This week on the podcast, we feature Dr. Alex Keller. He is the medical director of Fullscript, and he’s here to talk to us about adherence. This has been a topic that we’ve been hot on at the Evolution of Medicine throughout our existence, and we’re excited to have a guest from our long- time sponsor on to share his insights and new resources.

Highlights include:

  • The five things that practitioners can do to drive adherence
  • Incredible statistics about adherence in medicine
  • Fullscript’s new feature: Treatment Plus
  • And so much more!

5 Keys to Treatment Adherence

James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to That’s

Hello and welcome to the podcast. This week we feature Dr. Alex Keller. He is the medical director of Fullscript, he’s also a naturopathic doctor, and today we’re going to be talking about adherence. This has been a topic that we’ve been hot on at the Evolution of Medicine throughout our existence.

What are you going to learn today? You’re going to learn about the five things that practitioners can do to drive adherence. You’re going to get some incredible statistics about adherence generally in medicine. You’re also going to learn about some new features from Fullscript, where they will actually call your patients who don’t fulfill their supplements and find out what’s going on. It’s called Treatment Plus, it’s going to be a part of the evolution of Fullscript as they move towards being a complete partner for all of your adherence needs in your clinic.

It was an awesome episode. If you don’t have a Fullscript account, go to and get set up and you’ll discover today exactly why. Enjoy.

So a warm welcome to the podcast, Dr. Alex Keller. Welcome, Alex.

Alex Keller: Thank you, James. I’m glad to be here.

James Maskell: Yeah, super-excited to have you. So this topic that we’re going to talk about today, I’m super excited about, because actually right from the very beginning of the Evolution of Medicine we realized that this shift from sort of a compliance model that is dominating in conventional care, where the doctors tell you to take the drugs and you’ve got to do it and that’s essentially the sort of the model that’s used, there was this new model that was needed for integrative and functional medicine.

Actually, back in 2015, we did a whole series of podcasts called The Future of Compliance, and the future of compliance that we sort of talked about was empowerment. I remember meeting with Kyle from Fullscript back then and he was saying that the word that they were using was adherence. Here we are six years later and I know that at Fullscript this is something that you guys think constantly about and I’m excited today to introduce some of the work that you guys have been doing to actually measure what adherence looks like.

So why don’t you take us back to the beginning of how this whole project got started and why this is such a critical issue at Fullscript?

Alex Keller: Yeah, absolutely. Thanks for bringing up compliance versus adherence right away. That became quite a sensitive topic for us as we were going through this research in that compliance has been a term that’s been used solidly for about 30, 40 years, and even before that, and it essentially implies the non-questioning following of a treatment plan. Adherence implies more the collaboration or the partnership in a treatment plan. So the patient needing to understand why they are on a treatment plan and then being a partner in that treatment plan. Which as we’re seeing in all areas of integrative functional medicine right now is it’s definitely a major trend of putting the patient at the center of care and allowing the practitioners to plug into that instead of the vice- versa.

So at Fullscript, we try to address issues of friction for practitioners and their patients. Ten years ago, we started by addressing the friction of dispensing and how that was a challenge to do, and now, 10 years later, we felt it’s really timely to start addressing the friction there is around adherence. This is a really big problem across all medicine and our research highlighted this that you’re looking at best at 50% rate of adherence across medicine.

There’s a number of things you can do to improve that, but when you’re starting with that being your best, imagine those practices where they’re high volume and not necessarily focusing on adherence. They might be 15 to 20% adherence. Think of all those patients that are now going through that treatment experience and not having an optimal outcome as a result. So we felt it was really important to do a deep dive into this.

Late in 2019, we solidified the idea of why don’t we do a research study to do a deep dive and actually analyze this from an integrative and functional angle? Because there’s never been research done like this where we analyzed all research out there on adherence and tried to pull in as much of the integrative and functional angle as possible.

But amazingly, there’s actually relatively little research in this space to pull from in the first place, right? So we had to be creative in what we were doing and how we were analyzing everything. Then ultimately, we brought in a second part of it where we did insights gathering with our own users. We have the benefit of having a very large practitioner pool now that we work with and pull data from and pull insights from and it gave us this joint perspective of kind of the big picture with regards to literature review, as well as our own backyard with practitioner review.

James Maskell: Yeah, super-critical. I would say even more critical in our medicine because ultimately what we’re not asking to do, necessarily, or a part of it, is to let’s say take some supplements or remember to do this, but ultimately what you’re asking people to adhere to is, in most cases, a significant lifestyle change. The factors that go into making a lifestyle change, like the factors of changing something that you eat, as an example, there are so many inputs into that decision, right? There’s the purchasing of the different products, there’s the learning how to prepare those products, and then there’s sort of more tastes and preferences that all go into that more than just remembering to take your Ambien. So I think that this conversation really gets to the sort of critical next step in what has to happen for this industry to mature if it has any hope of becoming a new standard of care.

Alex Keller: Absolutely, yeah. Again, you touched on such an important point here. Integrative and functional care is complicated. It’s usually multifaceted. There’s a wide variety of different types of interventions and points of behavioral change that you can influence. In contrast, conventional care tends to be more standardized, it’s more simplistic, it’s usually pharmaceutical-based and maybe some lifestyle changes. But even in a simple model like that, your adherence rates are still at best 50% typically. So you can imagine when you’re bringing in so many other factors how much harder it becomes to deliver an effective treatment plan and then have that long-term behavioral change after the fact, right?

So this is what we wanted to understand is what are all those factors and what are the points that we can start to affect both as practitioners and also, in our case, as a tech platform to change what those adherence rates are in our space, and to make it easier for practitioners to deliver a treatment plan and for patients to follow them.
James Maskell: Beautiful. Cool. Well, I want to dive into this research. I know there’s a lot that went into it and it’s very significant, but in the show notes for this podcast, we will have the report that Alex is going to draw from here. So if you want to download it and read the whole thing, I highly recommend it. It is super interesting just to see.

Really, if you take a step back, just think about all the time that you have spent clinically with the primary research in any topic that you treat patients on, and if you add in going to conferences or otherwise. What just strikes me about this which is so interesting is that we spend all of this time, all of this effort, all this energy to understand the clinical pathways and all these different areas of research, and yet this, what we’re talking about here, whether we understand what will have the biggest impact on the potential of patients to getting well, it seems like adherence is the number one thing. Because it doesn’t matter how good the program is, if the adherence is not there, the value of the program just goes down and down and down.

So if you only ever read one study or one paper over the year, make it the one on adherence, because it plays a critical role in your success as a patient, as a practitioner, and I’m sure that’s something that we’re about to find out.

Alex Keller: Yeah. That’s high praise coming from you, James. Thank you very much.

I’m actually really excited to announce that we are now going to be published in PubMed as well, so this will be an official PubMed indexed study. As of this podcast, we also are publishing IMCJ as well, so you can check it out there. It might be quite a read if you read the whole thing, because it’s about 40 pages long. But if you want a synopsis, just read the first 10 pages, should take you about 10, 15 minutes, and it gives you a really good snapshot into what’s the state of the problem and what are the things you can do to intervene or to make it better for your practice.

So let me give you some stats just to start off here, because again, we wanted to do an analysis of the entire industry, as well as our own backyard, and then come to a conclusion of where we’re at with adherence being a problem. So right off the bat, there’s a 15 to 30% rate of non-adherence to new treatment plans. So that’s, again, across medicine.

Fifty percent rate of non-adherence, as we mentioned already, to ultra-compliance, but especially in chronic disease. So you can imagine chronic disease management, just like generally in integrative and functional medicine, it gets complicated and things are often outside of the practitioner’s hands and very much out of the patient’s hands and so things are continually adding friction to the treatment plan at that point. So you see those adherence rates really start to drop as soon as it becomes chronic.

Thirty to 69%, so upwards of 70%, of hospital admissions are due to medication non-adherence. So let that one soak in right there. Up to 70% of people going to hospitals are as a result of not following their medication plans. That is enormous and imagine if we can improve that by even 1%, what kind of an impact that will have on population-wide health. That translates into upwards of $300 billion a year in costs being associated to non-adherence to treatment plans to the US healthcare system.

So again, an annual cost of $300 billion that we could ideally be improving with some relatively simple interventions, but a lot of it comes down to if you’re not delivering your care effectively in an individualized way and you’re not following up in order to elicit that long-term behavioral change, that’s where you start to run into problems.

Now, the good news for us in functional integrative medicine is that we’re already pretty darn good at delivering individualized care. That’s a big check-mark in this space. So by doing that, you’re already being sensitive to the patient’s needs and you’re delivering a treatment plan that’s realistic for them to follow. That we did not see across the rest of medicine, and that’s really a massive problem. So take that as kind of the first clinical pearl here, that if you can be sensitive to what the patient’s needs are, then you’re already making big strides in improving your adherence.

James Maskell: Yeah, it’s such a really, really critical point. Ultimately, there’s many reasons by which I see that the medicine that we’re talking about here becomes the standard of care and that just is one of them. I’ve seen over just being in and seeing what’s going on in medicine generally in conventional care, there’s all sorts of gadgets and gizmos and apps and all kinds of things that people have tried to develop and when I see like a dispensing machine that sits on your living room table and sends you the drugs at the right time, I kind of feel like you’re missing the point. I don’t think people don’t do it because it’s not easy like that, it’s because at a certain level they’re just really not bought into it and they haven’t really been heard or that there’s just something that’s standing in the way of them doing it, and that’s really where we need to get into.

I guess that’s why I’ve been so fascinated with groups and those kinds of areas because I just feel that it’s not really being driven by it’s not easy enough. I’m sure there are parts of it that we can do with that, but there’s just sort of like this need that has yet to be really met in the patient.

I guess one of the questions I have is what did you learn from the study that you kind of thought you would find and then what were some things that surprised you?

Alex Keller: Yeah, great question. So I just wanted to add one more stat quickly, just to frame kind of how important this topic is. We’re right now in an era where 60% of U.S. adults are dealing with at least one chronic disease and upwards of 40% live with two. So you can think, again, relating back to the stats we just covered, how big a situation this is.

So what did we discover? Well, as I mentioned, individualizing the plan is really one of the key things that you can do as a practitioner because if you’re truly listening to the patients and to their needs, then you will be able to build a plan that makes sense for them. So framed in a different way, there was five key things that we found that were effective for improving adherence.

The first was being cost-conscious across the board. So that can be high cost or it could be low cost, but make sure you address that with your patient in a transparent way. A lot of people we found in our own research with our practitioners tended to skirt that topic because of awkwardness or embarrassment or whatever and it actually was far more effective if you didn’t do that, if you just tried to understand what the patient’s needs were cost-wise so that you didn’t throw a plan at them that didn’t align with costs.

The second was patient readiness. Is the patient ready to change? Are they in a position where they can absorb what it is in the treatment plan? A lot of that has to do with the transtheoretical model of change and figuring out where they stand on that model.

The third was using staged approaches. So is it possible to deliver the treatment plan in different stages so that, again, it’s easier to consume? When we’re talking about complex treatment plans, it’s very overwhelming for patients to receive everything at once. I’ll even admit I’m guilty of this, where, especially early in my career, I would build vast treatment plans because that was compensating for my inexperience and my lack of confidence. So I thought by giving the patient more they would feel like they got more out of the interaction, and that was absolutely counterintuitive to adherence. I look back now and I realize that the more I would throw at them, the less likely they were following the treatment plan, or even come back for a second visit. Now it start with the simple stuff and slowly build up, let them start to have momentum over time, and that’s really, really effective.

Fourth is communication. Again, communicate the plan effectively to the patient and try to really understand who they are and what their needs are. Again, you can do that with specific questioning in the intake and in the first interview and subsequent interviews to understand what’s your driving force here? Is it aesthetic? Is it your family? Is it something else? Then communicate the treatment plan using those nuggets so that it really clicks with them.

A fifth key thing was streamlining the care. This is where, again, where we talk a lot, James, as well is how can we bring other practitioners into the mix? How can we make it such that it’s not just you, the clinician, and the patient, but an entire team of support, as well as a community of support?- We found that community definitely has an impact with regards to reinforcing plans and making people feel supported in way that they’re not alone going through this.

So those are really the five key things that we found. In terms of surprises, I’ll be honest, the biggest surprise was that we didn’t really find anything unusual. This was the irony, if anything, we found that many practitioners were not doing the basics and were not doing the obvious things. I guess that kind of surprised me because I thought this knowledge would be so common and so obvious that there would be more practitioners doing this consistently.

If anything, there may have been some element of overwhelmed within practice and people not knowing how to structure visits and structure delivery of care effectively. Such that, as you mentioned just a few minutes ago, people could be really good at clinical medicine, but terrible at the delivery of the treatment plan at the end of the day. Right? So there wasn’t really that much that was out there in terms of what you need to use for interventions, it was more that there was relatively few people who were doing it effectively and having significant impacts on their adherence rates.

James Maskell: One of the things I always wonder, so a couple of months ago, the results came out from the Cleveland Clinic and were comparing and contrasting the one-on-one functional medicine at the Cleveland Clinic versus the group functional medicine at the Cleveland Clinic and it showed that the group functional medicine had better outcomes and lower costs. I think that could go sort of counter to the way that we’ve thought about individualizing treatments and so forth because your assumption is that, well, if it’s in a group, then everyone’s getting the same thing.

I guess one of the things that I learned from writing the book about group visits was that, one, is that individualization is definitely possible within a group structure, but that ultimately what it shows me is that more important than individualization is activation, right? Activating patients into participating because we’re really talking about, one, more patient readiness, staged approaches, communication, streamlining care, four out of those five, and the fact that now it can be done on insurance, that’s the fifth one, cost-conscious. So just seems to me that that really reinforces sort of why that would happen.

I think what you also shared there is really important is that we hear so many times that patients end up with an incredible treatment plan when they go to a functional integrated provider that never gets executed because it’s just like a barrage of things. Ultimately, that really got me thinking last year, what is the best entry point to functional medicine? Is it more of like something, a container, where people can find some momentum for change? So it’s super interesting.

I’m really interested in the data that you guys have at Fullscript, as well, because ultimately you know if someone prescribes some supplements. I remember early on you guys had some data years ago where it was like, I think, on average people rebuild their supplements a number of seven times. I was just thinking how critical that reduction in friction was to make it easy for people to just continue on the plan, because people don’t reverse a chronic disease in a month, but they might in six months if they follow the plan.

So what were some things that you learned from your data that you think would be interesting to practitioners who maybe have resisted using Fullscript?

Alex Keller: Yeah, great question. Let me see if I can frame this. So what we try to do when we’re analyzing our own practitioners was to segment them into low adherence versus high adherence and figure out what some of the differences were. So I’m going to emphasize more what we found with the high adherence practitioners. For them, again, a lot of the things that we just mentioned were kind of more naturally implemented and they were typically very good at communicating with their patients and using technology in creative ways to streamline the care.

So we talked about streamlining care with regards to bringing other practitioners in and I didn’t specifically mention bringing in other services as well. This was one thing, too, that we found that practitioners who tended to use EHR platforms and then use Fullscript integrated into those EHR platforms and allow for a very smooth streamlining of their delivery of treatment plan. Especially using EHR platforms that were patient-friendly, which is a big factor, too.

I mean, we can go a little bit deeper here, but being sensitive, especially to an aging population, around how to use technology, that these were factors that came up too, right? So you have to be kind of understanding of what the entire journey is here in how you’re delivering care.

So percentage-wise, I don’t really have stats in that sense, but what we found definitely was that the higher adherence practitioners were those who were far more sensitive to leveraging different technologies and making care much more streamlined and easy. Then on top of that, they would often use other practitioners within their models in order to support the care.

So imagine now a scenario where as a practitioner you give a treatment plan and two days later you have somebody reaching out saying, “Hey, how’s it going? Is everything okay? Are you on track? Do you have any questions?” Then at that point to reduce the friction point where if the patient hasn’t, for instance, ordered products or started their plan yet or something, you may catch them before they fall off. Again, a lot of this has to do with the transtheoretical model, where if people are in those stages of change and you catch them at the wrong time, they could very quickly relapse or fall out of the cycle of care because they’re no longer engaged.

So that was a really big factor that we found with our high adherence practitioners. Then another one I’d say was that they were extremely good at facilitating trust. I guess the communication lines were always open and they were ensuring that everything that they were delivering was being communicated in a way that made sense. So the patients would report back that they had a high trust for the practitioners, whereas low adherence practitioners, there wasn’t that trust there.

So where that comes in with a platform like Fullscript, again, is if the patient has a high trust for using Fullscript because it’s not Amazon or it’s not an ecosystem that’s out there, but it’s actually the practitioner’s account that they’re logging into, those kinds of tech interventions, or any kind of intervention like that that helps the patient truly buy into their treatment plan, tends to go much further. So again, a platform like Fullscript makes it much easier to deliver that kind of care.

James Maskell: Yeah, that’s really interesting. It’s interesting you mention that because I’ve been in the last year really connected with a friend of mine called Barclay Burns, who I work with, and his PhD, he went into Mountain Healthcare for four years and studied the trust. Not just trust between patients and doctors, but actually patients between doctors and doctors as they would cross-refer in the inter-Mountain Healthcare system.

His PhD essentially came out showing that outcomes follow trust. That where there was trust in referral, where one doctor trust another and referred out, the outcomes were excellent. Where there was no trust, which was in a lot of places in conventional medicine, that the clinical results ended up being significantly affected by that lack of trust.

That sort of aligns with what you’re saying here and really, I guess, brings me back to this sort of unifying principle of what we’re talking about is that if people are happy in that position, either in the patient position or in the practitioner position or in the teams, there’s just something magical that happens.

I remember when I was a sales rep, I could walk into hundreds of practitioner offices and you could almost tell how things were going by like the energy of the front desk staff, right? Are people getting well here or are people just shunting through and getting it? There’s something that you couldn’t really measure, but I just get the feeling from what you’re saying is that some of that you have been able to measure in your adherence rates through all the data that you have.

So I think it’s just, yeah, it’s very interesting to now turn this into an area of real study because we’re going to have to get this right if we want functional integrative medicine to become the standard of care.

Alex Keller: Let me expand on that, if you don’t mind. I think in this moment I wish I didn’t work for Fullscript because it’s going to sound like I’m trying to sell the platform, but we are truly trying to build our interventions based on research. That’s why we did this study, to understand, again, what those friction points are and then to tackle them one by one.

So another point of data for you is that we found that on average when using an intervention to improve adherence, you can usually improve adherence around 10% or so. However, every month that passes, that improvement decreases by 1%. So it’s a bit of a weird kind of combination of stats there, but what it’s saying is you have to keep changing up what interventions you use to keep things fresh to keep the patient adherent. So if you do a lot up-front, great, you’ve just established really good trust, really good communication, you’ve delivered an effective treatment plan, but if you wait six months to do anything further, you may have lost what that initial trust was that you built.

So we take our brand equity as a platform extremely seriously when it comes to patient care. We want the patients of our practitioners to trust Fullscript’s brand as much as they trust their practitioner’s brand. Even more so if we can, right? Let’s say the practitioner is too busy and can’t work on that, well, then we’ll support that by making sure that our brand is strong.

So last year, for instance, we started putting out patient wellness communications or emails. I don’t know if you’ve seen these, James, but twice a month we send out emails that are purely meant to help improve health literacy with patients to help them understand generally what’s going on with their health and give them some tools and tips that helps reinforce what potentially the practitioner is delivering to them. We’ve found this to be just that. Just putting out an email twice a month with some useful content has shown about a 10% improvement in adherence across practitioners who have opted in for that service. This is a relatively simple intervention, but the whole point of it is that simply by receiving ongoing information like that and trying to impact a patient’s health literacy so that they understand more about why this treatment plan and what’s going on, we’ve seen that kind of improvement.

Beyond that, if you’re using something like Fullscript built into an EHR, you right away have a trust that this is a tech platform that is advanced in the fact that it’s kind of plugged in all over the place. So we found, again, that if practitioners are using the EHRs with Fullscript integrated into it, it tends to be a very good response from patients in terms of that trust.

So now what we’re doing is we’re taking it one step further. We’ve just launched a program called Treatment Plus where practitioners can opt in to have our agents reach out proactively if their patients haven’t filled their treatment plan to do what I just said, say what’s going on? Do you need any support? Do you have any questions? Can we clarify anything? We saw that that had nearly a 20% improvement in adherence. So this is for practitioners who don’t necessarily have the ability to have health coaches or other practitioners or admin staff even to be able to do this. We’re trying to simplify and reduce the friction, again, when it comes down to delivering the treatment plan.

James Maskell: Yeah, I think one of the things that we recognized early in the Evolution of Medicine was that for the first time ever it was possible to have the kind of full-service delivery system of a clinic without having to own all of those pieces, right? At that point, Fullscript was just like an e-prescribed service that made it easy to prescribe the supplements and meant you didn’t have to have a cupboard somewhere with them all there that you would have to like roll out. I think what you’re talking about here is just like your continued efforts to go above and beyond.

I mean, that service is ridiculous, right? To have someone like, if they haven’t done it, it’s no cost there. Just seeing those kinds of numbers in adherence, I mean, every clinic needs that kind of help because who has time to go back and say, “Well, Marjorie from four days ago hasn’t fulfilled her prescription. What are we going to do about it?” That’s just like data that’s accumulating somewhere that depending on the sophistication of the clinic either will or won’t ever get dealt with. I think that we owe it to patients as they go on this path, they’re only really going to give this medicine one shot in most cases before they decide either that it’s real or it’s not.

I think that when patients give us that trust and step forward to say, hey, I’m going to try this different way of doing healthcare, we have to make sure that we’re putting our best foot forward. I can see that many people, who would be kind of lost in the shuffle because they didn’t realize they were going to have to do so much stuff, to have someone reach out and say, “Hey, how are you doing? Were you able to fulfill your prescription? What’s going on?” I could imagine that those conversations were, one, super-valuable for the patient, but also pretty interesting for you guys to be able to see what are the common things where things are missing the mark.

Alex Keller: Absolutely. Yeah, you’d be amazed what kind of feedback we get. Things from, “Oh, I never received my treatment plan. Oops.” Right? If you’re not following up, what happens? “Oh, I wasn’t sure why my doctor had prescribed that to me. Can you clarify what it is?” Yes, certainly. Here’s a handout on it, here’s a referral to our medical team, or here’s the quick answer, if they have that at their fingertips. There’s so many insights that you can gather just simply by having practical coverage, but it’s not always possible for all of us do that. As you know, James, the building of a functional clinic better than most, it’s complicated to build a system where you can have people who can proactively do that.

We talk a lot about Cheng Ruan as being such a beautiful example of having built an automated system that does that. So how can we, as the platform, do that for more practitioners and make it easier for practitioners to be able to have access to that kind of a service. That’s what we were trying to figure out.

One other thing I wanted to call out here is similar to what we often hear in finances, people who tend to know their numbers better are usually better off financially, right? If you pay attention to your budgets, if you pay attention to your monthly numbers so that you know what’s going in and what’s going out, you tend to have better control of what’s going on. So one other thing that came out of this research that we felt was a priority build was an insights dashboard, which again, we’ve just launched now, which will allow practitioners to look into what’s going on with their patients. Who’s following the treatment plan, who’s not? Who has never signed in to begin with? Well, they might be a priority to reach out to versus those who have signed in, but maybe went somewhere else to buy other products.

So what can you start to glean when you understand the numbers? This is a major problem point, again, and maybe one I should have called out earlier, is if you don’t have the perspective of where your adherence rates are to begin with and who’s following your treatment plan versus who’s not, it becomes very hard to intervene at that point. So we thought, okay, we need to give more data to our practitioners.

Ideally, we see our vision going forward of having a community of data-driven practitioners, people who understand the numbers. The more you understand your numbers, the wealthier you will be both in money and in practice, in this case. Right? So we thought this was a powerful tool and we’ve just put it out and we’re already receiving really good feedback on that. So make sure to check that out if you can.

James Maskell: Yeah, that’s great. Yes, super-interesting to see that. I guess the one last thing I want to share, or just something that makes me think of, is over the last year, I’ve been involved with a project where we’ve been starting to work with, I would say, people who’ve never integrated with functional medicine before. Right? Just one thing for most of you who are listening to this to think about is that patients that come into your office have already kind of self-selected themselves out from the general population. It’s not your average person that’s showing up in your office. They’ve already decided they want to do something unconventional and they’re ready to give it a shot to activate into that.

That is very different. This sort of activated health consumer is very different from Medicare, your average Medicare patient, or your average commercial health patient that is always just done conventional medicine and has never really heard of these kinds of things. When you start working with those people, you will start to realize that what we’re talking about here is absolutely fundamental and that that population, you need all the tools that you can get, because getting them to change is very different than the activated wellness consumer.

As we start to shift from this sort of early adopter phase where it’s just been the very sick, the very rich, and the very green, to quote Robin Berzin, who accessing this medicine to the bigger sort of blue ocean of patients out there who need it, but haven’t accessed it so far, you need this. You need every help you can get, all the help you can get, because ultimately shifting biology and behavior in that group is no mean feat.

Alex Keller: Yeah, definitely.

James Maskell: Well, thank you so much for coming on. I would say, everyone, if you have got this, I guess what I just want to say, we’re super grateful To be able to have this relationship with you guys because ultimately every company has to decide how they’re going to partner and what that’s going to look like. We were very clear from the beginning that if we could just find the best in category tools that we could represent to practitioners that that would be something that would be in the highest integrity because we’d be helping practitioners truly be successful, but that also we’d be able to build partnerships that would be valuable in building an industry.

I guess I just want to share that I’ve never been disappointed by Fullscript and that the fact that you are going into these really hard areas, right? This is not an easy path, this is a difficult path, but it’s a necessary path just to acknowledge that you keep going there. Services like you’re going to call up people who prescribed but don’t do it, I mean, that is super above and beyond and I know that we’re going to learn a ton from that. So I just want to acknowledge that before we end the program. We’re super grateful to Fullscript.

If you haven’t got a Fullscript account, you can go to and you can get your free account and get started. I would imagine you can sign up for some of those new services, right, that you’ve just launched?

Alex Keller: Yes, absolutely. Absolutely. After you go through that link that you just mentioned, you can also check out, where you can access the paper and a number of other resources. We put out a full tool kit related to adherence to help support you in your practice.

James, I just want to say, as well, not to sound like a fanboy, but the feeling is very mutual for working with you and your team. You’ve been a pioneer for practitioners in this space and now patients and it’s an honor for us to be in partnership with you. So thank you for having us on the podcast and for the opportunity to talk about this.

James Maskell: Absolutely. I’m really excited about the future and I see the team coming together for the transformation of healthcare and it’s looking very strong. So hope you enjoyed the episode. Let us know if you have questions. If you’re a Fullscript user, or if you’re a Fullscript non-user, we’d love to hear from you.

This has been the Evolution of Medicine podcast. We’ve been talking with Dr. Alex Keller. He is the medical director of Fullscript and their new work on treatment adherence. You can find all the details in the show notes. Well worth your time. I think we’ve got some great lessons here today. Thanks so much for listening and we’ll see you next time.

Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit to find out more about their clinical tools like the group visit toolkit. That’s Thanks so much for listening and we’ll see you next time.


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