Welcome to the Evolution of Medicine podcast! In this episode, part of our Group Visit Series, we sit down with Dr. Elizabeth Markle to talk about her revolutionary practice, Open Source Wellness. It’s an incredible story of their journey to organize and synthesize a consistent group visit model. In this episode, you’re going to hear about their thoughts about why behavior change was difficult, how to democratize it and make it available for prescription. Dr. Markle also talked about the sequence of behavior changes that happen through patients’ 16-week visit at Open Source Wellness. You’ll also hear a lot about how to facilitate behavior change in a group. It was a really interesting conversation, and I think you’ll really enjoy it, especially if you’ve been thinking about starting group visits. Highlights include:

  • The origin story of Open Source Wellness and Dr. Markle’s and her co-founder’s vision for the future
  • Why patients need democratization and experiences to build healthy lifestyle behaviors and overcome health issues
  • Human behaviors that predispose us to crave community, especially when creating healthy habits
  • Dr. Markle’s secret sauce for developing a thriving community in your practice
  • How group visits reward the patient with improved health and community, and practitioners with a deep sense of purpose in their healthcare practice
  • And so much more!

Resources mentioned in this podcast:

James Maskell: So, warm welcome to the podcast, Dr. Liz Markle. Welcome, Doc.
Elizabeth Markle: Thank you so much, James. Great to be here.
James Maskell: Really excited to have you here on the podcast. We’ve been doing this series on group visits, and it’s been really interesting to hear from so many practitioners and doctors who, for different reasons or others, have ended up creating these group structures. Earlier this year, I had an opportunity to get introduced to you and the work that you were doing, and I just thought this would be super interesting for all of the practitioners who are listening all around the world, because this is sort of a universal problem that you’re solving. Let’s get back into the story. Take us right back to the beginning for when you first realized that this was a problem and sort of your early stages in thinking through what a solution could be.
Elizabeth Markle: Sure, yeah. I love telling the origin story of Open Source Wellness. So, I’m a psychologist by training, as is my co-founder, and we both worked in integrated primary care behavioral health for many years in safety net health systems and bigger healthcare organizations, hospitals and clinics. We kind of came to a realization, and here’s what it is. It’s that, regardless of patient diagnosis, whether a patient has diabetes or depression or hypertension or almost any other chronic condition, and almost regardless of the provider’s identity, whether it’s a primary care doc, a behavioral health person, a specialist, a case manager, that most of our patients were getting the same four what we call behavioral prescriptions. These are just instructions for lifestyle changes. Everybody listening to this will pretty much know what they are.
Elizabeth Markle: In brief, they are number one, exercise more. Number two, eat better. Number three, reduce your stress. And number four, get some social support or some meaningful connection in your life. And then here’s the part that makes me depressed. Providers give these four behavioral prescriptions, some subset of them or all four, and then they say something like, “Good luck with that. I’ll see you in six months.” Ben, my co-founder and I, we would look at each other and go, “Wait a minute. We would never say you need to start antidepressants. Good luck figuring that out. Take care now.” Or “I’d like you to start taking insulin. I’m sure you’ll figure that out.” We would say, “Your prescription will be ready at the pharmacy that’s around the corner from you, your insurance will cover it, and a helpful pharmacist will be there to make sure you not just talk about the medication or the treatment, but actually get it.”
Elizabeth Markle: So we set out to design the behavioral equivalent of a pharmacy, and that’s really the premise of Open Source Wellness, is that we wanted to create a democratized and experiential delivery system for these basic behaviors that underlie human health and thriving. So we abbreviate our universal prescription to be move, nourish, connect, be. So, physical activity, healthy meals, social connection, and stress reduction. And I want to sort of highlight the word democratize, first of all, because James, you and I know that if you have privilege, if you have financial and sociocultural capital, you can access whole foods and Pilates and hire a private health coach, and you have access to all these things. But for the patients and the populations that need it the most, they don’t have that access. So a prescription like eat better, exercise more, reduce your stress is really a prescription to nowhere.
Elizabeth Markle: We were very committed to this work addressing equity and being a democratized solution. And secondly, I just want to highlight the experiential part that most of us have worked in clinical settings that have a health ed department or a health promotion department where there are a lot of handouts and some didactic classes and workshops. We really come from the belief that people don’t need more information at this point. Information is not the key missing variable. It’s actually experiences that, in addition to knowing they need to eat a little less sugar, people need the experience of eating well in a way that’s tasty and moving their bodies in a way that’s fun and rewarding and doesn’t feel like work. Let me pause there. Is that all making sense?
James Maskell: Yeah, it absolutely is making sense. I think both of those points, democratization and experience are key features. I mean, I guess what I really want to get into is what were the things that you knew about behavior change that made you think, even before you ever ran your first event, that this was going to work?
Elizabeth Markle: Well, let’s see. I have this strong bias that people will mostly do what’s easy and fun. You might change their perception about what’s easy and fun, but telling people to do something that is hard, that is lonely or alone, that is sort of swimming upstream to what our culture and the communities around us predispose us to do is sort of doomed to failure. I feel the same way about solutions that rely on willpower, right? If you’re white-knuckling it, that resource is exhaustible. So our belief is really that we need to create environments, systems and structures, and communities and microcultures where the healthy thing is actually the default.
Elizabeth Markle: At Open Source Wellness, the structure is that people are prescribed participation in the community that is Open Source Wellness, and we actually physically bring people together four two hours a week for 16 weeks. That’s like an initial dose. So, if you get 10 days of antibiotics, you get 16 weeks of Open Source Wellness as your initial dose. The belief is that we actually need to make it socially rewarding and create really enjoyable on-ramps to healthy habits that people will remember as positive experiences in addition to educational experiences.
Elizabeth Markle: The other thing I’ll say is that, when people engage with Open Source Wellness, this move, nourish, connect, be is the set of pillars that the empirical literature suggests sort of are responsible for tremendous amounts of chronic disease, not to mention human suffering and healthcare spending. So we actually do all four of those things at every time we get together. We start off the evening or the afternoon with physical movement. We do a little bit of mindfulness. We have a conversation about health and well-being and values and the things that matter most to people, and then we have a meal together in small groups. And that’s where people really get to share what’s alive for them.
Elizabeth Markle: So I think another underlying fundamental belief is that, in addition to receiving information, people need to be heard. They need to tell the truth about their health, their well-being, their families, their values, their traumas. Social connection and high-quality attention are, in fact, the secret sauce. If there’s an active ingredient, we say community is medicine.
James Maskell: Beautiful. Yeah, I love that. That’s certainly in line with everything that we’ve said and we’ve done here at the Evolution of Medicine. What was it about the 16 weeks? Is there a certain sort of formula that you were going off that there would have to be a certain dose that would work? And how did you come up with 16? And what’s been your feedback since you started doing it?
Elizabeth Markle: Sure. We really arrived at 16 weeks experientially in that we tried a lot of different things. We even tried it just as an ongoing open drop-in group, and this is what we found to be most effective. I think, in sharing a little bit about the changes that we see, I can best communicate what happens in 16 weeks. Within the first 2, 3, 4 weeks, we start to see what I would call social outcome. People consistently say things like, “I just don’t feel as alone anymore.” Or “I have a feeling of hope.” Or “Wow, I feel a sense of belonging here in this community. My coach is texting me and checking in with me. My small group is helping hold me accountable.” There’s this experience of activation or engagement that happens very, very quickly in the first few weeks.
Elizabeth Markle: Then, between weeks four, six, even to eight, what we’re seeing is dramatic changes in mental health outcomes. We measure depression via the PHQ-9. We measure anxiety and social connectedness. This is where…depression scores come down at an effect size that’s two and three times as large as what we’d see with antidepressants. It’s not surprising to us, but this is the consistent finding. And then it’s the latter half of the program, so weeks eight, 10, 12, 16 where we see very significant behavioral changes. People start exercising more, their minutes of exercise per week goes up, their consumption of fruit and vegetables per day goes up. This is where we start to see biomarkers change. Hypertension comes down, weight comes down for those who are tracking that A1C starts to improve.
Elizabeth Markle: I think the conventional wisdom is sometimes that we give people information and then their health is going to change, and their biomarkers are going to change. And we really just see a very different socially-driven arc that people feel connected and their mental health improves, and then their physical health improves. So when we say powered by connection, that’s kind of what that means, and that’s how we arrived at 16 weeks. That’s about how long it takes for that cycle to get fully activated.
James Maskell: Beautiful. Yeah, no, I really could see that happening, and that sort of mirrors some of the other practitioners and doctors who we had on this series who have really talked about first of all the profound mental health applications of creating this kind of community and how that tends to move along quickly. And then how the physical health sort of goes from there. You obviously had a plan at the beginning, right? This is 16 weeks and we’re going to do each of these things during each week and we’re going to do the food or we’re going to do the exercise. What have you learned along the way in actually executing this? You’re in San Francisco. That’s where the first groups are starting, right?
Elizabeth Markle: Yeah. We’re in the Bay Area. Right now we’re in Oakland and Hayward. And I should name that we actually have groups that we offer in the clinical setting that are workflow integrated and EMR integrated, and really the provider’s prescription is the key trigger of all of this. Then we have community-based groups that are happening in sort of open-access settings where multiple healthcare providers can prescribe into this free-standing setting. So you asked about what we’ve learned. We’ve learned a lot about how to make this as universal, as trans-diagnostic, and as appealing to diverse groups as possible. While we’re not going to get everybody and we understand that that’s the case, we’ve learned a lot about how to do physical movement, say, in a way that is really accessible and is fun. It shouldn’t feel like work, and we say that laughter is sort of the key performance indicator, just as well as sweat. It’s really taken us a while to figure out and to train leaders to engage folks in a way that sets up the rest of the program to be intimate and vulnerable and connected and really successful.
Elizabeth Markle: The other thing I would say that we learned is that…I keep coming back to this idea of health powered by connection, but that people come back because of the relationships they’re forming. Sometimes their first relationship is with their coach, so we hire health coaches to be the social glue for each small group, so it sort of facilitates a conversation and create activation, but it’s really the sort of high-touch communication before they come in the door, during their first visit, and then in between visits during the week, every small group is on a group text thread communicating with each other and helping provide support and accountability and care that amplifies the dose of this 16-week intervention.
Elizabeth Markle: The last thing that I’m so excited to say we’re learning and that just blows me away is that our participants, after 16 weeks, often don’t want to be kicked out. They often feel a little offended like, “Wait a minute. I finally have this community. What do you mean it’s over?” Some of them apply to become peer leaders, and that’s great, so they’ll stay with us. But a bunch of our graduates, who we have unfortunately had to say, “You’re done.” Have started something that they’re calling OSWx. So, OSW for Open Source Wellness, and then OSWx is like TEDx. It’s the independently-organized version of what we’re doing. So we have a group of graduates who get together. They found a space once a week, and they do our four pillars. They do move, nourish, connect, be together. They have a standing invitation to anybody who graduates the program to join them.
Elizabeth Markle: This just inspires me to no end, because while clinical healthcare might be the on-ramp for some of these behaviors, for some of these human experiences that underlie well-being, really the vision is a culture of health. It’s a self-sustaining community that doesn’t end when your prescription ends, but is actually lifelong and regenerative. So I feel so, so hopeful that sort of like AA for human well-being, that we are slowly finding our way to something that can be truly peer-led and ongoing.
James Maskell: Yeah. Is 16 weeks enough for someone to learn it so well that they can teach it?
Elizabeth Markle: Not for everybody. You know, a number of the participants that come through don’t have the social skills to be a leader, or the life consistency to show up somewhere every week and be responsible for a group. But we find that some percentage of our participants do. The Dalai Lama is famous for saying, “People need to be needed.” We find that some percentage of our participants, somewhere along the way, got a little derailed or they don’t have sort of an outlet for their contribution, for their desire to be of service in the world. If we can give them the right on-ramp, if we can create potentiation pathways that make it possible for them to be of service, to be recognized for that, to have their own sense of esteem be built through that, they become incredibly devoted to being a mentor, being a leader, helping to move this movement forward.
Elizabeth Markle: So I don’t aspire to everybody being a leader, but I do aspire to every community having this sort of opportunity available for the graduates and their families such that it doesn’t end in the clinical setting, because I think we all know there will never be enough resources in the clinic to just keep this going forever for everybody.
James Maskell: Yeah, absolutely. Such an interesting structure. Have you found ways…you know, one of the things we’ve heard in other podcasts is that sometimes people will be more vulnerable to a group of strangers that they don’t know than even to like a health professional, who oftentimes they’re just telling enough just to get whatever goal they’re looking for from the appointment, and then there’s sort of a level of vulnerability and authenticity that comes through these kind of connections. Have you found that there’s ways that you can sort of facilitate that in the first group, for instance, so that they trust and make people want to participate and really participate in the process?
Elizabeth Markle: Absolutely. Yeah, James, this is part of why we actually don’t hire licensed medical professionals to lead these groups. When it’s a group medical visit and being billed as such, there is a practitioner in the room, and I can say more about that later. But in essence, it is the vulnerability and the vitality of our peer leaders and our health coaches that make the whole thing go. We hire not for health knowledge, but for one, vitality, a sense of sort of joy and aliveness and the capacity to invite participants into that context and for the willingness to be vulnerable, to tell the truth, to share their own experiences and struggles, not from the perspective of an expert that’s teaching, but from a truly open-source perspective that, if you’re human you probably have some areas in your life where you’re doing great and really rocking it, and some areas of your life where you have fear or grief or a feeling of being out of integrity or a feeling of being out of control.
Elizabeth Markle: And that’s the human condition, so everybody who leads, whether it’s a site leader or a coach or a peer leader really is embodying that. So yes, from week one, we have participants saying, “Wow, I’ve never told anybody this before” or “I’m crying at the dinner table, and I’m really surprised by that.” You know, hugs are a little weird, but in this context, they feel great. So it is a little bit of a culture shift from what healthcare knows itself to be, and there’s a lot of work there to really integrate community and peers and coaches into a formal healthcare setting. I think one of the things that brings me joy is when the medical assistants or the admin staff say, “Can I participate? Can I be part of this group? I want to work on my health.” That feels like the marker of the possibility for real health in a clinic to me.
James Maskell: Absolutely. Tell us a little bit more about sort of the details of the nitty-gritty side of it, like the billing and the recommendation and how it’s prescribed and that part of things, because ultimately that’s kind of where the rubber has hit the road for quite a few of these projects is understanding who’s paying, how’s it being paid for, how it’s organized, how it’s prescribed.
Elizabeth Markle: Absolutely. Let’s focus in on the clinical context, because that seems most relevant here. The first thing to do is to organize an event, an Open Source Wellness event for the entire clinic staff. So all the providers, all the admin support, everybody. What that does is, it gets the entire clinic on board with what we’re doing, that it’s something new and different and exciting, and it makes them incredibly strong referrers or prescribers. So instead of a half-hearted, “Yeah, you should do this healthy living group,” you get a really robust conversation about what it is and what’s possible. So that will up the referral success rate tremendously. We then set up inclusion criteria. Really, our inclusion criteria anyone who has or is at risk for a behaviorally-mediated chronic condition. Within that is a number of mental or behavioral health conditions like depression or anxiety, social isolation and a whole host of physical diagnoses, many of which are often comorbid. At Open Source Wellness, we don’t have the depression group and the diabetes group. We have everybody together, because the fundamental prescription of move, nourish, connect, be is pretty universal.
Elizabeth Markle: So we educate the clinic on inclusion criteria and exclusion criteria. The exclusion really just being anybody who can’t participate appropriately in a group or someone whose suicidality is so acute that it’s over the heads of our coaches and peer leaders. We get it integrated with the EMR such that providers, when they sort of make a prescription, they actually get booked for their first visit as a medical appointment. So it’s in the system, they’ll get reminder calls, et cetera. The next thing that a participant should get is a phone call from one of our health coaches, and this is a 20-minute conversation with a coach really starts to build a relationship and just starts to understand their world. What hurts? Why did your doctor send you here? What do you want? What do you care about? Having that conversation also tremendously increases the odds of that person actually gets in the door during the first time.
Elizabeth Markle: Then again, the staffing is primarily health coaches and peer leaders. It’s a pretty ratio. For every six participants we have a coach, and that allows for really intimate conversation over the meal. And then the way the billing works in this, if we’re in a fee-for-service environment, here’s how it works. You have one licensed provider, so an MD or a nurse practitioner, in the room. They participate, and they also pull participants aside for quick five-minute check-ins. These need to be set up such that nobody…the patient doesn’t expect it to be the full medical appointment, but really just a quick check-in.
Elizabeth Markle: Doing that, the provider who previously might see eight or 10 patients in an afternoon is able to essentially see and bill for up to 20 in an afternoon. That’s because they’re impact is being leveraged by really the facilitation, the whole thing is really handled by the coaches and that provider is liberated to just pull specific people aside, do quick check ins and gather enough information to bill for that group medical visit encounter. We’ve learned ways to help our coaches gather information that they can then transmit to the provider to help them have enough information to be billing in a way that has integrity.
Elizabeth Markle: What we’ve found is that this generates tremendous extra revenue, you know? Out here the group medical visit billing rate is $200-$225 a session. So if you’re billing an extra 10, even eight patients per week on that, that generates plenty of revenue to cover the cost of implementing the Open Source Wellness model. Did that make sense?
James Maskell: Yeah, that makes total sense. There’s definitely some crossover here with some of the content we’ve had before on The Functional Forum and on this series with Dr. Shilpa Saxena the two-provider model, and sort of pulling people out to do the insurance billable part of it. So yeah, that makes a lot of sense. And 16 billable sessions simultaneously is not causing red flags for the insurance companies who are paying the bill?
Elizabeth Markle: Yeah, that’s a good question. When we first set it up, there was a question about churn. Is this going to get flagged? What we have found is that sometimes we have really large groups, so sometimes we’ll have 25 or 30 patients there that then of course get split out into small groups for the meal. In that case, the providers pick and choose who they’re going to bill for. So if they billed the last three weeks for a particular patient, they might not do an individual check in, or just not submit billing for that. So there can be discernment on the part of the provider and the administration about how to stay within the appropriate realms of number of visits.
James Maskell: Got it, yeah. That makes sense. So people are billing the codes and choosing how to put people through. What have been some of the best ways that you’ve found to keep people in? Because ultimately we have seen that there can be a drop off as people life happens. What are some of the ways that you’ve found to be able to keep people engaged into the process for the full 16 weeks?
Elizabeth Markle: Again, I’m going to land on this community as medicine or powered by connection thing. Yes, there are certainly people who show up, their eyes are wide the first week and they go, “Nope. This is not for me” and we go, “Of course. Great. Thank you. Let’s find another way to support you.” But for those for whom it’s within the realm of possible or close, what keeps them involved again is relationships. Our coaches have a conversation before the person comes to their first group, and then there’s often a phone check-in between weeks one and two to just say, “How was that for you? Yeah, it’s kind of strange. It can be a little awkward. What was it like? Anything come up for you? What would you like to work on? There’s a lot of goal-setting.”
Elizabeth Markle: And then it’s the small group support that really becomes magic. The coaches set up a group text thread for everybody who’s in the group who wants to participate in group texting. And those conversations, the coach will seed them saying, “How’s everybody doing on the goal for this week? How’s the group challenge going?” Sometimes it sort of stays on that topic and generally health-related, and sometimes these groups really take off and end up supporting each other about life and getting together outside. I recently learned that a whole bunch of our participants went to karaoke together, and I was stunned and a little nervous and thought, “Oh my God. What’s the liability around this?” But as my coaches remind me, they say, “This is what people need to be doing. This is community as medicine.” Again, the best solution we have for retention is to make it really fun and then to use our coaches and our peers to spark the kinds of connection and the kinds of relationships that people value very deeply.
James Maskell: Beautiful. I love that. I appreciate you saying that, and that’s certainly something that we’ve heard, again before. It’s just the power of making it something that people want to do and in some ways asking people…we still have the same thing with our Functional Forum meetup groups, like getting practitioners and doctors together. The groups that really sustained were the groups that asked each other, “Hey, why are we doing this? What’s this for? What do we want to get out of it?” And ultimately that led to a situation where they were coming for their reasons and not ours. Obviously there’s got to be a reason at the beginning to show up for the first event, but then it’s about facilitating from there.
James Maskell: So you’ve got the first pilot off and running here. What do you see in the future for Open Source Wellness? How do you see it growing and how do you see it moving into other states, different countries, different areas, and what’s the game plan from here?
Elizabeth Markle: That’s a great question. Something sort of exciting happened for us in March. We won the Scattergood Innovation Award. The Scattergood Foundation is actually focused on behavioral health, but they host a national health innovations competition every year. Through a long process, we were named finalist, and then the winners of that at the National Council for Behavioral Health. What that did is just give us some national visibility that we hadn’t had before, so we’ve been fielding inquiries from both clinical and non-clinical settings around the country saying, “Hey, this is cool. This is different. How do we do this?” So one of our real priorities this Spring and Summer has been building out the training model, because our intention is not to have an Open Source Wellness empire where we have staff in every city, but to train the very, very capable clinicians and coaches and peers in a given clinic or in a given city or community to do this themselves. So we’re sort of finalizing what our training model looks like. It’s a combination of both direct experience and transmission, and then of course web-based and distance-based coaching and support and accountability.
Elizabeth Markle: We’re happy to operate sites in the Bay Area, and potentially at other places as well, but our focus is on training and essentially licensing individuals and clinics to deliver this model on their own, in true open-source fashion because the more people doing these things, the better. So we’re excited about that and we welcome conversations with individuals and organizations that are interested in doing this or something like it.
James Maskell: Absolutely, yeah. And I love…when I heard the name, Open Source Wellness, I had a feeling that this would be the model. It’s just making it available for people to use and seeing how quickly it gets spread. You know, just a word, there’s a lot of practitioners that are listening to this, and one thing that we’ve recorded is it’s not just that there’s obviously these heroes that show up for these events, right? The community, they go through this hero’s journey through the 16 weeks and their behavior changes otherwise. But you know, there’s another hero in this, which is obviously the practitioner that decides to put this on, actually sort of watches and facilitates this transformation. Can you speak to your experience of what it’s been like for the physicians and the health coaches involved and what their experience is typically when they go through doing this for the first time?
Elizabeth Markle: Yeah. This is a great question. I really appreciate your attention on the providers and the team members and why they do what they do. You know, I think what we often see is a sense of demoralization, frankly that we hear over and over again, “This isn’t why I got into the healthcare field.” Whether it’s providers who are feeling just slammed with the number of patients they need to see and the sense of profound ineffectiveness, the feeling like, “I don’t know that I’m actually making a difference here. I’m kind of watching my patients cycle through the emergency room, and I can’t get inside this with enough power to make change.” I think that’s profound.
Elizabeth Markle: And then just the sheer number of community-based volunteers or folks who are working in tech, say, and then they had a health crisis and they went to the ends of the earth to solve their own problems with the degree of privilege that they had and then are coming back saying, “Wow. I need to reorient my whole life around making a difference in this system and creating a system that has some sanity and some humanity in it.” So that often is the starting point. I think for those who were educated in traditional healthcare, their experience with our model is, sometimes they kind of have a moment of like, “Wow, this is really different.” You know, people are dancing. People are hugging each other. People are telling the truth about their trauma. People are speaking really openly about their feelings of shame and failure around health and diet and weight loss, et cetera. So I think there can be a moment of, “Whoa, this is both everything I ever dreamed of and this is really different.”
Elizabeth Markle: And then, once a site has matured, once it’s past the first few months and there’s sort of a culture developed, there’s some peer leaders, there’s a sense of gravity and richness and vitality in the community, it just becomes a generator of well-being and joy and vitality, whether it’s within a clinic or within a community. I think many of our providers and our coaches say, “I kind of do this just as much for me as for the patients, because we’re all getting something out of it that’s needed and really shared.” It remains to be seen for me what it takes to transmit this culture across 3,000 miles to a different site where we don’t have the same level of staff support. To me, that’s sort of the most exciting challenge ahead.
James Maskell: Absolutely, yeah. Super awesome. I love it. That is certainly consistent, and we’ve had so many practitioners who where it’s sort of a meta example of the patient. They were a little intimidated because it was new and different and they never tried it. They never got taught to do it in medical school. And then it’s like, “Oh wow, this is really powerful.” And a lot of the weight of behavior change has been taken off my shoulders. I think for a lot of practitioners, they feel like…they know they’re not equipped to facilitate behavior change. They know it’s not working that well. They know their patients aren’t getting better. And yet, because of the history of paternalism in medicine, they kind of feel like they should be responsible for it, because they’re responsible for getting the right drug dosage and the right prescription, and they know they’re giving the right prescription, but they can’t understand why it’s not being delivered properly, and maybe they have issues with their own delivery of these kind of things for themselves.
James Maskell: So I feel like there’s just such a weight when they realize, “Hey, if I can put people in these groups and these other people can support them, it takes the weight off them and it takes the weight only off the shoulder of the patient, too.” And ultimately, that’s why I’m so bullish on this model, however it’s being delivered. The group, the healing in groups model, is so powerful because ultimately people are supporting people to do it. And in every other model, there’s just not enough health professionals to go around, even if you are using health coaches.
Elizabeth Markle: Yeah.
James Maskell: So it’s really exciting to see how efficient it is, as well, how beautifully efficient and how elegant the outcomes are. I guess one last question I want to ask you, because ultimately if you’re standardizing the process and you’re standardizing the structure, I would imagine that part of the standardization is so that you can track the outcomes and actually see what does happen. So I’d love to know, have you got any of that data yet? What does it look like? And how long until we know what a standardized 16 week dose of Open Source Wellness does for people?
Elizabeth Markle: That’s a great question. I want to answer that, but I just want to go back for a minute, if it’s okay. I really appreciate your speaking about the experience of patients and providers being so parallel and that in some way, the current system is a setup for us all to feel failure and shame and to personalize it. Right? Our patients feel shame that they somehow haven’t been able to work two jobs, pick up the kids, shop for healthy produce, prepare it, cook, clean up, help the kids with homework, and then they’re supposed to go to the gym and meditate and see their friends. If I could be a little radical for a moment, give me a break! The social structures are not set up to potentiate well-being in our communities, nor is healthcare set up to help our providers be well or to help them be effective in supporting our patients.
Elizabeth Markle: So I think looking at what is the individual experience of shame and failure that is so endemic, and what would it look like to design both clinical and also social systems and structures to make health the default and well-being the default is a really worthy question. So glad you’re thinking along those lines.
Elizabeth Markle: To answer your questions about outcomes data, yes, we have strong outcomes data. Maybe this can get posted with this podcast. In essence, depression scores come down from an average of almost 15 to an average of about 8 for the population that has depression to start with. So the effect size is about .9, which is two to three times as strong as what we’re seeing with antidepressants. For our hypertensive subset, blood pressure is coming down between 12 and 15 points, which is just as good as what we’re getting with gold standard blood pressure medications. Minutes of exercise per week goes up by about 40. People are eating, on average, about one serving of fruit and vegetable more per day than they were. And then, here’s the really exciting one to insurers is that ED visits and unplanned hospitalizations go down by about 75%.
Elizabeth Markle: Now, I want to sort of give the caveat that this is pre-post data. We don’t have randomized controlled data yet. I hope we will, but seeking some substantial funding to really do that right. But for a cohort of about 50 people, there were 22 ED visits in that cohort in the six months prior to participation in our group, and there were only four in the six months after participation in our group. So that’s one that I feel personally really excited about and I think if that’s a claim that actually bears out, with this kind of high touch contact and support we can reduce very, very expensive utilization of the Emergency Department, I think that will get the attention of the folks who are making big decisions about funding.
James Maskell: You’d hope so. Let’s see. I’m very bullish on it. I’m really excited to hear what you’re saying. I mean, if you just take it away from the medical aspects of it, the human elements of this are really undeniable, and that’s what I’m really excited about. I know that it’ll take some time to work out the science and to convince everyone, but ultimately those people who have been in the process and have all these new friends and are surrounded by a community of people that are empowering them to their best health and participation in health, that’s a real human thing that’s happened. I think it’s clear to almost everyone that we need more of that, and that’s part of the sort of recalibrating of the social structure of America and the West, and all of particularly countries that have lost that social structure through the implementation of the individual culture.
James Maskell: I’m very grateful for the work you’re doing. I wish you all the best. It’s OpenSourceWellness.org. Thank you so much for being part of this podcast series, and I wish you luck. Is there anything else you’d like to share with our audience?
Elizabeth Markle: No. Thanks so much, James. Pleasure talking with you. I feel your kinship on all of these perspectives, and yes, I just want to say that we just welcome folks who are interested to reach out, send us an email. We’d love to have a conversation and explore how we can support you doing this kind of work or similar in your communities.
James Maskell: Beautiful. All right. This has been Dr. Liz Markle. She is one of the co-founders of Open Source Wellness. You can find out more about them on their website. You can find out more about how it’s working and how you can bring it to your area. This has been the Evolution of Medicine podcast. We’re doing a series on group visits and shared medical appointments. If this is the first episode that you’ve listened to, go back and listen to all the rest because it’s been a truly transformational series. But for now, thanks so much for listening. I’m your host, James Maskell, and we’ll see you next time.


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