Our podcast guest, Michael Mabry, DO, works in a fully capitated medical group in Johnson City, Tennessee. Capitation is a fee-per-patient model, which tends to promote health by incentivizing preventative medicine, chronic disease reversal and helping patients maintain their health.
Implementing group medical visits has allowed Dr. Mabry’s practice to improve patient outcomes and increase the local community’s access to lifestyle medicine. In his group visits, patients who have similar medical issues come together once a month for a two-hour visit to learn relevant health information.
Dr. Mabry also shared that he can spend more time with patients individually because he has systemized patient education. Part of the success of the group visits, according to Dr. Mabry, comes from the much-needed sense of community experienced by participants.
Early in his career, he learned about how to build and scale his practice through some of the first Functional Forum events and the Group Visit Toolkits from Lifestyle Matrix Resource Center.
When you listen to this episode, you’ll also learn about the following:
- How to connect your business needs with your passion for lifestyle medicine to evolve health care
- The benefits of capitation as a business model
- How you can foster connections with your local community to build your business
- Practical alternatives for dysfunctional payment models in the health care industry
- And much more!
James Maskell: So, tell us a little bit about some of the groups. I mean, this is the Year of Connection. I think we’re really showing that if you can connect to a better payment system, you can incentivize things. But can you just talk us through how did you start your groups? What did you focus on first? How did you recruit people? Where did you do them, and what some of the outcomes have been?
Dr. Michael Mabry: Absolutely. Oh, yeah, the outcomes are fantastic. Yeah, so I started about 18 months ago. I’m finishing up my 14th different group. I started with a lot of the Functional Forum work. I started with some of the folks down in Florida, like the Lifestyle Matrix Resource Center, started with some of their materials that I learned through you guys.
I got in touch with Dr. Sumego up at the Cleveland Clinic who runs all their lifestyle medicine groups, so I just started calling around asking, “What do you guys do? Can I have some materials to see what you do?” I just started picking people’s brains. I started making a curriculum. And so, I pulled from some different sources, and what I ended up doing was is I have a six-month course where patients come in once a month for a two-hour visit, and it goes through what causes inflammation and chronic disease, nutrition, stress management, exercise and movement, sleep, and then brain health.
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 Evolution of Medicine Podcast. I’m super excited for this week’s episode. We have Dr. Michael Mabry, and Dr. Mabry works in a fully capitated medical group in Johnson City, Tennessee. Appalachia at its finest.
Over the last 10 years, Dr. Mabry has made significant inroads with functional and lifestyle medicine into his organization, and over the next half an hour, you’re going to hear an incredibly inspiring story about how doctors are now operating inside the system and seeing fewer patients and taking more time with them and being financially rewarded to do so. It’s built on capitation, it’s built on functional medicine, and it is the future of medicine as I see it. So, I’m super excited to share this with you and really look forward to your feedback. Enjoy.
So, a warm welcome to the podcast, Dr. Michael Mabry. Welcome, Doc.
Dr. Michael Mabry: Thanks, James. Thanks for the invite.
James Maskell: Really excited today to get into some topics around this Year of Connection. We’re going to talk about connecting patients, we’re going to talk about capitation, and this is a topic that we’ve actually talked about here on the podcast before. We had a few months ago Dr. Robert Pearl, who was very critical in helping Kaiser really turn their business around.
Talked about the fact that capitation was really a way where lifestyle medicine could really thrive. So, I’m excited to jump into some of those topics, but why don’t we just start with your story. Obviously, anyone who is practicing somewhat outside the standard of care with lifestyle and functional medicine has some reason how they got there. So, why don’t we just start there?
Dr. Michael Mabry: Yeah, absolutely. Again, thanks for the invite. You know, man, I could compress 20 years. I always knew I wanted to be a doc when I was a little kid, and I think I’ve always just been wired to pull people together in a community. I’ve done that in other nonprofits along the way. But yeah, ever since I was a little kid, I wanted to go into medicine. In college, I worked for a chiropractor, and I’m like, “Man, I really love what they do here. I see people walk in, and they walk out feeling better.” I’m like, “This is great.”
Fast-forward, I went to Israel on a just vacation with my grandparents, and I ate the Mediterranean diet for two weeks and I felt fantastic. I was like, “Man, I feel so good.” I get home, I get back to eating your normal American diet, I was like, “It wasn’t the vacation, it was the food.” So, just another little steppingstone, but then what really got me interested was I was a first-year med student back in 2013, and I had met a man who was told with his prostate cancer he’d be dead in three months.
I met him 10 years later, and I’m like, “What are you doing to stay alive?” So, I stayed with him and his wife, and they were doing nutrition and juicing and fever treatments and hyperbaric oxygen and far infrared. And they just had all this stuff going on I was never taught in medical school.
He had went to a lifestyle center, and again, he lived 10 years longer. He showed me all his scans and his labs, and I was just like, “Wow, this is incredible. This is not stuff I’m learning in med school.” So, I was very interested in really how the whole person can heal. And then funny enough, I stumbled onto Functional Forum. I think you guys started in 2013, so—
James Maskell: 2014, yeah, just February 2014 was the first episode. Yeah.
Dr. Michael Mabry: So, I stumbled onto you guys right at the beginning of med school. So, I’ve just been tracking with the functional medicine community ever since.
James Maskell: That’s cool. Wow, awesome. Well, it’s really cool to hear the journeys and the personal experiences and those are certainly some unique ones, but I think it always involves someone, sometimes the person themselves, getting better and staying better.
So, tell us a little bit about the situation that you have right now and who you work for and how that system is set up, because I think ultimately the Evolution of Medicine started out would be to convince you to leave the system, leave what you’re doing and go and start your own practice, but you’ve chosen to be part of an organization. Why don’t you just talk us through how you ended up here, and why you’ve chosen the path that you have?
Dr. Michael Mabry: Absolutely. Yeah. Well, so I had a few friends that were here already from residency, and we went to the same medical school in Virginia. It was an osteopathic program, so I had some connections, and we actually got pregnant with twins right at the end of med school, and I was like, “We got to go back home.” So, as we’re looking around the region, State of Franklin Healthcare is where I work now. I applied, and I work now for Family Physicians of Johnson City. It’s a wonderful organization.
So, I’m an owner, I’m one of 100 owners, and we have OB-GYN, a lot of family medicine clinics, internal medicine, pediatrics, and then a few specialties. So, like podiatry, rheumatology, sleep medicine, but all in an insurance model. But what’s really great about it is they give us… And we really have full autonomy to practice in our own little clinic, but we have the support of the whole organization.
Our organization just from the top down is very supportive. They’re supportive of new ideas, they’re supportive of ways to help get patients healthy. One of the things SOFA, State of Franklin Healthcare Associates, one of the things they’ve done so well over the last 20 to 30 years is they have really maximized the quality metrics and really the capitation side of medicine, meaning they will go to insurance companies and say, “Hey, we will take responsibility for this patient population at this cost, and if we take excellent care of them, then we share in those savings.”
So, our team has just made, way before I came along, wonderful advancements in how do we do that as a whole medical group with 1,200 employees, they have mastered that. It’s been so nice that my friends in the hospital and other clinics, they’re always like, “You got to see more patients. You got to see more patients.”
Whereas here, they literally tell us, “Hey, why don’t you see a few less patients, and just take extra good care of them?” You end up making maybe twice as much as some other family doctors because that quality money coming back from insurance companies, those savings is substantial. So, I’ve been able to practice more lifestyle medicine, functional medicine in an insurance model. So, it’s just been a really nice hybrid for me.
James Maskell: Yeah, I really want to just double down on that point, because so many practitioners leave conventional medicine because of exactly what you just shared. They’re being forced to see more people, and yet when you switch the paradigm around and where you get paid in a capitated way, the incentives is towards the fewer patients and better care because ultimately, if you can keep them away from high cost services, high cost treatments, high cost medications, you actually make more money in those areas.
So, I’m really glad that you said that. I really want to get this message out to the functional medicine community because I feel like there are now work situations where you can have it all, you can be a part owner, you don’t have to be a solo entrepreneur. You could be incentivized towards getting better care.
If you can actually deliver disproportionately better care through functional medicine education, you could probably influence the other doctors once they see that your outcomes are better. So, do you have any good stories so far of doctors who have come sniffing around because of some of the work that you’ve done with patients?
Dr. Michael Mabry: Oh, yeah. Yeah, tons and tons. Well, and it’s been a wonderful problem to have. I’ve only been practicing for about two and a half years outside of residency, and I was booking out six or eight months for new patients, and I’m just like, “My goodness.”
So, I actually had to turn it off recently, I just didn’t have room for people. But I had a lady last week where she was diagnosed with MS a long, long time, and she just came in here exhausted, absolutely exhausted, and she’s doing a cane, she can barely walk. So, I just start peeling back the layers and seeing is there anything else? Something as simple as her B12 level was just horribly low, but it was still in the normal range. So, I started her on some methylated B vitamin shots. She comes back in here six weeks later without a cane, and just runs up to me, hugs me.
We both start crying, and she’s like, “I’ve not felt this good in 20 years.” So, the other docs in my group are like, “Why is she crying?” So, then I’m just walking them through B vitamins and how to check that, and all this. So, I think as you see patients get better, other people in the community hear about it. So, one of the things I try to do is I always have medical students or PA students or NP students, I feel like functional medicine, we really need to be teaching others as much as we can.
So, I always have students rolling through so they can see it, but I always have other docs texting me and calling me and coming to me saying, “Hey, what would you do for this? What would you do for that?” I don’t have all the answers by any means, but just having that paradigm shift of how you look at patients goes a long way. I don’t know if we’re talking about this yet, but I’ve been doing group visits for about the last two years. So, now I have several doctors in my group, my organization, who now want to start doing groups. So, I think as people see how you practice, it’s contagious.
James Maskell: Yeah, that’s really great. Well, look, and the incentives really work in the right direction. Now that we’ve been doing groups with Heal Community for three years, we’ve just really realized that in the value-based entities, if a group helps get someone better, that adds value because they don’t use the services much. If the group helps reduce the number of messages that come into the portal for the doctors to deal with, that’s an added value.
If it keeps people out of the emergency room and on a high-cost services, that’s a value. If it gets them off the drugs, that’s a value. If it reduces loneliness and people just don’t overuse the medical services because they’re lonely, that’s a value. So, all the value runs in the right way when you’re running groups. In the last few years, we’ve had some of those, but we’ve also had in some a fee for service, and we’ve made it work.
But that ultimately becomes a juxtaposition of does this health system really want to reduce admissions, when that’s the majority of how they make their money? The answer—
Dr. Michael Mabry: Exactly right.
James Maskell: —is not really. Even if you do exceptionally well, someone somewhere is going to come in with a red pen and say, “We don’t like this.” Whereas in your organization, the more that you could do it and the more efficiently you can take care of people and the higher quality metrics you can get, the better. So, I think it’s really about the payment models lining up with that.
So, tell us a little bit about some of the groups. I mean, this is the Year of Connection. I think we’re really showing that if you can connect to a better payment system, you can incentivize things. But can you just talk us through how did you start your groups? What did you focus on first? How did you recruit people? Where did you do them, and what some of the outcomes have been?
Dr. Michael Mabry: Absolutely. Oh, yeah, the outcomes are fantastic. Yeah, so I started about 18 months ago. I’m finishing up my 14th different group. I started with a lot of the Functional Forum work. I started with some of the folks down in Florida, like the Lifestyle Matrix Resource Center, started with some of their materials that I learned through you guys.
I got in touch with Dr. Sumego up at the Cleveland Clinic who runs all their lifestyle medicine groups, so I just started calling around asking, “What do you guys do? Can I have some materials to see what you do?” I just started picking people’s brains. I started making a curriculum. And so, I pulled from some different sources, and what I ended up doing was is I have a six-month course where patients come in once a month for a two-hour visit, and it goes through what causes inflammation and chronic disease, nutrition, stress management, exercise and movement, sleep, and then brain health.
That’s the six. I’ve actually been giving those away to other practitioners who are now starting their own groups down in Knoxville, Tennessee and also here in Johnson City. So, the way I start recruiting was just as I’m in my rhythm seeing patients in my office, I just say, “Hey, you may be a really good candidate for group visits. Have you ever heard of that?” They say, “No.”
I just walk them through how you bring a group of people with similar medical issues and you teach them ways to perhaps prevent it from getting worse, or maybe ways to reverse it and maybe ways to get off medication. I’m like, “And your insurance will pay for it.” So, nine times out of 10, they’re on board. I also started putting up flyers in the office just has my little face, and it has a group of people hugging each other, talking about group visits.
So, then my partner’s patients are also coming to it because they’re still in my office, so I can still bill them for groups, because they’re all part of the same group. So, then I just started planning out three to four months ahead of when the groups would start. Every day, I’m just keeping a list of, “Oh, I talked to Joe Smith, he’s interested in the group.” So, I wrote him down to my Excel sheet, and I just had a long list of patients. So, when time came to fill the groups, just me personally, I found that to be much more effective.
I just went through and started calling, “Hey, Joe, are you still interested in the group? We’re starting April 1st.” It’s been fantastic. Some of the results we’re seeing, yeah, loneliness is so high. So, when you bring people together in a group, they no longer feel alone. They don’t feel isolated, and they feel like other people understand what I’m going through.
That’s as much therapy as medicine is half the time, so I’m seeing people come off insulin. I’m seeing people lose 30, 40, 50 pounds. I’m seeing people really get into fasting, really get into nutrition, really get into exercise. I got this couple, they ride Harleys, they’re rougher folks. I got them going to the senior center doing yoga every week because they love it. So, often we just write people off like, “These country folks, they’re not going to go stretch or do yoga,” and I disagree.
If we’re not teaching them or training them or living it out ourselves, well then yeah, you’re probably right. But if you encourage them and do it in community, I mean, we’re just watching people thrive. So, I’ve probably had eight or nine people come back for a whole ‘nother six months, just because they loved it so much.
James Maskell: Yeah. I guess in that theme of connection, I wonder if you could share, because one of the things I saw when I was working in a clinic like 18 years ago is one successful outcome leads to a whole network effect, where all these other people who touch those people in some way and community end up coming through, and that was in the South. I mean, that was in Georgia, and we saw that even then. So, I’d imagine 18 years later, there’s a greater openness even in areas that we might not think of as hotbeds of “functional medicine.”
Dr. Michael Mabry: Sure. Yeah, you’re exactly right. I’ll just speak for people in my area. They’re really craving community. COVID really did a number on them, on all of us. So, unless you’re very intentional, a lot of folks have been totally alone the last couple of years. Based on fear and all these other things, so just coming in a room together of people smiling, and they’re happy to be there, that’s therapy in and of itself.
Also, for me as the provider, it brings me a ton of joy. One thing I didn’t mention is I hired a health coach to do that with me, and I would encourage others to consider a nutritionist or a health coach. So, she teaches with me, and then in between that four-week visit, she calls them in the middle as a touchpoint. The other thing I do too that I have really enjoyed is around month four or five, my health coach and I cook a big dinner and we all go down to Food City, a local grocery store, and we feed 30 or 40 of them dinner, them and their spouses, and they share some testimonies of, “Hey, how’s our health improving? What are some things we’re proud of?”
So, now, they’re all supporting one another. So, very minimal cost, costs me 200 or 300 bucks to feed 40 people, and then after we’re done eating, we walk them around the grocery store. That word’s gotten out in my organization as well, and now some other docs are interested in, “Hey, we want to do group visits, we want to do group medicine. We’re interested in grocery store tours.” So, you’re exactly right though, I think as you’ve always said in the past, success leaves clues. So, just as you’re having success with patients, other people just naturally want to get involved.
James Maskell: Man, I’m so excited for this conversation because I’ve been thinking about this concept of these diamonds in the rough in that for years, we were always trying to get doctors to leave the system and start their own thing because I think in the payment models that existed pre-COVID, it was very, very difficult to be in a position like yours and make it work, but now things have changed, and I think that fee for service has changed.
So, I think it is possible now to run a functional medicine or a health promotion clinic in fee for service. But once you get to capitation, I mean, you see the biggest capitated organizations like Iora Health that was bought first by… What’s it called? One Medical, and then sold on to Amazon, that was in capitation. One of the first things they do, they pair a doctor with a health coach, and we’ve seen the same thing in these other models.
So, I think it has changed. So, I would love to hear from anyone, a doctor who’s in the system and is fighting the good fight, because I do feel like you can make a giant impact. I think you can already get a sense for the way that this is starting to spread out. I mean, across these 1,200 doctors that you mentioned, how many patients are in the ecosystem that you’re working with?
Dr. Michael Mabry: Well, so there’s 1,200 employees. I think we have 130 doctors and probably 130 or 150 mid-levels, so call it 300 providers. I think we have I want to say it’s 150,000 patients, so it’s quite a bit.
James Maskell: Yeah, you’re there in Appalachia. I mean, you mentioned COVID as an issue. What about chronic pain and the opiate crisis? Tell us what you’ve been working on in that regard.
Dr. Michael Mabry: Oh, I mean, I had a fentanyl overdose yesterday. So, we’re seeing that somewhat often. There’s a lot of meth in our area. As you know, the Appalachian region, it stretches clear through past West Virginia, but we live in a pretty sick part of the country, a lot of drugs, a lot of chronic disease.
But to me, that’s not as discouraging as much as it as look at the opportunity to get into some people’s lives and really make a difference. If we can make things like this work here, you can make it work anywhere. It just requires people who will roll up their sleeves and say, “Hey, let’s get this done together in community.”
James Maskell: Yeah, absolutely. Yeah, it’s really, really beautiful. So, give us your take on what’s next and what you’ll be working on from here. You’ve obviously got other doctors taking your model for your groups and taking it to more people. You’ve got interest in functional medicine. It sounds like your own patient capacity is almost full. Are you looking for ways to create more capacity into functional medicine? Are you looking for other ways to spread best practices throughout the group?
Dr. Michael Mabry: Yeah, we just hired a new girl who is already in her IFM training, so just bringing more people into the organization who are like-minded is really helpful. There’s three things I have on my mind right now as far as vision where I’m trying to spend my time.
One of them is continuing to maximize our groups, because they’re just doing so well. But one of them, as you know, we’re starting a Functional Forum here. Early 2024 is our goal. I’ve been talking with some of your team members of help getting that started, which I really appreciate. So, just as a way to bring all of our local, not only docs, but NPs, PAs, and we have three or four higher education colleges around. So, bringing in NP students, PA students, and medical students, so they have a place to land, to come to a quarterly meeting to learn about functional medicine, lifestyle medicine.
But then the really big thing, which I’d love to pick your brain more on later, James, is we are always… I’ve thought about for 10 years, what would it look like to have a wellness center in East Tennessee? Then another buddy of mine was like, “What if we call it a wholeness center?” A place where people can come and not only learn health, but learn what it means to be whole, to be a healed person, to work through trauma, to work through depression, to work through mental health, to have a place where they belong.
Then the second part of that is how do you make it affordable for people in Appalachia. We could make some place that costs $5,000 a week, and those places are wonderful, but how do you make something affordable? So, those three things are top of my list of how could we do those in community, but if you or people in the community have any thoughts about that, I’m wide open.
James Maskell: Well, I wasn’t expecting you to bring that up, but actually I do have a thought about it because I was reading something last night. Have you seen the video of the guy, the Rich Men North of Richmond? Have you seen that guy?
Dr. Michael Mabry: Uh-huh, yeah.
James Maskell: So, I saw Bobby Kennedy on his Substack yesterday had an article where he went to visit that guy. They were basically talking about the level of addiction in these communities. I don’t know if you know this, but Bobby Kennedy is/was an addict and gave up drugs and drinking years ago, and has been sober for a long time.
Actually, one of the things that he announced in that blog post was going to be the creation of these, I mean, he didn’t use the word wholeness, but certainly it was healing centers in areas where the traditional investment has been prisons because that’s what you need when there’s lots of people who are doing the wrong thing. We put them in prison, and he’s talking about creating these healing centers. So, it just happened that I read that yesterday, and I was very inspired by it because I do recognize the thing that’s there on the front lines.
Yeah, I’m very interested in seeing whether or not those efforts are starting to be mimicked by some of the other big presidential candidates, because who doesn’t want that? It’s actually a really powerful message. So, that just came to me because I read that Substack yesterday, and we’ll link to it in the show notes so people can read it for themself, but it was stimulated by that guy playing his banjo and sharing what is the state of the world for the working man in Appalachia, one way or another, I think.
Dr. Michael Mabry: Exactly right.
James Maskell: It’s interesting that you mentioned that in that time.
Dr. Michael Mabry: Yeah. Oh, yeah, that’s coming. So, what we’ve started doing there is I had 25 people over for dinner a month ago, and we’re going to start having dinner at my house every two months and just talking and praying and saying, “What does a wholeness center in East Tennessee look like and how do we get it paid for? How do we serve people here who have no money?”
So, we’re just going to hang out until we know what to do, so as more people, if y’all have any thoughts, I do not have the answers for that yet, but I think it’s something that we can do, and we should do.
James Maskell: Absolutely.
Dr. Michael Mabry: So, yeah, email me that link from Bobby too. That’d be great to read.
James Maskell: I will definitely send that. Well, Doc, I think I speak on behalf of the whole population who listen to this podcast, I feel a lot of hope from this conversation because I feel like many of the things that we have thought that have stood in the way of the evolution of medicine are falling away. I think the payment model being the most dysfunctional historically, and something that has kept so many people away from this world, and I think what you’re sharing is a beacon of hope, and it really ties together a few things that we’ve spoken about over this year. We’ve spoken about capitation and Dr. Pearl.
We’ve spoken about groups and how they work. We’ve spoken about practitioners just doing their thing and spreading inside the organization. So, I’m really excited to see what’s possible and look forward maybe to a site visit in 2024.
Dr. Michael Mabry: Let’s do it, dude. Yeah, we’re planning on starting in January, but yeah, I appreciate you, James. You got my phone number. I’m happy to help any way I can. If anybody wants my group classes, I’m more than happy to send you what I put together. You can tweak it, edit it. I believe in having an open hand with things. I learned from others. I’m happy to pass it on.
James Maskell: Wonderful. Well, thanks so much for the time today. We’ve been with Dr. Michael Mabry, and we’ll put all the details there in the show notes. If you want to get in touch, you can get in touch with Dr. Mabry directly, or you can get in touch with us here at the Evolution of Medicine, and we’ll help out as much as we can. Thanks so much for tuning in.
If you’re inspired by this episode, we’d love for you to share it on social media, especially in places where you think other doctors or other health professionals working inside health systems could get into it and be inspired by it, because I think it is really inspiring work. Thanks so much for tuning in. This is the Evolution of Medicine Podcast. I’m your host, James Maskell, 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 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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