The Blueprint for Functional Medicine in Big Health Systems

Defining Whole Health 0:00

I think full health to me really means being able to look at the whole picture and hold the complexity of somebody and being to integrate not only like a conventional approach but also bringing in integrative and functional principles and looking at what are all the possible interventions that I could use for many different disciplines and how do I put together a very collaborative team to care for a patient. So it's this ability to hold the wholeness and get complexity and then make it very practical into a plan that somebody can actually take.

Hello and welcome back to the Evolution of Medicine podcast. We are coming to you live from the Institute for Functional Medicine's annual international conference. we are speaking to leaders and innovators, speakers, people who are taking functional medicine into places that has never been. And I'm super excited today to connect in person with people I've spent a little bit of time on Zoom with over the years. We have Laura Sandquist and Kate Atremba, leaders in the implementation of bringing functional medicine into the whole health system.

So let's talk a bit about your journey to get here and how you ended up speaking here, and sort of what started this all. Yeah, well, what started this whole thing is that Kay and I have been working together for the past six years to develop a really large integrative and functional medicine program within a conventional health system in Minnesota. And throughout doing that work, we've learned a lot of lessons of what works, and what doesn't work. We wanted to present to really help other people know how they can implement this into systems because it can be a challenge.

Yeah. Different challenges than before. And this year I hear that 40% of the attendees work inside health systems, which is a new sort of growth area for IFM. So it's probably good timing for you to be here. What were some of key lessons that you shared in your talk and what has been the response from the community here?

Building Functional Medicine in a Health System 2:00

Yeah, the main areas we focused on sharing with people attending here were how to build an infrastructure so that you can thrive within the conventional system because the Conventional System does have some constraints like you have to meet certain RV requirements to be sustainable. You need to chart in a particular way to able to bill through insurance. And you want to make sure you don't burn out your practitioners because of those constraints. And sometimes, too, you have a limit on how much time you had with patients versus a private practice where you can call your own shots on the time.

So within those constraint, what we're trying to show people is kind of what is the infrastructure you need to build. Some of it is clinical tools that clinicians can use right at their fingertips as soon as they get into practice for translating what they learned in the Institute of Functional Medicine into the day-to-day. So we developed smart phrases, practice guidelines, and other templated things within their day to day practices that really helped it work. And then we also found that it was so popular within the system that we needed to deal with that access issue.

So we started group medical visits as well, which is something you had supported us in doing, learning that whole process. And so we have also successfully launched two different types of group, medical visit, some that are nutritionists only led, and then some of our practitioner nutritionist co-led. So those have been kind of the main infrastructure we've built to make this possible. And I don't know if you want to talk about how we also kind made ourselves known within the system, too, with the training.

Yeah, you know, because when you're in a system too you need to really develop trust with a primary care provider and specialist, and that can be one of biggest barriers. We created a two-day CME for primary care providers and specialists, physicians, MCEs, PAs, and we offered that six times over two years. Two-Day Conference, that just gives them the basics of taking an integrative and functional medicine-informed approach. And that was really effective to gain trust and just help to spread that across the system.

What was unique about Alina Health that made it a good fit for this to sort of flourish within it? Yeah, Alaina House actually has had an integrative institute since 2003. So they're pretty early adopters. And so when I came to the system in 2016, there was a really nice stage set to be able to do this work. I can take what had been built and then you continue to move that forward. But I would say even after all those years, for people to understand what is an integrated and functional medicine.

So those doctors take that training that you did and then you find them more likely to refer across or to actually run their own group visits. How did that work? Yeah, mostly we saw an increase in referrals and collaboration, reaching out and saying, I have some tough cases and I'm kind of stalled on where to go, what might you guys have to offer? How could we partner? We also saw them doing more integrative things in their practice, so starting to think about magnesium for constipation or breath work exercises for their patients, not just an SSRI.

So we also felt like it shifted how they were thinking more holistically and from that whole person lens as well. Yeah, that's super cool. I'm glad to reconnect because in the process that I got very excited about the potential for group visits, I convinced myself with a book and I just want to say from my perspective is just how wonderful it was for me to feel like validated that you guys were excited about doing it and that we got a chance to, you know, start the journey together. You know I think I can say learned a lot, like I never really integrated with the health system in any way and didn't really understand what I was getting into, right?

And it's a lots different than, than organizations where practitioners just make their own choices and do it. Um, but I, I hope that the time that we spent together, you know, maybe accelerated some things, may be supported some and that,

Infrastructure, Group Visits, and CME Training 6:00

when I saw you guys on the list saying that hey, we've been successful and we're going to show you how to see us. I was like, yes. Yeah, it was a great experience to go through that process and understand. And it would get me excited all the time because I just felt like we were breaking new ground and bringing something in that could solve the equation that everyone wants to solve, which is like, how do you do this on insurance? How do actually move the needle? And so, yeah, I'd love to understand some of the some of the things that are resonating since you've been here.

We had a guest who I just interviewed who said that that was their favorite talk of their whole time. She wasn't there, so she's probably biased. But yeah, what has been the resonance here and what do you think is possible moving forward? Yeah, well, I think, you know, one of the best things about being on the conference is just connecting with other people doing the same work and just learning from them what's working and what not working. And so that's what I find, most valuable. Yeah. And we've also had a lot of people approach us on these billing questions.

So it's been really nice to be here and be able to say, yes, this is doable. This is how you do it. It's definitely inspired us to think about maybe a course that would teach people on how to do that as well. I think another thing we have noticed is a hey, I understand functional medicine, but how do I translate it into practice? And that was something we saw when we built our very large team is we had to kind of give people some support with bridging that gap. And so that's why we launched our new company was to just help teach people how to start to apply functional in practice.

That's something that we've been hearing here at the conference too. So we're excited to build that network and share what we have learned about how translate this all into practices as well. Yeah, share a little bit more about that. Because I think that when you start doing this, you started to realize, oh, there's a missing piece here. You know, people who are going through different trainings are missing this key part that we've learned from being in tension with the problem for a while. What was the starting point where you looked at each other and said, we got to do this?

Yeah, well, I think, you know, after we've trained, about 24 people in on how do you do this, we just saw the need and kind of the desperation of someone who has the training, but then someone's in front of you and you think how can I piece this all together? And really needing that additional mentorship and support. And so we knew it was a need, and we'd done it a lot the last several years. We just thought we have to do that for more people. we can teach this on a broader perspective and just help make that transition easier.

Also, I think not only though is functional medicine trained, but we get a lot of requests of people who say, you know, i'm really interested in taking an integrated as functional informed approach or a whole health approach. But they feel that doing an entire training in functional medicine might be too overwhelming. And so what are the basics that you could do in a primary care setting or specialty setting, especially with illness system? How do you do that practically? And we've figured that out over the years.

So that's what we want to be able to share. Cool. I know it's called Whole Health NP. Why NP? What is special about the NP and what is especially about NP, what they can bring to this transformation of medicine. So I just want to take a minute to talk about incredible mission partners that we have here at the Evolution of Medicine that have made this possible. First and foremost, I want thank. So Fullscript has been an amazing partner for 10 years. We only pick partners that can help us achieve our vision and help you achieve your practice vision.

FullScript have been incredible partners for a decade, but their new offering journeys, this is why we called it the Evolution of Madison Journeys, is allowing practitioners to combine the relationships that they have with the newest technology to sell direct-to-consumer lab testing and use it as a

Launching Whole Health NP 10:00

funnel to bring into your practice and it's a game changer for the whole industry. So go to goevomed.com slash journeys and you can get started on building the journeys for your practices an optimal way into practice. We're going to have some conversations about it. This is a Game Changer. Next, Jenova. Janova have been fans of the Evolution of Medicine for a long time. We're big fans with them and they now have a lot more specialty testing. They have lot of more tools and it's a key part of understanding the body ecologically.

So go to goyomed.com slash Jonova to find out more. Come on over here. I want to show you about the other mission partners. If you've been following us for a while, you know that these are organizations that we trust, that add a lot of value. Freedom Practice Coaching, I have been supported by them since the beginning. And so many of the issues that practitioners face in building a successful practice, scaling a success practice come down to having the right support with people who have being there and done that.

Go to goevomed.com slash FPC. Big boost marketing. Uli and his team are the best in the business when it comes to really understanding how to market your functional medicine practice. Go to goevomed.com slash big boost and see how they can help you. And then what you're going to be hearing a lot about is the formation of clinical networks. Ultimately, True Neura is our first effort at that, which is to build an integrated clinical network combining independent practices from across the country into a network that can reverse cognitive decline.

And if you go to goevomed.com slash Trinura, you can get a demo. You can see what it means to be part of an integrative clinical networks. That's mentorship, that's software, and that is making it easier for you to get incredible outcomes in a disease state where there are no other options. So thanks to our mission partners. Let's get back to the content. I'll let you add to this, but essentially because a lot of our lens is from the nursing lens and we think it lends very well to what functional medicine also has to offer.

So we're essentially blending the two, so that's why we wanted the NP for nurse practitioner. Just to essentially signal that there is a bit of the Nursing wisdom that is also infused in the way we teach people how to be in front of a patient and where to start applying the functional Medicine principles. also supported by the principles of nursing, and I don't know if you'd say any more. Yeah, we're both trained in integrative nursing which is a specific type of Nursing and that aligns really well with functional medicine's philosophies.

They found combining that is really great synergy and so many nurse practitioners and nurses kind of just get this way of thinking. And so we wanted to really just like highlight that this is the skill that nurses and MPs have. And it can be kind of unique, you know, to our profession. A lot of other people can do it as well, but nurses are fabulous. Well, I didn't tell you I was going to do this, But I'm going put you guys on the spot right now. If I just interview Tracy Gordet, and we have a great relationship, And one of the things that she's worried about is that the use of The word whole health will not represent what whole Health really is.

So it's a test that you have to answer is what does whole-health mean to you? Yeah. Good question. I can start and then go for it. Yeah, I mean, full health to me really means being able to look up a whole picture and hold the complexity of somebody and being to integrate not only a conventional approach but also bringing in integrative and functional principles and looking at What are all the possible interventions that I could use for many different disciplines? And how do I put together a very collaborative team to care for a patient?

So it's this ability to hold the wholeness and that complexity and then make it very practical into a plan that somebody can actually do.

What Whole Health Means 14:00

Yeah, and specifically looking at the person is not just a bunch of body systems that may or may not be dysfunctioning, but also someone in a context, right? So relationships, environment, all of their spiritual connection, their sense of purpose, All of those things potentially impacting their health on all levels, you know, spiritually, psychologically and physically. Good news. You passed the test. That is whole health. And, you know, we were joking about the idea of being, that we're talking about things being dressed up as whole-health that aren't because it's sort of out of the now and it is a new word in that.

I think we, in the same way that functional medicine is having to now set standards for what functional is and the certification, because You know, there has been the use of the word functional medicine in many different ways, which I think is healthy for this emergent movement that we're part of. But now it's sort of like trying to, you know give people confidence that when this word, functional, medicine is used or functional medical certification is that there's some sort like foundational standard.

And, in the same way we were talking about that is like, what is whole health? And whole-health is really about the rehumanization of medicine. So I'm really glad that you came together with that answer because I feel that Especially if you have the background in integrated nursing, that's really where this all came from and that the foundational elements for it. So I'm excited to see that moving forward. Who are the kinds of groups that you'd like to work with? If you could wave your magic wand, who would sign up that would be like, this is the dream?

Well, as far as practitioners that we want to train, even though we're coming from an integrative nursing perspective, we really think any practitioner could use the knowledge of how to take a whole health approach. And if everybody on the team has that perspective then things tend to flow and work better together. So it's really anyone, physical therapists, occupational therapists acupuncturists, speech pathologists. And we can go on and on. Even psychologists, like we've had a lot of conversations even with a local clinic that is a psychology clinic and they were saying, gosh, we really want our clinicians trained in this model because sometimes you're sitting with someone and you know you are at the end of what you can offer from your skill sets.

But if I had a bigger sense of all the picture and the connections, I might know who I need to refer them to and really keep them on their path towards healing versus stalling with me. And so we see it valuable to anybody who's working with people in the healing realm. I can really see the need for that in mental health, but guys, you know, if you are a talk therapist, there's only so much talk therapy you can do. But if have a range of physiological factors driving on mental conditions, and you need that support and that might be.

There's so many obvious examples, but let's say something like pans in a kid, right? Precisely. It goes off the reservation and you don't know why it happened rapidly and find out why that happened. That could be a lot of pain and suffering for something there's quite an elegant solution for, and it could also be what's happening at home and trauma. There are so may ranges of things that it can be and when you find it and deal with it because you've got the right team together. Exactly. you know, whole health solution, while you can only do talk therapy, you sometimes realize, and I've spoken to a number of people who are psychologists and doing mental health, where it's just taking one patient for them to send someone to more of a whole-health approach, come back and see, they say, now you see it in every patient.

Exactly. So now with the new organization, does that mean that Alaina is fending for herself now without you, or are you still in there part-time? Laura's gone, so I am fening for myself without Laura.

Scaling Whole Health and System Change 18:00

I'm still the clinic lead as of right now. And yeah, they're kind of looking at the next steps for the Clinic and where we move into the future and focusing a little bit more on prevention. Okay. So if you come back in a couple of years back to IFM and we do this again, tell me where things are at at that moment. Yeah, I mean I'm hoping that more people are able to access some of the things we're teaching and that we are seeing more functional medicine in the conventional system successfully and insurance-based access for sure.

Anything else you'd add? Yeah. Yeah, my dream is just to see everybody in healthcare taking this whole health-informed approach. You know, it doesn't necessarily have to be in-depth functional medicine, but I think if we think of everybody coming at care with that perspective, we will see transformation in the healthcare system. I mean, I guess maybe just a word on that, because the real transformation that I think that you understand and that your facilitating is not easy, right? There's a lot of mindset shifts that have to happen.

There are systems that has to change. You know, there's whole sort of ecosystem of changes that that had to occur. Is there anything that would like to share on some of the things that might be helpful for other people who are considering this shift? I find that, at least from our experience doing the education series at Alaina, was that when practitioners could experience this type of care themselves, that was really transformative into their buy-in. And so, I mean, definitely something I'm hoping to see more of is people seeking this out for themselves who are already clinicians and understanding the value.

Yeah, and I would like to see the incentives change for insurance. You know, we're still stuck in a fee-for-service model. And really, the system probably won't change much until the incentive change is really what I learned. So if we can see a shift somehow there, that would be really meaningful. Can organizations that profitably sell tertiary care get behind prevention in a meaningful way? Or is that just too big of a structural incentive to overcome? I think they can. They just have to want it.

And I mean, we've proven with our clinic that it can actually be profitable. So it's just a matter of having the people with the training, the right philosophy of care in there and given the opportunity. Well, look, thank you so much for your leadership. I'm really grateful to get to meet you in person and to be able to thank actually for the time that we spent working together. All of these lessons inform where I am going. The functional medicine whole health revolution hasn't really happened yet.

We're still right at the beginning of it. But I see that all of the battle scars along the way inform what has to happen next. You know, as much as I hope that at this moment, you know we would have found a way to help a hundred health systems deliver, to deliver group visits at scale, I can tell you that the problems of loneliness are not getting any better, right? The problems with disconnection are getting better. The problem of implementation into systems are better but the problem still remains and it's like a huge population that needs help.

And so I'm grateful to be on your team. Likewise, great to see you. Wonderful. All right, well this has been the Evolution of Medicine podcast. We've been here live from the Institute for Functional Medicine and these two have been educating this community about what it takes to build successful practices and to deliver whole health in a large health system environment. Check out Whole Health NP and if you're interested in finding out more, we'll have all the details in the show notes for you to get in touch.

Thanks so much for tuning in and we'll see you next time. So we are here asking practitioners about their practitioner journeys and the reason why is because journeys is a new product from Fullscript. Journeys allows you to set up your own lab offerings as the top of the funnel, give the patients what they want, they wanna know about themselves and it's the easiest way to bring them into your practice. We have all types of practices from across the country that are building their own unique lab panels for their unique practices, selling them to their community and acting as a great funnel into their practice.

This is a massive innovation. I think this will accelerate the evolution of medicine. You can go to goevomed.com slash journeys to find out more. Set up your own journeys in half an hour and transform the health of your community. Go get them. So that was the podcast. What an epic session. Thank you so much for tuning in to the Evolution of Medicine podcast, we'll be back again next week. And thanks so