This week on the podcast, we have another episode in our New Models Series focused on concierge care for the poor. Dr. Angela Bymaster and her husband Brett are on to talk to us about a really unique community-focused model of business that they created. They’re able to take concierge medicine patients at full price and use that money to pay for other people in the community who don’t have access to care. What they’ve achieved in just a small time and just during COVID-19 is tremendous, all the way up to the California Supreme Court. It’s an incredible story, and it’s just getting started.

Highlights include:

  • The Bymasters three Rs for selecting where to live
  • How they’ve gone above and beyond in transforming their community, including advocating for the creation of a park
  • How they’re taking advantage of those resources for the most underprivileged in their society
  • And so much more!

Resources mentioned in this episode:

New Models #6: Concierge Care for the Poor


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 is going to be one of the great episodes. I’m super excited for everyone to listen in as we talk about concierge care for the poor. I first heard about Dr. Angela and Brett Bymaster on the ZDogg Podcast. And they have created a really unique community focused model, where they’re able to take concierge medicine patients at full price, and use that money to pay for other people in the community who don’t have access to care. What they’ve achieved in just a small time and just during COVID is tremendous, all the way up to the California Supreme Court. It’s an incredible story. It’s just getting started. I’d love to hear your feedback on it, and super excited to introduce you to this model as part of our New Models podcast series. I’d love to get your feedback, enjoy. So, a warm welcome to the podcast. We have Dr. Angela and Brett Bymaster here. Welcome.

Angela Bymaster: Hello, nice to be here.

Brett Bymaster: Hello.

James Maskell: So, over the last seven years on the podcast, we have been talking about all things evolution of medicine. And one of the themes for this year series was New Models. And we need this new models in this reinvention of healthcare. And I was really excited to connect with you because I think for many practitioners in our community, and doctors who have made the shift into cash-based medicine, or are looking at where their journey goes from here, one of the things that always comes up is that they just have an innate desire to serve everyone. And that sometimes these innovative models like direct primary care that we’ve talked about a lot, or packages, or just being in direct care has not allowed them to serve their whole community. So, I just, I guess, wanted to start with a little bit of the backstory of how you two connected and your pathway to thinking about building new models in direct primary care.

Angela Bymaster: Yeah, I don’t know how far back you want to go. But we—

Brett Bymaster: Well, we connected because we’re married. So, that makes a pretty strong connection, sometimes kind of a wild connection because that means we get along really well. And we both get along well and fight well. So, that’s exciting.

Angela Bymaster: Yeah, and we’ve always really been…We are people of faith, and we just feel called by God to always work with low-income people and be in…We physically live in a neighborhood that’s low-income, and I have been here 15 years now in the middle of San Jose.

Brett Bymaster: Yeah, so we live in just about the lowest-income community in Silicon Valley. So, Silicon Valley is a place where there’s great wealth, but there’s also a lot of poverty. And so, when Dr. Angie started her residency, we looked at a poverty map and chose to move into just about the poorest community we could find. And then there’s a tradition of Christians that’s led by this guy, John Perkins, who has a way of living called the three Rs, which is relocation. So, intentionally relocating to an impoverished community and sending your kids to the local public school and being totally part of the community. Racial reconciliation, so thinking deeply about what it looks like to address racial inequality and racism in your community, and then redistribution, so thinking strategically about poverty alleviation. So, for the past 20 years, we’ve been doing that, and for the past 15 years in this particular community at the heart of Silicon Valley.

Angela Bymaster: Yeah. And so, I worked for the homeless program for the county for a while. I worked for a low income FQHC clinic in the neighborhood for a while, and I was just always frustrated with quality of care issues and even access, the FQs, and they’re all different, and it’s hard to paint with one brushstroke. But the one I was at was not real excited about taking uninsured people because they got a lot of money for Medicare and Medicaid, and they did not get much for the uninsured. And so, I saw that there was this really big group of people who were not able to receive really good care. And so, we just ended up-

Brett Bymaster: Well, being Christians we’re excited about Jesus, and Jesus has this really interesting take on healing. Jesus did a lot of healing. And so, we ask the question, “Well, what if we healed like Jesus did?” I think sometimes modern medicine is about generating a billing code and writing a prescription. And I don’t know that that’s actually healing. And so, we started asking questions about, well, what would it look like for us to really get people well? Not to deliver medicine, but to get people well.

Angela Bymaster: And then I’m sure you’ve talked about this a lot and think about this a lot. But it is so interesting to think about what is actual wellness, and what is actual healing, and what do they look like? And sometimes they look to me more like I’d have patients come in, and I just knew that our visit was more about loneliness than about anything else. And that we were talking about back pain, and we were talking about headaches, and we’re talking about all kinds of stuff, but I was like, “This is a very lonely and isolated person.” And, man, healing to that person would look like community, right? Would look like friends, and family, and loved ones, and people who call them, and visit them, and bring them something, and celebrate their birthday, and all that stuff that is way more important than the ibuprofen I was going to give them. And so, all of a sudden I realize, I really want to be in a space where I can engage in that kind of healing. And so, between that and a series of events that would take a really long time to explain we ended up building our own clinic, and we found a model that we thought would work that we can talk about in a minute.

James Maskell: Let’s definitely jump into that. I’m really excited to jump into the operating system of care clinically because I completely agree about that. I mean, that one example you gave, chronic pain is a biopsychosocial condition, right? It’s not just a biological condition. And so, there is so much more to it, and you can make a big impact by solving loneliness there. And yeah, obviously, the payment model is the most interesting, and it’s super interesting what you said, because I think that a lot of people who…

I guess, one of the things that we’ve seen is that when you think about serving everyone, you typically think about having to take insurance because of Medicare and Medicaid, and all these different areas. But the fact that there’s this uninsured population that you couldn’t work with, even in a federally qualified healthcare center is really fascinating, too. Okay, so let’s just jump into the model before we get into the clinical side. Talk us through your model, how you came up with it, and I guess, particularly, I’d love to just get an idea of do you have a number, which you know that this whole thing works, right? Where there’s a certain number of people that are paying were at that moment you’ll have enough time in the day to see all the people that are in the membership, and you’ll be helping this many people? And how did you come up with that? And what’s been the journey to work out what the math’s had to be in order to make the whole thing work?

Brett Bymaster: Yeah, that’s a great question, James. So, our basic model is to sell concierge care. So our price point here in Silicon Valley is $200 a month for concierge care. So, that’s a little bit more expensive than a DPC model. And then every paying patient funds two low income uninsured people to be able to access the clinic. So, the basic revenue model is 300 paying patients, and 600 low-income patients per FTE physician. We borrow this model from a clinic called St. Luke’s, which is a Catholic clinic in Modesto, which is about two hours outside of Silicon Valley. And they’ve been doing a similar model for 15 years. And the beauty of the model is that we’re able to generate recurring revenue to care for both the wealthy and the poor without needing to be a fee for service clinic.

We’re a nonprofit, so we take donations. Right now, we’re primarily running on donations, but we’re working on building our concierge model. You can ask, “Well, how did you come to the 900 patients per FTE physician?” So, because we are doing a one paying member and two low income members, our budget is really tight. So, our physicians, we’re not driving Teslas. We’re not homeless, but we’re not making a killing.

Angela Bymaster: We have enough.

Brett Bymaster: We have enough. So, what we did is we really sat down and looked carefully at the math. And we started out from what does it look like for us to be able to do 30 to 60 minute visits. So, a normal clinic, you really have to be seeing a patient every 12.5 minutes to be financially viable. So, we started the math that 30- to 60-minute appointments. And then also looking at we have a Spanish-speaking counselor on staff, we have two pastors on staff, we have an employment program. So, all of these ancillary wraparound things. The model can’t really cover all of that, but it can cover a chunk of it. And so, we do operate partly on philanthropic donor support. But then the concierge service gives us that recurring revenue that a lot of nonprofit clinics really struggle to get.

So, a typical free clinic that really is set up to serve low income uninsured patients, they tend to max out at one or two million dollars in annual revenue, and then they can’t replicate because the fundraising component is so hard. Our model is really interesting because if there’s a physician out in practice that wants to do a concierge conversion. If you have two or 3,000 patients on your panel, and you go to them, and you say, “Hey, in my new practice, I charge 200 bucks a month.” Most of them are going to say no, but you really only need to convert 10 or 15% of them to have a fully functioning funded clinic on day one. And so, that allows us to build a model where we can really replicate and grow quickly. And we’re already working on our second Healing Grove plant, which will be in Sacramento. So, I think it’s really an exciting model to be able to do concierge medicine that really is deeply equitable.

James Maskell: Yeah, really, I love that. One of the things that when you talk about your practitioner team there, there’s some unlikely characters, and I think one of the things that you probably identified is that solving the social determinants of health is a critical piece. And it sounds like you’re geared more towards that than let’s say having a health coach or someone in that role because ultimately these people we have to deal with the 50% of the environment that’s not really the medical environment or the food environment, right?

Angela Bymaster: Yes. And that’s the fun thing about not being tied to insurance. When I was tied to insurance all the time, they were constantly telling me what to do with my day, and it was a lot about things that they could measure. And it wasn’t really about what my patient’s needs were. And now I’m looking at the whole community and saying, “Okay, all of my pediatric patients, except for two are overweight,” and they don’t have enough money to be in YMCA basketball or anything at all. And so I was just like, “Let’s make a sports program for them.” We have a lot of patients over and over and over, I’m having the same conversation again, and again, about diet and exercise with the mommies.

But I’m realizing as we’re talking, you don’t learn how to cook by talking about it. You learn how to cook by doing it. So, we built a kitchen into the clinic, and that we just go back there and we cook together. And I’m like, “Okay, let’s put some carne asada but let’s put in a whole bunch of spinach and broccoli and see what’s it looks like to have a taco with a ton of vegetables in it? Could that be palatable for your kids?” And so, we can actually really get to the bottom of what’s going on to, like you said, make the social determinants of health.

Brett Bymaster: As a physician, you can sit there all day long and tell people to exercise but if they don’t have a place to exercise, they’re not going to. And so, Dr. Angie, and I have spent more than a decade…So, we live in a really low income community that doesn’t have a park. And so, we spent more than a decade getting a $10 million park built in our community. And that involved us filing a lawsuit that actually went all the way to the California State Supreme Court. And about a month and a half ago, the full park opened. And we already have a three day a week sports program running there with 60 kids that could never afford competitive soccer, or competitive volleyball. So, we have a program where they’re cycling through volleyball, soccer, and basketball, with coaches from the community, and the kids are walking there because they live in the community. And that is going to do 100 times more than can ever be done in the clinical setting, but when you couple those two together, it becomes really powerful.

Angela Bymaster: Yeah.

James Maskell: I just want to button that because that is amazing. And honestly, throughout this whole seven year journey, I remember right at the beginning of this whole process there was a doctor that came on and showed a map of farmers markets. And he was like, “Hey, here’s the map of farmers markets in 2005 and then it was 2013 is what it looked like.” You saw this explosion. He was the first guy that really got my mind thinking about what it would look like to have these integrative micro-practice, low overhead practices that were delivering this new era of care. There was always this idea that if you got the clinic established, and it really… It could take hold in the community, it would have more of a community focus, and that vision there you shared with the park to go to battle with the state for that to have that created. And then to use it effectively as part of your clinical operating system is incredible. I mean, obviously, you guys are…I hope that you aren’t too unicorn-y in a certain way that other doctors couldn’t do what you do. Can you share some of the things that you learned along the way about advocating for your community at that level?

Angela Bymaster: So, that’s a good question. We are weird in that we choose to live in a low-income neighborhood. But other than that, I think it’s pretty common, at least in family medicine, for people to feel like we want to make their advocate. Like to be politically involved in some way or other, although I do think it is something that’s maybe missing from medical education a little bit to even know, where does the board of education get involved? When do you go to city council? When you go to the…In California, it’s really county-based politics.

Brett Bymaster: Well, I think one thing that doctors can really think about is ask the question like, “Who is my neighbor?” So, coming from a Christian perspective, our two commands are love the Lord your God and love your neighbor as yourself. And so, we’re really passionate about loving our neighbor. And so, I think if you’re a physician, it’s just interesting to ask, “Well, who is your neighbor?” The neighbors to your house and the neighbors to your clinic. And then ask the question, “How do we really love them?” I think to Angie’s point, a lot of times we are really preoccupied with national politics, but I would argue that our day-to-day lives are actually much more determined by local politics. And yet the vast majority of people couldn’t tell you who their city council person is, who their board of education school board member is.

And so, we’re really passionate about place-based work. So, we are in a community, we really know our neighbors, we’re a part of the local school, and we really want to see our community grow and improve. And we think that, for example, let me give a good example. Let’s say that we convinced one individual to eat healthy. Well, that individual doesn’t live on their own. Particularly, in the Latino community where relationships are really tight, they live in a family. Well, if their family isn’t convinced, that individual is going to really struggle. So, let’s say you convince the family. Well, now, the family’s eating healthy, but every weekend the family’s going to birthday parties, and quinceañeras and community events. If the food there is not healthy you’re really not going to be able to make much change.

And so, you really have to make change at the community level. And so our mission at Healing Grove, we’re very mission, our mission is to share the love of Jesus through health care, soul care, and culture care, in order to bring the healing of the nations to our community, and the healing of nations is this beautiful image from the Bible. But we talk so much about culture care and the healing of nations because we really have to think at the community level if we’re going to make impact. And that does mean working with individuals. But you can’t stop there. And I think that’s where the park is a good strategic example of that where we did advocate politically at the local and regional level for this park. But then we brought it back to the individuals that need not just a park, but a program to really be able to fully utilize that as a resource to really be more healthy.

Angela Bymaster: But you know who’s really going to get this is rural doctors. So, I grew up in a small town in Oregon. And actually, my dad’s a family doctor there, too, and rural doctors are in the community that they practice in. There’s no escaping it, and they know everybody, and everybody knows them. They’re probably already doing this. Just their kids go…There’s only a couple schools and unless you homeschool, which is hard to do while you work. You’re in it.

Brett Bymaster: So, one way of looking at what we’re doing is we really brought rural medicine to an urban environment, and I think there’s a lot that physicians could do. Like you said, just look at who your neighbor is, and really think strategically about how can I love my neighbor.

Angela Bymaster: Yeah, and what does my neighbor need? Not thinking like, “Oh, well, what do I need?” We’re thinking, what does my neighbors need? And even just having kids in the local schools, we had…They were doing a science fair, and it became really clear when we were there at the school that most of the parents didn’t know how to do a science project with their kids. And so, we were just like, “Oh, they want to learn how to do this.” And so, we brought in lots of books and different things about how to make a science project, and what’s a hypothesis, and all of that. Educating also the parents so that they could do this with their child. So, just being really, really observant. What are the needs? What do people want? What do people not have, and how can you be a bridge?

Brett Bymaster: And I’ll add one more thing to that. I think in a fee for service model, you can feel like, “Well, I’m a doctor. All I can do is just seeing patients all day long. And then that’s really all there is.” And one of the things we encourage people to do is you probably can’t think strategically long-term about every patient you have, unless you’re in a different kind of model. But what if you just pick five patients, and you said, “You know what, everybody else is going to get to 12.5 minutes for a visit. They’re just going to get a billing code at the end of the visit. But I’m going to take these five patients, and I’m really going to think about what do they need? Can I call their teacher? Can I call their pastor? Can I take them out to lunch? Can I go visit them at their house?” And you might not be able to do that for at scale, but you can do it for five patients. And for those five patients, you’re going to make a really huge difference. And so, we always encourage people, if you can’t do it big, start small. If you can’t do five, do three, and you can really have a big impact on those three lives.

James Maskell: Is there anyone on your team that you found has played a critical role in either sharpening your thinking with regard to what people actually need or have actually been on the front lines and helping you out with that kind of work?

Angela Bymaster: Yeah, well, our clinic was born in the middle of COVID. So, we basically got all of our legal framework, and then I put in my last day working my old FQHC for March 12th, 2020. And so, that was shelter in place. We were the epicenter of shelter in place over here because our health officer just was the first one to close it all down. And so, we immediately called, so our community engagement director whose name is Maria, and she’s amazing, and she’s very connected to everybody.

Brett Bymaster: So, just so you get the idea here. So, Maria got kicked out of her house when she was 11 in Mexico, and had to cook and clean in Mexico City to make it work. So, she’s got just really significant childhood trauma. She comes to the US, grows into this amazing community leader. She’s gotten awards from our city council, from our county board of supervisors, from the California State Assembly and Senate. Just this amazing leader who really understands the community and has this incredible set of connections. And so, that was our first hire. She came on staff before Angie and I did because we recognize that without that integral connection, we can’t be successful.

Angela Bymaster: Yeah. And of course, we have blind spots because we didn’t grow up in this community, and we don’t…Even our language skills are limited in Spanish, and so she just… We just said, “Hey, Maria, can you call up everybody who’s willing to meet with us outside in this middle of this pandemic, and tell us what’s going on? What do they need? What are the biggest issues?” And then, yeah, and so that’s where we started.

Brett Bymaster: And then our second hire was Pastor Lourdes Sarmiento. And so, here we have a health clinic, and our two first hires are a communication director and a pastor, and it’s sort of the same story. Pastor Lourdes has these deep connections in the community. When people are in trouble, they knock on her door in the middle of the night, and come crying to her. And so, she has this amazing gift of being able to discern what people’s real problem is and she…In our patient flow, Pastor Lourdes prays for patients before they come to see the physician. And oftentimes their problem is already identified and solved before they even get to the doctor.

Angela Bymaster: She’s Honduran, and she’s lovely.

James Maskell: Nice. Yeah, it’s really amazing. I’d love just to identify who are the kind of people that sign up for the concierge service? Because ultimately I know, there’s a couple things. So one is who those people are, are they intentionally signing up so that they can be part of the solution? Or are they just looking for really good care? Have you had an opportunity to engage some Silicon Valley companies where…Because one of the big ways in which DPC is growing is that I know a number of DPC doctors around the country that have basically filled up their whole practice with employees from one company and being able to really scale that way, and cut out the need for one-by-one marketing. Is that opened up and who are the people that sign up for these concierge membership, and how do they feel about being in close proximity to the free payers?

Brett Bymaster: We have not been able to get into the employer market. So, we are doing the one by one marketing, and that’s a slog. It’s a lot of work. So, we’re launching advertising campaign where we built on your website, a lot of marketing materials and marketing strategy happening. So, because we are faith-based we’re primarily targeting people of faith in Silicon Valley. It’s a mix. I mean, most people join because they want great healthcare. And the equity part is a side benefit. And then a lot of people join because they want to be a part of the community. They see something really magic happening here, and they want to be a part of that.

Angela Bymaster: I think right now, our early adopters are very equity minded people. It’s interesting when we try to sell it to just random people that we meet, and we’re like, “Hey, you should sign up for this.” People, oftentimes at meetings about equity who come because they’re like, “Oh, I care about equity stuff,” and they really just tell us, “No, I would never [crosstalk].”

Brett Bymaster: Yeah, I’ll tell a good story, James. Last night, I was at a meeting talking about Blue Zones, some people might know what that is. And I talked to a person who’s on the foundation of a large health organization in Silicon Valley. And he told me, “Oh, yeah, I go to concierge care.” He’s like, “I’m not going to tell you how much I pay. It’s ridiculous.” And I said those, “Those sorts of practices really drive deep inequities in Silicon Valley. I’m really concerned.” He said, “I know.” He said, “It really bothers me.” I said, “Oh, you should join Healing Grove.” And he just looked me straight in the eye and said, “I would never do that.” And my response was, “And therein lies the problem, right? ” And so, we launched during COVID, which is not a great time for people to sign up for a concierge practice. So, we’re really building out the concierge model right now and we’ll see what we get. If there are any Silicon Valley companies out there that would like to offer this as an employee benefit that would be something we’d be excited about.

James Maskell: Yeah, give me some of the highlights. You mentioned that a minute ago, that people see in the community and they see what’s happening. What do they see, and what have been some of the highlights of engagement? Obviously, the park is a big deal and people engaging in that. I’m really interested that you mentioned the Blue Zones because we’ve had a lot of content on those ideas over the years. We’ve also had some content on the Daniel plan, and the way in which health has been brought into churches in small groups. And I’m very excited to just hear ways in which medical clinics are really having an impact at the community level.

Brett Bymaster: Oh, yeah. I also wanted to say you asked about how concierge patients feel about having the low income people in the clinic, and that people are uncomfortable with that until they actually come. And once they come in, and they see it, they want to come back. And so, we’re so segregated that people are really fearful of people from other social classes. I think actually, classism is a much bigger problem right now than racism. But when you actually come in and see people and see that they’re real people and stuff, it really breaks down a lot of those barriers. And then people are like, “Oh, I want to be a part of that so that.”

Angela Bymaster: Yeah. And then the other things that they’re seeing is just, again, that we were born during COVID. And so, so much of what we’ve done has been COVID related, but we were just…A series of really, really fortunate events allowed us to do massive amounts of COVID testing, and we never closed our doors in COVID. We tested and treated probably about 2,500 COVID positive—

Brett Bymaster: Yeah, so we did 10,000 COVID tests and had 2,400 positive. So, we run in just about a 25% positivity rate. And so, we were able to support all those patients through quarantine at scale.

Angela Bymaster: I was seeing them in the parking lot. If they were really sick I said, “Come meet me in the parking lot.” And I was using my O2 set and my stethoscope and I was giving them injections in their car and all kinds of things, just keeping them out of the hospital. To my knowledge, I don’t think any of our patients ended up passing away. I think we had 100% health rate with those. We ended up doing a lot of grocery boxes.

Brett Bymaster: Yeah, so we distributed $5.5 million in financial aid during COVID through grants and donations, money that we raised. We were able to distribute more than 100,000 boxes of groceries. We delivered to more than 2,000 addresses of families that were quarantined because of COVID. Since COVID ended, and our family practice is up and running we’ve done about 1,500 patient visits. So, many people are just excited to see the model working at scale and you come in and people are praying and people are in groups. There’s the youth group happening, and there’s community advocacy projects happening, and we’re-

Angela Bymaster: They’re just hopping, and there’s so much good stuff happening in families. I’ve had a lot of teens who were so…I mean, the teens got really hurt the most I think out of all of the people groups during COVID. There were just so much depression, so much anxiety, so much cutting, so much isolation, so much hopelessness about the future. And we’ve got now a bunch of groups of teens where they are really, really thinking about how can I have a future that’s going to be exciting and fun, and meaningful, and purposeful? And groups of women getting together. We’ve had a lot of people who’ve been able to work through domestic violence situations. A lot of people who’ve had really serious health conditions diagnosed and treated over the last six months.

Brett Bymaster: So, I’ll give you a good example of a story. So, we had a group of teens and adults all from low-income, Spanish-speaking families themselves who were volunteering to do food distribution in the community. And so, in the past month, or month and a half, people got back to work, and we didn’t really have a need for that. And so, these volunteers were like, “Well, what should we do now?” And so, now that team of volunteers is doing what we call Luke 14 parties. Going out, and doing barbecues with homeless people in the creeks. And they were terrified to go do that. And then it was just beautiful thing where they actually went, and they got to meet people. And so, we have people from very low income families going out and barbecuing with homeless people. And so, people just get excited about that, and are like, “Wow, I want to be a part of that.”

James Maskell: That’s really, really special. I’m glad you mentioned groups because this has been a focus for the last three years here at The Evolution of Medicine is group-delivered care, and we’ve had a lot of content on it. We had a whole series of podcasts on it. I wrote a book on it. I think it’s really powerful. I haven’t really seen groups take off in direct primary care clinics, except there’s been a couple cases I’ve seen. There’s a pediatric clinic that we know where they did all the well-baby visits in groups, and that seemed to be really powerful as a way to engage. But in general we haven’t seen it take off in that group in as much as it has in the insurance game. I would imagine that just given the nature of the clinic, and some of what you shared there’s being really powerful use of groups, and it sounds like those teams, particularly, have you found any clinical areas where you found good use of groups?

Angela Bymaster: Yeah, so on the clinical side, I’ve only just started in the past month really doing some groups because it finally, COVID died down enough that we could get our head above water. I have been bringing in clusters of low income people into our membership, and just lots of blood tests, lots of diabetes diagnosis and other things. And so, finally we said, “It’s time to do a diabetes group.” And so we did…But I really love cooking with people. It’s just something I enjoy. I noticed that that was so much of what I was talking about over and over and over and over and over. And just talking about what’s a carb? What’s a fat, what’s a protein, what’s all of these things? With lots of pictures and stuff, and I was like, “You know what, let’s just cook.”

And so, we just meet in the kitchen, and we talked about some topic about diabetes, and we all sit around this big round table, and then we’ve usually asked one person to bring a tomatillo salsa or some beans or something like that. And then we’ll cook the main part of it together. I just say, “Let’s experiment together. Let’s take the recipes we already make, and let’s just make them a little bit lower in carbs, a little higher in vegetables, a little lower in fat.” Just alter them slightly because so much of what I see is the handouts we’re supposed to give people are just really just going to a whole ‘nother zone of foods that the Mediterranean diet ain’t going to happen in my neighborhood. It just ain’t going to happen. And so, I’m like, but Mexican food is amazing, and let’s just make little alterations.

And so, yeah, at one point we were playing with jicama tortillas, and I didn’t think…That didn’t seem like that one was really catching on. I’ve tried cauliflower rice. We’ve tried a bunch of different things. But just at the last Monday we had this little group and one of the ladies was just enjoying it so much. She was so excited because she’d never…For some reason, had never seen meat and vegetables cooked together for taco or burrito or whatever enchilada purposes and she was like, “Oh, my goodness, you can just put them in the same frying pan and that’s amazing.” They can take each other’s flavors. And it was just really mind blowing. And I was like, “Man, if I can get…” My evil plan is to get all the mommies in the neighborhood thinking about those little changes. And then that goes down to the kids, and it goes down to the whole community.

James Maskell: Absolutely. Well, it’s super inspiring, and I’m glad we’re able to talk about food as medicine because that’s been a huge theme. I think that what you just shared there is so aspirational for so many doctors and practitioners. In our community, we have a lot of dietitians, and health coaches, and nutritionists who listen who I’m sure that’s like music of areas as well. So, I guess I just want to acknowledge both of you for the work that you’ve done already.

And obviously, this is just the beginning as well. I can say that we could probably come back in a year or two time and there’ll be an exponential increase in the value that you’ve added. And all these other little nodes of that woman who just learned about vegetables is probably teaching other people about it. And there’s just this exponential community effect that I’m sure will occur. So. I just want to acknowledge all the work that’s happened. This year the theme in our whole program is the reinvention of medicine. So, I’d love to just get your thoughts, either both of you on when you hear the words the reinvention of medicine, what does that mean to you?

Angela Bymaster: Well, to me, it’s stepping away back and saying, “Okay, why are we here? What is the whole purpose?” We have patients who are suffering in all kinds of ways, and what can we apply that will relieve their suffering, make them healthier, help them to live more whole and fruitful lives. I think it’s like going to be… The answers, I think, are sometimes very surprising. But they’re fun, and they’re different, and I think that’s a really good place for medicine to go.

Brett Bymaster: I’m super excited to be alive right now because we have more tools to alleviate suffering than we’ve ever had. You think about the power of Western medicine, evidence-based medicine—

Angela Bymaster: Antibiotics.

Brett Bymaster: You think about how…Like Advil, Advil is amazing. You think about some of the poverty alleviation tools that we have now. We know so much about alleviating suffering in our communities. And yet, we’re at a point where we have social and political systems that really make that difficult. I think at the bottom of that, we really struggle because all of those tools at the end of day require sacrifice, right? It requires personal sacrifice from individuals to make their community better.

And so, we’re excited to start thinking strategically about movements of how do we really eliminate poverty in our community? How do we use these amazing tools that God’s given us not to just put band aids here and there randomly, which is sometimes what happens now. But really to use those tools strategically to eliminate suffering. I’m just so excited to be alive right now when we have access to these just incredible tools, and to get people excited about putting them into motion and using them to really benefit people’s lives.

James Maskell: Beautiful. Well, thank you both for sharing and for people who are listening to this who want to support you either through recommending people to become concierge members, or just connecting you to other resources or donors, what’s the best place to get in touch?

Brett Bymaster: Yeah, go to healinggrove.org. So, we have our…When you go to healinggrove.org, we have two websites. We have our foundation, which is the nonprofit side, and then we have our concierge practice. So, you can learn about both of those sides of the work. We love to encourage people to make a donation if you’re far away. And if you’re close by we’d love to encourage you to become a patient or consider making a donation. We’re able to provide healthcare to a low income uninsured person for 70 bucks a month. So, if somebody wants to just chip in 70 bucks a month, that’s awesome or make a larger donation. If people have questions, there’s a contact form on the website and my email, so feel free to get in touch.

James Maskell: Beautiful. Well, thanks so much for being here and part of The Evolution of Medicine Podcast. We’ve been looking at new models this year, and we really think that wherever you are in the world, this will be a huge dose of inspiration for you as you create your new model. Thank you to you, Angela and Brett for being part of The Evolution of Medicine Podcast. Thanks so much for tuning in.

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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