In our second episode of the New Models of Care Series, we feature Dr. Katherine Bisharat. Dr. Bisharat is an internal medicine physician from the Sacramento area. We have partnered with her and her clinic to launch virtual group visits and bill them to insurance. On this episode, you will hear about Dr. Bisharat’s journey into functional medicine and how she operates her practice. Also, you will hear about group visits and the impact they can have on your practice and on patient outcomes. If you are thinking of adding group visits or transitioning to virtual group visits, then you won’t want to miss this episode!
Highlights include:
- How we can bridge the gap between internal medicine and conventional medicine
- How group visits, and now virtual group visits, are beneficial for not only your practice but your community, too
- The origin of HealCommunity and the mission of this initiative
- And so much more!
Resources mentioned in this episode:
James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.
Hello, and welcome to the podcast. This week, we feature Dr. Kate Bisharat. She is an internal medicine physician from the Sacramento area. As you’ll hear in the story, about the opportunity over the last couple of years to really get to know her and her clinic really well because I live very close to them. About this time last year, I started to really think about how The Community Cure and the ideas for my book could be delivered in a pandemic and in a virtual environment with virtual group visits. And as you’ll hear, we started a pilot over the summer that then turned into a pilot at Dr. Bisharat’s clinic where we essentially delivered virtual group visits, run by health coaches and delivered through technology in partnership with Dr. Bisharat’s clinic and billed it to insurance. This is the second in our series of these new models of care. And we are super excited to share that this has become a new venture called HealCommunity. You can find out more about HealCommunity at healcommunity.com, but this is really the origin story of how this business came to be.
And so if you are a physician in the US that’s billing insurance, make sure to pay attention, and I’d love to hear from you if it resonates. So a warm welcome to the podcast out to Kate Bisharat, welcome, D doc.
Katherine Bisharat: Hey, thank you. Glad to be here.
James Maskell: This is actually a first because I’m actually in the shed where I work, which is in my garden. And normally, I record all these podcasts via Zoom because they’re not here, but this time for the first time we are here together. So we should probably call this not a podcast, but I think you said a “shedcast” and it’s a very special moment because it’s actually your birthday today. So., so…
Katherine Bisharat: Yes, and I am excited to be happy and well at the age that I have, and I am ready for more.
James Maskell: Amazing. Well, let’s jump into it and share a little bit about your story. So you have a practice here in Sacramento and has taken an interesting journey to get to be practicing some integrative medicines and functional medicine but inside the payer system. Tell us a little bit about your journey to become a doctor and what you learned along the way?
Katherine Bisharat: Well, I have had a rather interesting and fabulous journey. All of us have who do functional medicine. I’m quite sure of that, but I did found my practice in 1998 as internal medicine and wellness therapies, knowing that I wanted to include a large portion of my practice as a wellness and healing clinic. But I am solidly trained as an internal medicine physician and board-certified, and I’ve enjoyed that journey as well. But I knew that the toolbox we have in medicine comes to a very abrupt end and we need more. And so, my patients were the ones who kind of taught me that. And so I decided…w Well, in the beginning, I obviously had a great deal to learn. I didn’t really know exactly what I wanted to do, but I did start with an acupuncturist and a biofeedback person and my fascial release and the best that I could, but then came on all the awareness of my learning needs.
So I went about being trained here and there and went through the functional medicine certification program and was in the second graduating class. And it’s been a fabulous time for me. And it totally met my needs as a physician who wanted to apply root cause medicine and look for ways to help people towards their health. So, it’s been a great journey and most of us in this branch of medicine heal ourselves in the process. So that’s the absolute beauty of this.
James Maskell: Yeah. Beautiful. Well, I know there’s probably been temptations along the way to have a cash practice. And I know that not only do you still take insurance, you’re part of the Hill Physicians Group, which is a group of 4,000 independent doctors. Why did you stay on insurance this whole time and why is that being really important to you as you staked out your plan for running your practice all these years?
Katherine Bisharat: Well, in the very beginning, I knew that I would not do a cash practice. I did try something. It was a little bit of a blended practice, but it was a disaster and I backed right out. And I really stuck with this because my deepest heart said, “This medicine belongs to everyone.” It was not meant for people who could simply afford it, it was really meant to be the standard of care and I wanted to step right into that and have that be my focus and my strongest wish is to have this be the medicine we all practice.
James Maskell: Amazing. And we’ll talk a little bit later about your…s So, I guess you shared with me that you feel like you’re here to be a bridge between internal medicine, conventional medicine, and what you’ve been practicing for years, where does that bridge kind of arise day-to-day in your practice now?
Katherine Bisharat: That’s a great question because it really is. I have remained that. We have a very blended practice. We have people who come for internal medicine, they just want their medications for their blood pressure or their diabetes and they don’t really see a need for anything else. We’re always there and we’re always dropping little ideas, and you might want to think about this and maybe add a little chromium one day or whatever it is. We’re always offering, but never insisting. And I wanted to stay with the group of people that I’d been with for all the years that I’ve been in practice. There are people who have been with me for so many years that I would never have crossed my mind to abandon people.
And now, of course, it’s a completely different thing. We have people who come from pretty far away with their insurance and we are providers for people who come for functional medicine exclusively. So now we have the bridge that I see that we provide is we provide care for people who have very different expectations and we meet their needs wherever they are and continue to offer in gentle ways opportunities at expanding people’s awareness of how to achieve their own health.
James Maskell: Beautiful. Well, I feel that in the clinic and I know that I’ve had a chance to come there a few times. I definitely see just the way that you set it up. It is a medical office. It’s not a med spa, this is a real medical office. And yet, there’s certainly some intention put into creating a healing environment, which I’ve certainly witnessed and seen. So, when we first met, I had just moved to Sacramento and your office was actually extremely close to my old house and my new house. And I remember coming to meet your staff because I was sort of in the journey to write the book, The Community Cure, and you guys had taken a shot at doing some group work. So, tell us a little bit about why that came up and what it looked like and what you learned by doing groups in the practice?
Katherine Bisharat: Yes. We have always been driving towards something that would sustain people in their search for health. So we started by doing these really wonderful teachings on different topics that I thought would continue to engage people in the work that we all have to do to get to our health. Some of them were about the basics like sleep and we have the great fortune to have these four wonderful young people. All of them, PAs, all of them trained to do various stages in functional medicine as well. So it’s really, we’re all kind of driven by the same purpose. And so each of them chose a few topics and we developed these teachings that we would do in group appointments and including one of them was a four-part series using the book.
James Maskell: I’ve got it right behind me actually on the thing, How to Make Disease Disappear by Dr. Chatterjee, which is one of my favorites and really is built on the foundation of lifestyle medicine.
Katherine Bisharat: Yeah, exactly.
James Maskell: It’s really explaining lifestyle medicine.
Katherine Bisharat: So, Katie, one of the PAs chose that one as her topic and she did it in a four-part series following the four parts of the book. Anyway, but it kind of always left me feeling like people still are out there and not really able to adhere to a guided, progressive, punctuated support system for achieving a lifestyle change. It is truly one of the hardest things that any of us can embark on. And for me, when I embarked on my journey, the group that I think I relied on the most not in terms of specifics, but in terms of pacing myself and exposure again and again and again, and that was the yoga groups that I’ve been in, where people come for a positive outcome, they come for quieting themselves. They come for focus. They come for all the reasons that one does yoga for a healthy body.
So that provided me something in that and then I came to really realize that you need to interface again and again and again, and again, for a true…t The ability to step forward into a new way of being in the world, whether it’s for diet or for exercise or for stress reduction or all these things come kind of under that category, because you have to seek out a new normal and the new normal can disappear in an instant in the face of all the forces that bring you to dysfunction.
James Maskell: Yeah.
Katherine Bisharat: You need that reinforcement over and over again to make that your new normal.
James Maskell: Absolutely. One of the things I’ve been talking and thinking a lot about recently is just the friction to shift to a lifestyle-focused medical system and how much friction there is. There’s friction for doctors for sure to come and learn functional medicine and go in that direction. But for patients, there’s so much friction because you have to go against the norm societally, you have to make a decision to eat differently or to live differently and then you have to do it enough times for it to become a habit. And I’m sure everyone who’s listening to this has come up against some of it even in their own lives where it’s hard to make that a habit. And it’s really even harder because we have the most unhealthy environment in human history and it only got more unhealthy during the pandemic where everyone’s at home, obviously opportunities to exercise are limited, opportunities to cook potentially are limited or people having to cook who maybe didn’t cook before.
And so, it’s a tricky moment than ever before to create a healthy environment and create a new healthy normal.
Katherine Bisharat: Yes. I really feel like people have a great deal of challenges moving those factors around in their lives. And sometimes when I have people who are newly diagnosed as diabetics, I tell them, “Look, don’t cast this in a negative cloud. Really just look at it as now you have a leadership role and an amazing opportunity in your own family to help your kids not become diabetic, to help your spouse lose those extra pounds or whatever.” So don’t take it as a negative, take it as something that you’re going to share something amazingly positive because why? Because all of us should be eating like we’re diabetic in the world, in this country that not everyone gets diabetes, but we’re all eating from the same trough. And it’s very hard and harsh on our bodies. So if you can see this as an opportunity to move past something that’s not good for all of us, then you can be part of a leadership role. So, I always try to plant things in a way for people to really metabolize it in a positive way not a fearful or overwhelmingly.
James Maskell: Yeah, absolutely. Yeah. Well, that’s a great point. So I’ll take us back now to the summer of 2019, and we had a dinner, I had moved to Sacramento and I didn’t really realize this sort of quality and depth of functional medicine practitioners that that was, and doctors particularly in Sacramento. And I remember hosting a dinner and talking about groups and I was fired up about groups that year because I was doing these podcasts and I’d been to the Cleveland Clinic. And the thing I think that we had sort of co-residence on was that for the first time in the Cleveland Clinic, I saw them doing a 10-part series. So they had 10 weeks where people would rub shoulders, not only with other people like them, but with these health-conscious practitioners in the Cleveland Clinic. You had PAs and RDs and health coaches.
And there was something really special that happened when you sort of extended this healthy program over a greater number of weeks, because not only were people actually able to make real friendships in those sessions, but they had a 10-week sort of journey into actually implementing these healthy behaviors. And that really sort of resonated with your experience of what you’re saying, like needing to rub shoulders with health for a bit to really feel what it looks like to do that. Was that in your yoga groups that you’d really seen that?
Katherine Bisharat: Yes, definitely. I think that anytime that group comes together with intention and with common ground to cover, magic happens, that’s where we reflect the purpose together. And so, as you gather, it’s like a trickle of water. You put two trickles of water together and then three and then four and five, and now you have a flow.
James Maskell: Yeah.
Katherine Bisharat: It’sIts individual trickles become a true flow, and there’s something very productive about unifying ourselves in a flow if we want to get somewhere.
James Maskell: Absolutely.
Katherine Bisharat: It reminds me, and I think I originally saw this online somewhere. It’s quoted as an African proverb that says, “If you want to go fast, go alone, but if you want to go far, go together.”
James Maskell: Yeah.
Katherine Bisharat: When we combine things, we go, we get there.
James Maskell: Absolutely. Yeah. And that’s been the sort of common thesis of the Evolution of Medicine get meetup groups, connect practitioners. So, I totally agree with that. So this podcast series is part of our series on new models of healthcare because I want to share a little bit about sort of what happened then. And pandemic hits, I’ve written the book and the book says, “Okay, we’ve got to do functional medicine group visits, and this is the way to do it.” And I was expecting that I would be out selling health systems on doing group visits. “Just look, here’s the Cleveland Clinic, look at what they’re doing. Here’s some other examples from the book, just pick one and start doing it.” And then all of those groups all relied on people being in a room together and suddenly that was not really going to be possible.
So through the summer of 2020, we started to do some experiments with virtual groups and thinking about how we could try and create the same kind of togetherness, the same kind of common experience, but also teaching the principles of healthy living, but also taking advantage of this group structure for behavior change in a digital environment. And we learned a lot over the summer. We ran a couple of groups and then I remember sort of around September last year, reconnecting and just starting to have the conversation of I could really see with everyone expecting telemedicine now, everyone had sort of moved to telemedicine that this might be something that would be synergistic with a clinic like yours, where you had four PAs, one MD, all trained in functional medicine, doing a lot of appointments every week. But certainly, there were no group visits happening in the clinic. So, take us to that moment and what your thoughts were at that point?
Katherine Bisharat: Well, we did have that transition as did everyone else to virtual medicine. We still do see people in the office, but again, we’re geared towards the digital world now. And so we kind of had to rethink our group visits too. And it was kind of like James said, very synergistically, right? Then this opportunity came up to do what I have actually always wanted is to do an ongoing group, a group that would establish itself as a healing group, as a group with leadership, with input, and then allow these ideas to keep percolating up every week, a topic, an idea. And then how did it actually sit with the group, and then the process that people can go through it as they share experience was really something that I was kind of trying to figure out how to do, but then James had his idea. And so, we kind of said about implementing it in the office so that we could see how it would work for us, so this has been a very exciting process, actually.
James Maskell: Yeah. Well, I’d love to talk about it from a number of different perspectives, because in one perspective, we set it up so that the PAs and yourself would prescribe the program, right? So, there would be an initial appointment to prescribe it to the patients and then do an appointment afterwards, three months later, after the 12 weeks. But uniquely, you went through the program yourself and sat in it as a patient, what was it like listening to your patients, and other people that maybe you’d known for a while be in this container of this 12-week virtual group?
Katherine Bisharat: Well, it was quite an experience actually, and I had a little sense of, “I don’t want to inhibit my patients.” I wanted to be there because I wanted to know what it was like. But I didn’t want to step on toes for my patients to be able to have the freedom to talk. So, I decided I really wanted to be there as a patient, and that would equalize that. And so, I set out my own goals and I talked about things and the things that I wanted to change and achieve for myself that were of value to me and my health. And so, it was actually a very rich experience, and I was very happy to be there with everyone. And it was a very worthy investment of my time.
So, I feel like I got a chance to see what the coaching was like. I got a chance to see what the format was like, and it made me very comfortable and confident that this is something that can sink into people’s world in an effective way, with all the added-on backside of things where people can communicate even during the course of the week. So, I think that this has actually been very beneficial to my patients. And what we decided to do, which is a little add-on to our understanding of how the group would change things for people was we did an MSQ, this medical symptom questionnaire, and had people numerically identify what degree of dysfunction they were in, and then we did an MSQ at the end of it. So, we have our own little nice data too that that allowed people to measure their own change, so…. So.
James Maskell: Yeah. That was really a special experience to see that you wanted to go into it too, that you went through it. Obviously, we’re talking to our coaches on your end and on our end, and hearing that there’s great energy in the group. There’s something about the vulnerability in the first few sessions of opening up because I think most doctors have their own health stuff. They’re not living in this bubble where they’re just like perfectly healthy, it’s stressful to be a doctor if nothing else and you don’t get a lot of sleep, maybe.
Katherine Bisharat: Yeah, that’s definitely true. And I think that our own self-care is something that we need to definitely endorse and take care of.
James Maskell: Yeah. Absolutely. Well, I’d love to just say, so in just before Christmas, so that we had four groups that kicked off in October and went through that 12 weeks, and three out of the four of them finished right before Christmas. And on the Tuesday before Christmas, we had a really, really special experience, and I remember it so fondly, which was kind of like we were bringing together all the groups who’d been going through this 12-week process. And having people who’d been through the group share their experience, and it was actually really moving. We had a number of people from our team on, I know some of the PAs and yourself were on as well as a few dozen of the patients.
And what struck me was, this was just normal people, right? This was just like the normal people that you would see in the grocery store who might be struggling with all kinds of things, really talking about what kind of experience it was to build new friendships in the middle of the pandemic, but actually, I think over the 12 weeks come to the conclusion that a lot more of their health was in their hands than they had thought before, and actually see it happen in front of them, and it was a really special moment for me.
Katherine Bisharat: Yeah. That was really a great conclusion to an experience I think that for some people, that was very elusive to them previously, and I think that the beauty of it is just that over time, over re-experiencing each other again and again, and the leadership from the coaches and the…t There’s a kind of, I can’t say just leadership, but a kind of energy that I think was offered from the coaches that was very inviting for people. So, vulnerability didn’t feel overwhelming or unavailable. I really appreciated that and you’re right, some of the commentary that came from that last meeting was just very wonderful witnessing of the power of that experience.
James Maskell: Yeah. It was really powerful. One of the things that I’ve been talking about for a long time is the fact that yeah, the MSQ data is wonderful because it gives us a good idea of symptoms, but you don’t get MSQ data inside the medical journals, because it’s not really like a validated measure. One of the things that I’m super excited about this project is the opportunity to one, deliver a consistent program that is based in functional medicine across different clinics virtually, because one of the cool things about this project is that the patients didn’t necessarily know that our coaches weren’t sitting in the room next to you, right? We would always sort of refer back to you and the other PAs and the clinic, and all the people in the group came from your clinic, so they all live within, I don’t know, 10 miles up here, or maybe more if they’re coming from further afield.
But yeah, it was really special also to be able to capture promise data from all these people, and we’re just tabulating that promise data from the: first four groups who’ve had now, actually almost about 10 groups of people that have gone through, and just seeing the promise data, the patient-reported outcome measures across the groups, it’s clear that something is happening.
Katherine Bisharat: Mm-hmm.
James Maskell: Something medical is happening, because people are leaving in general with significantly better health, and when they came in. And I’m excited just to see what this can do to really bridge… I think the word bridge that you used in your vision is really a word that keeps coming up to me, because I feel like it’s not really about functional versus conventional, it’s really about finding a medicine that works, and we’re seeing a lot of conventional doctors kind of reaching out into the functional medicine space, because maybe they didn’t know anything about vitamin D, and it seems pretty important. So, I’m excited about the potential to really feel into this as a bridging moment where a doctor who wasn’t trained in functional medicine might think, “Okay, group of patients working on their health over 12 weeks, connecting with other people like them, sounds like something that I can get behind.”
Katherine Bisharat: Absolutely. And as a project that’s successful, all it will do is give conventional people a little clue that there’s more in this way of thinking than they might have previously thought, as an approach to medicine, functional medicine is so rich with rewards for people’s health that it’s good for conventional doctors to have even this level of success in their practices. If they can see a benefit, then it will be a positive outcome. I think we all are pretty much aware that medicine needs to undergo the change that James has been promoting and endorsing for all these years. We all see it, we all know it, but we need ways to make it happen. And I think this is one of the ways that I will continue to plan for in my practice, because it met that very, very…j Just a very big need to continue to reach out to people in a way that I was not really able to. So, it’s been really exciting, and so much fun to be part of this.
James Maskell: Even though you’re a functional medicine trained physician, there are limitations in your ability to really support people’s transformation when you’re dealing in short visits and dealing in visits that don’t happen that often, that is a limitation. And if a lot of behavior change is really about rubbing shoulders with health enough consistently to really make changes, this seems to me to be a priority for people who are in that sort of middle of the bell curve, who are either pre-chronic illness or in a chronic illness, maybe on a couple of medications. And they know they want to do things differently. They know they want to live a different lifestyle, but it’s hard because they’re living in a very unhealthy environment and making changes hard, and we need to solve this.
This is the journey that we’re going to have to go through to solve chronic diseases at scale. And it’s been just such a joy to get to do this in my own backyard, working with your incredible team. The joy and passion that your PAs have for healing is amazing. And just the personnel, I couldn’t have wished a better pilot program for what we’re doing.
.Katherine Bisharat: Yeah. It’s been great for us too. And I can absolutely say the same for your team. Your team has passion, knowledge and a lot of heart. They’re excellent.
James Maskell: Yeah.
Katherine Bisharat: So, it’s been a great blend of efforts, so I’ve really appreciated as well.
James Maskell: Amazing. Well, is there anything else that you want to sort of share about your experience or about your sort of vision moving forward or what you think is possible now that you’ve seen virtual groups being delivered sort of in partnership with clinics and on insurance? Do you think is there anything else that stands out as far as what you see in the future?
Katherine Bisharat: Well, I certainly see that it opens the door to refining this even further on specific topics. Like if want to do one that supports neurodegenerative diseases, that’d be a really awesome thing to do. So for me, it’s like tailoring a little bit further into different diagnosis and diagnostic or symptomatic patterns. We could refine those and promote them a little more. Almost every area of chronic disease can be addressed in this format because almost all of them have lifestyle at their base. So, I think there’s great potential in moving this forward and in other ways, and even in introducing functional medicine as a tool in individual healthcare is going to be a way to introduce functional medicine to even more people.
James Maskell: Absolutely. Well, good. Well, I appreciate you coming to share what you’ve shared here today. This is no longer a pilot, this is an organization called HealCommunity. You can find out more about it if you’re listening to this at healcommunity.com. If you go back to my book, you’ll see that the thesis for The Community Cure is really for everyone to have access to this kind of new layer of care that sits between patients and the primary care system, which is this group-delivered services that focus on empowerment, right? So for the large swathes of the population that will only ever get their healthcare on either commercial insurance or government insurance, where they can be empowered to participate in their health in a way that they have never been participated before. It looks at stimulating the self-healing mechanisms of the body and there’s a number of ways that we do that through lifestyle and through different modalities and then nutrition.
One of the key parts of it is going through an elimination diet over five weeks and sharing your experience with other people to think what is it actually like and making those changes over time. And so we believe that this can be a new layer of care. And then if we can establish a layer of care that brings people together and helps them implement healthy behaviors, that we can really flatten the curve on healthcare costs and heal a lot of people more than anything. But my sort of passion drives from trying to create something that creates a sustainable healthcare system so that my daughters and the people that come after me, that I can be a worthy ancestor to the people that come afterwards.
And I know that we’ll remain friends in the years to come and that I just want to acknowledge the courage that it took to venture into the unknown with me on this, I really appreciate that and just that more than anything to bet on the principles that you knew are right, it takes a lot to do that. And I really appreciate your courage and leadership to hold that vision.
Katherine Bisharat: Thank you, James, thank you so much. And I’m very excited and happy that we both took this step forward and it’s been exciting, and I really love your historical path going forward and all these things and your book has been a foundational thing for you to continue to formulate your thinking and you’re just such a contributor to all of our processes as you format things for us in a way that’s the beauty of this. You’re a really good partner. I think you partner extraordinarily well in the big vision and in the individual vision. That’s what it took to match my practice. And so I just really endorse your view and I’m grateful that you are a young man with all these years to go, offering these kinds of visions and the strength behind them. So, this has been a very exciting journey for me as well. Thank you so much, James.
James Maskell: And I appreciate it. Well, thank you for listening here today. HealCommunity is live. We’re now working with dozens of clinics that see the value in outsourcing essentially their lifestyle delivery part so that the providers can really focus on sort of like the precision medicine end of functional medicine. There’s a lifestyle component, there’s a precision medicine component. And we’d like to keep those providers who have gone through the training focused on that right part and I think it’s a very synergistic affair, and this is part of a whole series and a whole theme this year, which is the reinvention of medicine. Last year, our theme was resilience. And that was because we had to be resilient in 2020 for many reasons. But this year coming out of our experience of 2020, it’s about reinventing medicine to fit today’s purpose.
And I’m super, super excited to be working on this project to really reduce friction in functional medicine adoption. And if you want to find out more about it, you can go to healcommunity.com. And if you’re a physician that bills insurance in America, we’d love to hear from you and excited to move forward. Now, initially working with people with lifestyle, I think there’s a whole exciting road ahead with actually monitoring patients in real-time. And really the vision that I have for this is decentralized community care, right? Keeping people in their homes, keeping them well in their homes and taking advantage of the unique power of virtual groups to help people change. And I’m excited to see where this goes.
Katherine Bisharat: Absolutely.
James Maskell: All right, this has been the Evolution of Medicine Podcast. This is part of our new model series. I’ve been here with Dr. Kate Bisharat. You can find out more about her on our website. We’ll have all of that in the show notes. Thanks so much for listening, and we’ll see you next time.
Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit 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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