In this Business of Functional Medicine episode, we hear from Zak Holdsworth, a leader in the health technology industry and the CEO and cofounder of Hint Health.
Hint Health supports the direct primary care (DPC) movement and aims to provide affordable, high-quality health care by offering a successful alternative to the traditional fee-for-service model.

Zak Holdsworth’s company offers technology solutions for DPC clinics, including membership management systems and employer infrastructure. They have also developed an EMR system specifically designed for DPC clinics. Additionally, Hint Health has created Hint Connect, a network product that connects DPC clinics with employers and other health care practitioners.

Their goal is to create a unified network of DPC clinics that can work together to provide better care and reduce costs. The company’s vision is to redesign the healthcare system to enable easy access to high-quality, affordable care.

Download and listen to the full episode to learn about:

  • The concept of unity and the value of working together in the DPC market.
  • Constraints of the fee-for-service model and how removing those constraints can lead to better patient care and alignment with functional medicine practices.
  • How Hint Connect allows for rapid patient onboarding and revenue generation for doctors.

  • A positive shift in the perception of DPC by insurance brokers, who now see the value in investing in high-value primary care.
  • And much, much more!

Plus, check out the visualization of the interconnected relationships across the Hint Health DPC ecosystem.


Business of Functional Medicine: Unifying Direct Private Care Providers | Episode #331


Zak Holdsworth: What you’re seeing is the emergent properties of a decentralized ecosystem forming. What you’re actually looking at is a technology thing where our customers are connecting with each other and essentially sharing business with each other and forming networks, and so we’ve automated that process for our clients.

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 and 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 goevomed.com/lmrc. That’s goevomed.com/lmrc.

Hello and welcome to the podcast. This week, we are coming back to our theme of unity, and we are talking about the unity that Hint Health has created in the direct primary care market.

For those of you who aren’t aware, direct primary care is a way of organizing your practice so that your practice members pay, in most cases, a low monthly fee to have ongoing access to the clinic. This is a movement that’s been going on since around 2008, 2009, but Hint has really formalized a lot of that, and now, they have a nationwide network of direct primary care doctors. And you’re going to hear some of the initial ideas and what the mission and vision is, and now, some of the things that are being created by having this network.

The reason why I wanted to bring Zak on is to be able to showcase a little bit of what happens when doctors work together, when independent practices work together. And hopefully, it gives you some ideas about what could happen in your community with the doctors in your area, and look forward to hearing if it inspires you. And if you want to get involved, check out Hint.com. So, here’s my time with Zak.

So, a warm welcome to the podcast Zak Holdsworth. Welcome, Zak.

Zak Holdsworth: Thank you. Good to be here.

James Maskell: It’s really exciting to connect. And I wanted, when we first came up with the year of unity as our theme for 2024, I just thought of you straight away because of the work that you’ve done to unify this direct primary care market and the value of that unity now is starting to really show itself.

Why don’t we go back to the beginning? I think we met back in 2016, I think, and that was pretty early on in the Hint journey. You want to just give everyone, if they don’t know about Hint, who you are and what you do?

Zak Holdsworth: Yeah, for sure. I think we met in 2017, actually. Well, maybe 2016. We started the company 2014, just late 2013, and on the back of this hypothesis that the US healthcare system is broken in very fundamental ways, and very specifically that the insurance fee-for-service infrastructure was used to pay for the vast majority of the healthcare system of care delivery and healthcare. And this is the lack of price transparency, all the administrative overhead, the perverse incentives that introduces, that’s a fundamental axiomatic problem that needs to be addressed.

That’s one theme we wanted to address. And the other one was how the system had essentially broken the back of primary care and that you can’t restore the integrity of the healthcare system unless you restore the integrity of the primary care system. That, really, we were looking for things to work on. This basically led us to direct primary care, which was this really interesting working manifestation of these, both of these two concepts. Insurance-free primary care, where the integrity of the primary care, the integrity of the doctor-patient relationship had been restored and tremendous value has been delivered to everyone that was participating in the ecosystem.

And so, we wanted to build a company to support that movement, and so off we went. We basically built Hint and started out by building technology to support these clinics. And so, basically, went from there and have the companies evolved, but happy to share more of what we do, but that’s the history. And actually, where we met was our first Hint summit. I think we met before that, but I think we really connected at the Hint summit, which was our first community event designed to help bring our community, basically our DPC community, together in a really positive, inspiring ecosystem event.

James Maskell: Yeah, absolutely, and it’s been great to follow the progress and see everything that you’ve done on the technology side.

I guess for the individual primary care doctor, I was at the Hint summit just a few months ago and it was amazing to hear that, I was speaking to a couple of doctors at the event, that still, even though their transformation towards a DPC clinic had been successful and even though the outcomes were good and their life was good and they had broken the shackles of health insurance, they still took some stick from their colleagues somehow. And it’s just there’s something about this shift that’s so counter-cultural to the brain space of how doctors… Do you think that’s all indoctrination, or what’s going on there?

Zak Holdsworth: I think there’s probably a few things going on. One of them is I think that, in fact, we had a client that wrote a guest blog post on this specifically, was how basically all the stakeholders in the healthcare system have a form of Stockholm syndrome. The patients do, the doctors certainly do, the employers do. The insurance system, to a certain extent, they’re captive to the incentives of the system as well. I think there is just a systemic level of momentum in the wrong direction that is hard for people to break away from.

In addition to that, I think as this movement has evolved, there has been, sometimes people will equate it with medicine for just the rich, for example, which we have clients that charge $50,000 a year or something for their concierge services. That’s the extreme case, but that is obviously medicine for the rich. But at the other end of the spectrum, we have clients that are charging $50 a month and they’re providing exceptional care, unlimited access. Often they’re targeting very poor communities. The way I tend to think about it is, in a free market that’s functioning, you’ll have the Prius… Or actually, a Prius is quite fancy. What’s less fancy than that? You’ll have a cheap car and then you have the Ferrari. But all of those cars, they’re pretty good for the market they’re targeting.

That’s why I tend to think about that piece of it. Yes, obviously some of it’s for the rich, but actually at the end of the day, it’s really just healthcare that works at the level where you can afford it. And I’d say the majority of the million-plus members across our few thousand-plus customers representing probably three-plus thousand clinicians at this point, the majority of that is those members are paying less than $100 a month. And the average, I think is something like $80 a month. Right?

James Maskell: Yeah. Well, I could even see at the conference what a big source of pride it was for many of your doctors to reinforce that the medicine that they were delivering was super high quality and super high value at a price that everyone could afford. And I know that there is obviously some confusion between concierge care and direct primary care, but ultimately, I feel like what you’ve been able to do is to really encapsulate the value of having that extra access, having that extra time. And that is one of the significant problems that blights us.

Zak Holdsworth: That’s right, yeah. No, I agree with that.

James Maskell: I guess for the individual doctor, when you speak to an individual doctor who’s considering going in this way, if you’ve looked at all the transitions of clinics that have happened and you look at the most successful transitions, what do they have in common?

Zak Holdsworth: Yeah, part of the reason I pause is because there is so many different successful manifestations that it’s, to a certain extent, hard to generalize. However, what I would say is a few things stick out for me, especially for smaller clinics. I think very large groups, this may be less relevant, but for a smaller clinic, if they’re transitioning their practice, it tends to be far less successful when they try to keep one foot in both camps. We have an insurance offering, and we also have a direct primary care offering on the other hand.

And what we find is those clinics, their direct primary care offering doesn’t succeed as much as it could. And the hypothesis there is that if you’re a patient with Stockholm syndrome and your doctor comes to you and say, “Hey, I’ve got this new offering. It’s optional, but you can continue working with me the way you’re currently working with me,” it may not be enough activation energy for those patients to say, “Hang on, I want to keep my doctor. I’m going to transition to this new model,” which ultimately is going to be better for everyone. And so, as a result of that, what you find is that those transitions are less successful.

I would say the other thing that is maybe a softer viewpoint is the authenticity of what these clinicians are trying to do, where they’re able to get into the community and explain why they’re doing it, the why. It’s, why are you doing this? It’s not what you do, it’s why you do it. It’s a Simon Sinek thing. I think really building that authentic mission into their go-to-market strategy and their messaging and the communication and the way they approach their patient population and their communities, if they’re able to really encapsulate that why, I think that’s very powerful.

When people understand the why, they’re much better able to do the calculus in terms of, “Okay, this is what this could mean for me, but also I can see why this doctor is doing it.” And so, instead of coming to them with a view of, “I’m actually taking something away, I’m taking this insurance away,” it’s really reframing as, “I know what I’m actually doing is I’m giving you this incredible new offering, and here’s why.” And then I think being able to encapsulate that message in a way that is really easily digestible, I think is very powerful.

James Maskell: Absolutely. You’ve got to burn the boats and you’ve got to fully commit and you’ve got to communicate why you’re doing what you’re doing.

Zak Holdsworth: Yep, that’s right.

James Maskell: Awesome. Tell me about some of the other entrants, because I know obviously you’re talking about primary care doctors, but I’ve witnessed, certainly in the functional medicine space, other specialists wanting to get involved because they’re like, “Hang on, this is the medicine that I thought that I was going to be doing when I came through school, and I’m disenfranchised by specialist care.” And then also I know nurse practitioners stepping into a role as well. What are your thoughts on entrance into DPC outside of primary care?

Zak Holdsworth: Yeah. I think when we started the company, we came up with a vision and mission statement, just like all of you should, including DPC clinics or clinicians starting their own business. And our vision was to redesign the healthcare system to enable easy access to high quality affordable care. That’s our North Star vision of where we want to be in over multiple decades. And so, we’re a decade in, and one more decade I’d like to think we could have had played a part in helping redesign the system.

The mission is, which, think of it as what we are going to do about it, how are we going to help play our part in that vision, and our mission is to power direct care and make it the new standard. And what you’ll notice is that our mission statement doesn’t say to power direct primary care. Our strategy is to start by helping empower the direct primary care movement, because we think that primary care is the most foundational element of healthcare, that if you don’t reform that, then it almost doesn’t matter what you do with everything else. You’re still going to have a broken system.

But at the end of the day, when we talk about direct care, what we mean is price transparent, incentive-aligned models with very little to no administrative overhead without the perverse incentives of the traditional fee-for-service infrastructure. And so, a lot of the time what that means is cash-based care. It doesn’t always have to mean that, but for the most part, if you’re a direct primary care clinic, accepting a monthly membership fee is probably the optimal incentive-aligned way to do that.

If you’re a imaging center down the road from that DPC clinic, then probably just charging a price transparent cash rate for X-rays where everyone knows what the price is, and it’s by the way 50% off because they’re getting paid upfront instead of in 180 days 70% of the time, which I would probably double my price if you’d said, “I’ll pay you 70% of the time in six months.” Yeah, cool. The price for that is double.

What we’re starting to see is more and more of the practitioners and clinicians in the ecosystem starting to catch on. If I charge a cash rate and just figure out what the actual value is and build relationships with other people in the local community so we can start to rebuild the networks, the informal decentralized networks, instead of the top down system controlled networks, it’s the grassroots bottom up networks. That’s what we’re starting to see happen across the board.

The thing I’m really excited about by that is how together at scale, if we can take the 70% of healthcare that is paid for by insurance and make that 20% or 30% of healthcare is paid for by insurance, that’s the catastrophic thing. That’s the car wreck. That’s the total your car equivalent of payments in the healthcare system. But everything else is more like getting your oil changed or getting your annual, maybe you’re servicing your car. Maybe if you have a little bit of a fender bender, a lot of the time it might be cheaper just to pay for that instead of dealing with insurance.

And so, the equivalent of those things, the 70% of care, the predictable things that you know should do, especially with things like functional medicine where it’s like a lot of this stuff is good practice for health and you just need someone to help you figure out how to actually get the knowledge to achieve those things, then we can shift that 70% over to a direct care model, and in the process, eliminate 30% of the total cost of care, eliminate a trillion dollars of waste in the US healthcare system, prove outcomes, make doctors and clinicians happier, save money, all the things.

I don’t know if I answered your question. It’s a bit of a monologue, but that’s the way I tend to think about it.

James Maskell: Well, I want to just acknowledge how thoughtful you’ve been about the strategy that you’ve taken, because I think you and I really see things very much aligned, and I guess I’ve come to appreciate just the dedication that it takes to do the same thing for a decade and to have another decade runway with it. But to actually start to see that, you could imagine at the beginning that there might be some unity value from working together, but I was really struck at the last Hint summit when you showed that diagram or that visualization of each clinic now adding, and all the patients in their clinic. This cloud was emerging and growing forth, and I just thought it was such a cool visualization because it was actually showing the network effect of what you guys have created, and I was really struck by that as a visual for the movement.

Zak Holdsworth: Yeah, no, I’ve always loved sharing that visual. I think it’s really powerful. I could show you and your audience now if you want to look at it.

James Maskell: I’ll stick it in the audience show notes. When you check out the podcast, I’ll get it from Zak and I’ll stick it in there because I think it’s really powerful. I guess let’s just talk a little bit about-

Zak Holdsworth: Maybe just some color on that, which is really interesting, is that what you’re seeing is the emergent properties of a decentralized ecosystem forming. What you’re actually looking at is a technology thing where our customers are connecting with each other and essentially sharing business with each other and forming networks, and so we’ve automated that process for our clients.

The initial manifestation of that behavior was not our idea. We just saw that, in the data, this weird pattern that was emerging where there’s also duplicate patient data showing up across our customer ecosystem, where multiple clinics went out with the same patient demographics and we thought, what’s going on here? Is this fraudulent? Is this fraud? Well, what is this behavior? And we ended up realizing that our clients were manually exporting data and sending it to someone else saying, “Hey, can you help provide care to this patient?” We built an automated way of just making that a few clicks, and it’s easy to do it automatically. And it’s really powerful to just see, from that point of us building that feature, that ecosystem continuing to form those relationships in a decentralized bottom up way, which I think is just very powerful.

James Maskell: Extremely powerful. Well, let’s get into the technology, because at the beginning I know that Hint was a way to charge your patients consistently and make sure the money kept coming in, but it’s undergone consistent growth. And can you tell us a little bit about the state of the technology today and all the things that are included in it?

Zak Holdsworth: Yeah, for sure. We started off as basically a membership management system. If you are a direct primary care clinic or concierge clinic or functional medicine group, whatever it is, if you want to do membership-based care, we’ve built a bunch of tools that allow you to have different pricing plans, enroll your family and get the enrollment for the member, keep track of all the payments, make sure that it’s all automated when you’re changing your prices, it’s really smooth. There’s just a lot of infrastructure that’s gone into supporting basically membership management. And we’re doing close to a billion dollars a year now in payments on behalf of our customers. It’s pretty cool.

Problem there, though. What we started to see is our clients started to work with employer groups, because what was happening is employers are starting to say, “Hang on, I don’t want to miss out on this really awesome direct primary care offering. Instead of my patients going through a traditional fee-for-service network for primary care, could I just pay the monthly fee for my employees?” And of course, the doctors are like, “Yeah, totally.”

But it’s a different business model. You have a different relationship with an employer as you would a patient. You’re ultimately still essentially delivering direct care to that patient, but the invoicing and the billing and the enrollment and everything that has to be connected to the HR system, you have to work within the constraints of these employer groups and what their capabilities are.

Anyway, we built our employer infrastructure, which sends a lot alongside that membership management system. Now, you can manage both your retail members and your employer members and have a consolidated system that handles both of those things. And so, at this point, there’s probably more than five, six, I think it’s 5,000-plus employers on the platform, many of them small, some of them are larger, representing probably half the members across the half retail, half employer roughly, plus or minus a little bit.

But from there, and then we just talked about this, networks started forming. And we just alluded to that earlier. But essentially, what the pattern there is that, if I’m serving an employer, if I’m Clint at Nextera Healthcare in Colorado serving an employer in Colorado, but they have an office in Florida, and Clint doesn’t necessarily want to build a new clinic for 15 employees, he calls a provider in Florida to say, “Hey, could I send you these employees? I’ll pay you your 80 bucks a month,” or whatever their relationship is. They need a way of adjudicating that payment as well, so the employee comes in, selects the clinic in Florida, and we’ll instantly enroll them in that clinic’s Hint account and handle the payment between Hint and Nextera in the Florida entity.

That infrastructure’s supported and we built that out. And then over time, we’ve just continued to level up all of that. More recently, over the last couple of years, we’ve started investing in the clinical side of the shop, the EMR designed to support a DPC clinic. The charting, e-prescribing, scheduling, lightweight communication, lab, ordering, all the things you’d expect in the email, we’ve been investing in building that specifically designed around these cash-based, membership-based models. And that’s exciting to see that product mature as well. It was actually an acquisition, and then we have invested. I’ve got about close to 10 people working on that product right now.

And then we also recently, there’s quite a few things. If you ask me what I’ve done in the last 10 years, it’s going to be a long answer. And then the more recent thing that we’ve been working on, which I’m really excited about, is a offering. It’s actually not a technology product, it’s actually a network product where we have, it’s called Hint Connect, where what we essentially have been finding is that often we would have, let’s say an innovative health plan come to us and say, “Hey, we’re really interested in integrating DPC. How do we do that?”

Or a, let’s say a benefit advisor like David Contorno, this is actually his T-shirt, Health Care is Not Health Insurance. Or the other way around, actually. He’s saying, “Hey, we want to put a DPC into every single employer we’re working with. Could you help us coordinate that?” And so, what we basically did is… Actually, what I will say is, to begin with, the way with the innovative health plan, what we would’ve done is said, “Okay, cool. We’ll just intro you to as many DPCs as you want and you can work with them all.” What we’re finding is that just didn’t work. The innovative health plan is too complicated, move on, next.

And so, what we’ve done is we’ve formed a product where they can have a single contract with Hint Connect, and then we go downstream and get contracts with all of the clinics and the networks that are part of the Hint ecosystem and consolidate into a single contract with a very thin price transparent, importantly price transparent fee that we take. But ultimately, we’re just passing that through to the DPC and just playing this role of connector, which is, hence the word Hint Connect. We’re starting to take that product to market over the last year, and that’s really exciting as well to see the connectivity forming in this ecosystem.

James Maskell: Yeah. Well, I want to feed back a few things that you said there because that, I think, is the most exciting thing that I heard and what I’ve been really excited about. And there’s a few manifestations of it. One, I’m in a group called Healthcare Hackers, I think you might be in that too, but with David Contorno and others. And just starting to, as I read the emails over the last few years, just seeing the degree to which those brokers were in love with DPC. That was really exciting to see that insurance brokers, traditionally the people who are telling employers what to do with their dollars, are saying, “You’ve got to invest in high-value primary care.” That was a huge thing.

The second thing is, following on LinkedIn, seeing doctors in your network announce that they added 30 or 90 patients in a day. And I don’t think anyone who’s listening to this who runs a functional medicine practice can even conceive of what that is, because the onboarding into a practice for a chronically ill patient in the current model of functional medicine takes a long time to bring them on and to do all that. And so, what you see here is, as employers start to want this and doctors have space in their available number of patients that can come in their book of business, you can create those transactions.

And I think that’s super exciting, especially for a doctor who’s maybe sitting in the wings and saying, “I can’t afford to take the risk of starting a practice because what if I don’t get enough members quickly? What if I burn the boats and no one wants this?” Now, there’s an opportunity where 90 people could be sold in one day and be paying their monthly fee from that day moving forward, and so it’s really creating a new opportunity that never existed before through the network effect and through you guys coordinating all of that.

Zak Holdsworth: Yeah, no, it’s really exciting.

One thing I would just say is we really want to make sure that people don’t rely 100% on Hint Connect for their business. We think it’s not healthy for a business to be reliant on one revenue stream like that. We want to make sure you build a thriving business, and we’ll help put a bit of afterburners after it, if that makes sense.

But you’re right, it is really incredible where, if you just spend six months getting 30 members or 50 members or whatever, and then we can help do that in one month, or even if it’s the same timeframe, but you don’t have to do the work of selling the members, if you just get the incremental new member coming in where you just have to provide care and you don’t have to do anything sales or marketing-wise, it is really quite powerful.

I’ll make a comment on one other thing you mentioned, which, just as this benefit advisor, this broker transition that we are seeing. The way I tend to think about it is that if you look at the narrative of doctors saying, “Hey, I want to transition out of fee for service,” there’s this really authentic, mission-driven thing they want to do to provide better care and really fulfill their Hippocratic Oath and all the things that DPC and models like it represent, they’re going on this journey from fee for service to this really holistic, high value human-centered loving care.

And insurance brokers and advisors and the insurance companies and brokers who are selling that, they’re almost like the enemy. But what we’re also seeing is this parallel trend from the other end of the spectrum where these brokers are starting to say, “Hang on, actually I’m going to move from being a broker to an advisor, and I’m going to shift from making money from selling, increasing the price of healthcare. Actually, I’m going to make money from bringing really high quality care to the employees and saving money for the employer group and working really closely with that community to build the optimal care delivery plan for that community.”

And what we are seeing is these two narratives are essentially meeting in the middle and forming this new almost community from these two extremes coming in the middle. And that’s why these different various conferences, they’re showing up. You’re actually seeing doctors and advisors and specialists, and all together trying to figure out, “What can we do together?” And I think that’s really powerful to connect to a certain extent as one manifestation of that happening, because again, we’re helping connect these two things together. I think it’s just for a lot of power and story, and I love that story.

James Maskell: Absolutely. Well, I want to take that concept and just talk a little bit about functional medicine because we just actually had our 10-year anniversary of the Functional Forum a few days ago in February 2024. And in our 10-year anniversary episode, we went to a community that has just launched in Johnson City, Tennessee, East Tennessee, and that’s a 120-doctor-owned practice that is all in value-based care. All their contracts are value-based care. They’re really delivering value-based primary care because they get paid more the more money they save for the rest of the system.

And it was interesting because, one, that doctor, there’s one doctor out of 120 that’s doing functional medicine and the CFO in the background is saying, “Hey, I don’t know what you’re doing there, but keep doing it,” because they’re obviously seeing in the numbers that his patients are not using care as much. That’s something that I’ve been talking about in functional medicine for a long time, is that when medicine starts to value value, then functional medicine will start to win.

And in that presentation, Dr. Patrick Hanaway gave a presentation of data that they had collected from the Cleveland Clinic Center for Functional Medicine, and they showed a particular case where there was a 62-year-old woman with asthma, and it showed in the eight months before her care had cost $74,000, and she’d had all these mini episodes of different things that had gone on with her asthma. There was a $5,000 episode of care within functional medicine that included all the labs, the supplements or whatever, that was two months. And then the eight months after that, it had gone down to $15,000. And some of even that $15,000 were her having operations that she couldn’t do earlier because she wasn’t healthy enough. Really, her care was even less than that.

And what I wanted to show in that is there’s similar things going on here, is that the thesis for these brokers or these advisors is that if you deliver something really valuable to keep people healthy in DPC, then the downstream costs are going to be much lower. And I guess what I’m sharing is that I see the same thing happening in functional medicine, where when you have extremely expensive chronically ill people with autoimmune diseases and costly digestive diseases and things like asthma, that ultimately there’s a real play in there to, in certain cases, deliver an episode of care that drastically reduces the future costs, and that ultimately there’s going to be some synergy. And I think that we’re aiming at the same target in that case, which is, how do you deliver the right care at the right time to reduce complex chronic care and all the costs that goes into that?

Zak Holdsworth: Yeah, love the story. And maybe a comment I’ll make is that I tend to think about… One of the things I’m quite excited about with functional medicine is where I see functional medicine providers going into primary care. Because a lot of the time, functional medicine providers say, “Hey, listen, I’m going to do my functional medicine thing, but you should still keep a primary care position.” But if you think about that, ultimately you’re creating a little bit more complexity for the patient. They have to have multiple primary relationships.

And to a certain extent, if you think about the long-term, steady state of where you want to get to, it’s probably some combination of, hey, this is primary care and certain primary care clinicians may have different specialties or different focuses. In the free market, as a patient, I might be going, “Okay, well, I really resonate with this type of primary care. Or I have maybe this ailment where this primary care clinician might be better for me because they can help me get through it and be my primary care doctor. Or maybe it’s someone that’s super fit and healthy or whatever and really into performance sports, and their primary care physician is actually also their sports physician and helping them figure out how to be the most optimal athlete they can be.

But it all is anchored around the single relationship with your primary person that you trust for your health decisions. I’d love to see that almost like a convergence of community in that way, where you don’t have this functional medicine industry that’s forming around this broken insurance service primary care system, but it’s this one holistic community of people that are trying to just do the right thing for the population. And there’s just slightly different manifestations of it, but the vision is all combined, if that makes sense.

James Maskell: I think it is coming together, Zak.

I would say, some of the things that you see is that the external manifestation of the Stockholm syndrome is that some functional medicine doctors recognize that some of the things that, if you follow the standard of care for primary care, you could actually be exacerbating or creating chronic illnesses, overuse of antibiotics. Was the COVID vaccine a net positive in the medium term? No one really knows. There’s those kind of things where I think doctors, once they see the writing on the wall, they’re like, “I have to create a situation where I can control everything, and if I’m expected to deliver on the primary care standard of care, I can’t in good conscience do that anymore.”

But I think you’ve seen the combination of functional medicine and primary care work very well in a few examples now. And so, I think in each little town, there are plenty of groups there, and I’ve even seen some innovative pricing things where doctors will charge $250 a month until your primary chronic illness is under control and you become a normal primary care patient, and then you can go back down to $85 membership fee because you’re not going to be using the doctor that much. And I think there’s a nice convergence there.

Zak Holdsworth: But I think maybe just to drill in on one of the points you made, and I think in a roundabout way, you’re helping make the point I want to make, which is in the traditional fee-for-service model, even if you know what would be the right thing to do. Let’s say a patient comes in and they’re just maybe stressed. And you probably did mental health stuff at college. You probably know what you need to do, at least as an initial point. Or if a diabetic comes in, you probably know, “I know what needs to happen right now.” But you have seven minutes, so even with the knowledge of the correct pathway or whatever for treating that patient, the correct pathway in seven minutes is to make a referral because you know you can’t deal with it in seven minutes.

Within the constraints of the fee-for-service system, the clinicians are actually doing the correct clinical thing, given the constraints. But if you remove that constraint of seven minutes and you remove that constraint of not getting paid enough if you deal with both of the comorbidities in one session because it’s going to take you longer and you’re not going to have to bill the insurance company twice, so you have to have them come in again for the second one, if you remove obviously that perverse incentive. If you remove just the time pressure and the stress of all of the charting needed to bill insurance, and then the overhead across the system of 10 administrators per doctor. In the clinic, it’s probably three or four per doctor, but across the system it’s 10. If you remove that and make it probably what it should be, which is, I don’t know, maybe 0.1 per doctor or something, so a hundred times different to what it is today, or 50 times different.

If you make those system levels changes, then my hypothesis here is that actually what would happen is DPC-type primary care models and what you see in functional medicine, obviously there’s probably more with a lot of what the functional medicine doctors are doing, but it’s much closer. You probably see eye to eye on a lot more things.

James Maskell: 100%.

Zak Holdsworth: And at the end of the day, maybe a lot of these DPC doctors actually may have an interest in nutrition and they may actually want to level up some of their skills there, now that they’ve got the time and the capacity to do it. I think, anyway, the vision I have is that you end up with, this community is really still going to be lots of different specialties and skills, but there will be a lot more shared understanding in terms of what is the right way to treat a patient holistically.

James Maskell: Absolutely, yeah.

Well, in 2015, I remember in the second year of the Functional Forum, Tom Blue came and gave a talk and was like, “Here’s DPC. It’s the best model for running your practice for all these reasons and gives you all this time. And then what are you going to do with that time over here? Well, you should probably do some functional medicine because you’re helping to reduce the cost of chronic illness, reduce the chance of chronic illness,” all those kind of things. I think that vision has been there for a while, and I’m here to tell you I’m looking forward to finding ways to continue that synergy, because super impressed with everything you guys have done.

It was great to come back around to the conference last year and just see the constant leveling up of the technology, of the community, bringing different people into the ecosystem together. And I feel like if you come back to your vision of direct care, I think there’s a big opportunity for direct care to be direct primary care, and then direct episodes of chronic disease reversal care, which I know that employers are also starting to buy now. And some of the bigger functional medicine clinics are putting themselves in a position to sell an episode of digestive care that’s six months and all included because they’ve got eight years of data to show that the symptoms go away and the people get better. I’m excited about that future and seeing what we can do together.

And I guess I just want to acknowledge just the amazing work that you’re doing and encourage anyone who’s listening to this, if you have a membership offering in your practice, look up Hint Connect and get in touch with them because you can set yourself up to get influx of new direct primary care patients in that way. And if you’ve been holding back from shifting to a membership model because you haven’t seen or you haven’t been able to think about how you could get those members through, there’s a lot of expertise now. This is not a new thing. This has been happening for 10 years, and there are thousands of clinics that have made this transition. And as you said at the beginning, the patients are happier, the doctors are happier, the costs are lower. It’s a rare win-win-win in medicine, and really grateful to share that.

Zak Holdsworth: Yeah, awesome. We’ll be happy to chat and be supportive if we can help you in any way.

James Maskell: Yeah, absolutely.

Zak Holdsworth: It’s really great to reconnect with you as well.

James Maskell: I just want to say, look, the theme is unity. And I guess what I wanted to bring you on, Zak, and the reason why I thought of you to kick off this year is that there is power in numbers. And as more organizations start doing things together, start creating a uniform or uniformish product, that’s really what you’re talking about, is that in order to create Hint Connect, there had to be enough uniformity across the clinics that one clinic would feel comfortable to sell to another clinic. And a lot of that happens because the model is the same, but also people actually getting together and meeting each other and building that trust network.

And I’ve seen that in some of the more sophisticated community meetups that we have in the Functional Forum, like in St. Louis for example. These guys have been getting together for a decade, so the functional medicine cardiologist and the functional medicine pediatrician have that much built trust that they start sending referrals back and forth. And so, we’re seeing a little bit of the beginning of that too, and I’m excited just to share this. And I hope that there’s some emergent properties that come from this conversation in the functional medicine space as people wrap their heads around how they could work more closely together, and excited to see that.

Thanks so much for being part of the Evolution of Medicine podcast. I’ve been with Zak from Hint Health. Check out Hint Health online. It’s Hint.com, right?

Zak Holdsworth: Yep.

James Maskell: Hint.com, and you can find all the details there. Check out Hint Connect. And we’ll put all the details in the show notes, and I’ll also put the video in the show notes as well so that you can see the visualization that we were talking earlier.

Zak, keep up the amazing work. Thanks for coming on the podcast. This has been great, and we’ll see you next time.

Zak Holdsworth: Awesome, thanks so much.

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 goevomed.com/lmrc to find out more about their clinical tools, like the Group Visit Toolkit. That’s goevomed.com/lmrc. Thanks so much for listening, and we’ll see you next time.

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