. And that’s exactly what I did in the beginning. But right now this platform is a whole lot more robust than it was in 2013 I noticed so.

 

Alex Keller, ND, CISSN

Yeah, it definitely is. Hey Cheng thanks so much for having me on, really a great time with you as always.

 

Cheng-Huai Ruan, M.D.

Yeah, thanks for your time, I really appreciate it.

 

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