On this week’s episode, we’re going to go right to the heart of the Evolution of Medicine, looking to solve the biggest issues and the biggest gaps that exist not only in conventional care, but also in functional medicine. We know that doctors don’t have a lot of time with patients; they wish they could add and deliver high-touch care, but often the insurance systems in which they work makes it difficult to do that. So, today we are going to be doing a special podcast episode with my partners at HealCommunity, Barclay Burns and Christina Tidwell. They discuss how chronic disease is being treated in the health system and how to succeed with those outcomes. This is going to be really valuable. I’d love to hear your feedback. If you’re interested in finding out more about HealCommunity, you can go to healcommunity.com.

Highlights include:

  • How functional medicine can help bridge the gap in the health system
  • How a group of people, a community, can support better outcomes
  • How HealCommunity can help physicians on the verge of burnout

Resources mentioned in this episode:

New Models #8: Solving Behavior Change At Scale


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 episode is going to go right to the heart of the Evolution of Medicine, looking to solve the biggest issues and the biggest gaps that exist not only in conventional care, but also in functional medicine. We know that doctors don’t have a lot of time with patients, they wish they could add and deliver high touch care, but often the insurance systems in which they work make it difficult to do that, many doctors leave and come to functional medicine to try and give themself more time, but are then faced with the fact that behavior change is hard, and getting patients to change behavior can be really a significant challenge. And so that was part of the reason I wrote the book, The Community Cure. And over the last two years, I’ve been working on a project to solve these problems at scale.

Today we are going to be doing a special podcast with my partner at HealCommunity, Barclay Burns, in his academic work he really looked at the power of community to heal. He went inside into Mountain Healthcare for four years to learn about how chronic disease was being treated in health systems and where the huge gaps were. And we’re going to hear a little bit about that. And we’re also going to hear from Christina Tidwell, who is our head coach at HealCommunity, and she’s going to be talking about how she’s delivered such profound results and outcomes in the trenches. For any practitioner who’s interested in getting great outcomes and creating access to functional medicine, I think this is going to be really valuable. I’d love to hear your feedback. If you’re interested in finding out more about HealCommunity, you can go to healcommunity.com. Enjoy. So a warm welcome to the podcast Barclay Burns and Christina Tidwell, welcome.

Barclay Burns: Super great to be here.

Christina Tidwell: Thank you.

James Maskell: So I’m super excited to talk about HealCommunity today with our practitioner community. Christina, I want to go back to a conversation that we had in 2018, where we talked about the gap in healthcare and how you’d experienced the gap. And I’d love for you just to start there.

Christina Tidwell: Yeah, definitely. So I think for me working as a registered nurse in intensive care and in cardiology, I really experienced a gap that functional medicine was able to fill. And then as I became a functional nutrition coach and started working as a coach in my own practice, I was able to see more gaps even within the system. And it was actually really exciting for me, because I think that coaching and working in groups and in community has the ability to fill a lot of these gaps. But one of the biggest gaps, first and foremost, is access to functional medicine care, whether that’s access to having a doctor actually in your area that is trained in functional medicine and this type of care, but also affordability and financial access was a really, really big one as well, for a lot of people it’s just simply not possible to even get in at this starting point, to get this type of care.

And then another really interesting thing that I was seeing as I was coaching, a lot of people, predominantly with chronic illness and autoimmunity, was really this gap in being able to translate knowledge into action. So, if people are able to get in first to the functional medicine paradigm and see a practitioner, they may get an amazing assessment and a detailed protocol, and everything that they might need to succeed. And like we talked about, some people are going to take this and run, and that’s going to be great. A lot of people that I was seeing really had a big challenge in implementing this information and translating knowledge into action, which was then really frustrating for practitioners, because they only had a certain amount of time with these clients each month, or maybe it was every couple of months to be able to get the outcomes that they wanted and that they know are possible.

So I worked really hard and many coaches and allied functional medicine practitioners worked to fill this gap to really support physicians and clinics. And also then to support the patient to be able to feel really confident, because it can also be really overwhelming for patients, because we have so much information out there about what we need to do to be healthy, that it can almost sometimes make people freeze in inaction, or really not know how to move forward because they haven’t really been taught the tools of behavior change, and that can lead to this cycle of not getting the results that they want. So filling this gap is something that I am really, really passionate about, that really has the ability to transform health outcomes for people, especially those experiencing chronic conditions, but also to support the wider ecosystem of healthcare practitioners as well so that everyone can feel like they’re playing their role and supporting patients who oftentimes have really, really complex health issues going on.

James Maskell: Yeah, absolutely. I’m really glad you shared that because I guess what I took from that conversation is that functional medicine is only as good as the behavior change that it facilitates. And ultimately if the behavior change isn’t there, then the outcomes are not going to be there, and that’s a really big problem. And so I want to come to you, Barclay, because I know that you are passionate about behavior change and actually did a whole PhD that ended up being about that. But I guess when you started the PhD, maybe you weren’t exactly sure what the outcome was going to be. So you want to share a little bit about that journey and looking at behavior change in conventional care?

Barclay Burns: Yes, absolutely. So with my dissertation, I was looking at things such as hospital readmission rates, reduction in A1C and what, from an organizational perspective, really had an impact on those and improving those outcomes. And what became clear, but, and initially surprising, is the actual nature of the relationship with the patient and the doctor, and the doctors and their staff, and how those all played together to create this, I don’t know, community center of interactions, that actually had as much of an impact on reducing say A1C as did a drug. And so the implications that jumped out at me is that behavior matters as much as pharmacology, pharmacy logical inputs into this system. And so it’s in those relationships with one another with the doctors, and even how important it was how the doctor and all of their people worked together, had a very noticeable impact on the overall adherence and behavior of the patient.

James Maskell: And when we first connected through our mutual friend, Dallas Hartwig, and I’d just written the, I think I was in the process of writing the book about The Community Cure. When I told you about that and you read it, what was it in that book that, I guess, got you fired up that maybe groups of functional medicine learners might be the solution to the problem that you’d identified through the research?

Barclay Burns: Well, I’d spent in another doctoral dissertation in psychology looking at how do you create a community of learners? And there’s just something powerful in terms of the outcome of learning, and I’ve done this in school settings where you create a community of learners amongst the students, you can see tremendous gains academically in ways that you wouldn’t otherwise. And I’d seen that happening going in and helping schools turn their whole learning culture around, and their learning outcomes together. So when I initially, when I saw the power of groups in the community care, it was clear to me that the groups were harnessing what I’d seen in a big hospital system, what I’d seen in a school system of people coming together, supporting each other, the peer support, that ability to work hard, persist and stay with it in terms of an endeavor come together. And that’s really what excited me, is I saw how powerful the outcomes were that you articulated and wrote about in The Community Cure.

James Maskell: Yeah. Well, I appreciate you sharing that, and I guess back to Christina, in the follow-up question to that, how critical is it now to fill those gaps given the way the world changed? I had no idea that COVID was coming and that loneliness would become not just a hypercritical issue before the pandemic, but maybe the most critical driver of chronic illness since the pandemic. And what have you seen in working now in the system, and working in groups using coaching in the pandemic?

Christina Tidwell: Yeah, well, all of the first groups, I coached all of our first groups that we ran at HealCommunity and they were all right in the middle of pandemic and quarantine. And we were really in it at that time. And so I was able to really see and get a glimpse into people’s worlds and daily lives and how these different things were impacting people on so many different levels. Stress Week was actually a favorite week of everyone in the groups that we were doing, because there was just massive amounts of stress and uncertainty and isolation on top of it too. So to be able to have this weekly group coaching call that these people could count on turned out to be really valuable. And I was able to witness this and see this. And I think, for me, when I was working at, I worked as a cardiac nurse in an outpatient clinic for several years. And what I would see is that our doctors would often recommend weight loss, or diets, or things to go along with the diagnosis to support their condition.

And what we would see as a team is that people would come back and they would’ve not lost any weight, or they wouldn’t have changed anything. And a lot of it is because they were going back into an environment, community, family setting, or whatnot, where other people weren’t on the same path as them, or maybe didn’t receive the same recommendations, and they also didn’t have necessarily the tools to know how to do that. So what’s really cool about these groups is that immediately people are given a group of people who are on the same path, because if anyone’s ever tried to change their health, and you’ve gone back into your family who’s not on the same page as you, it’s exponentially harder to do something that’s already hard. And so these people get set up and connected with other people who are on the same path who have the same goals, and they’re able to articulate those out loud to other people.

And the biggest thing that we hear is, wow, it’s so nice to know I’m not alone. I’m not the only one experiencing that. And even in the groups, we have a little hand wave kind of thing that people will do when they resonate with what someone else is sharing, or that’s their experience, too. And for a lot of people that was just really powerful to have this weekly time where they would come together with a group of people who had the same goals as them, but also that they could see themselves reflected in someone else, especially during the time that we were coaching and now, and beyond, it was really important. And we saw it have huge impacts just that, just that piece of it have huge impacts on people’s vitality and health, and some of our outcomes, we can talk about it too, have shown that as well, but the group really creates a whole other aspect to healing that one-on-one I haven’t found in doing a lot of one-on-one work on my own.

James Maskell: Barclay, would your research have predicted these outcomes?

Barclay Burns: Yeah. Well, I don’t know, these are spectacular outcomes, I think it would suggest that this is more possible when you’re able to fully harness the group, and you have a really spectacular coach who’s able to facilitate that coming together and that exchange of ideas and exchange of minds. So I would’ve sense that, that’s possible, but again, I was actually pleasantly surprised by the, how dramatic these are, these are really spectacular outcomes.

James Maskell: Yeah. I think that’s something really special, and this is what I really had my whole book about, which is that creating the container of the group and then infusing it with this missing curriculum, which is functional and integrative medicine and empowering patients to actually participate in their care because you get this double whammy of solving loneliness and creating new relationships, but those relationships being mutually empowering. And I want to go back to something you said at the beginning, Christina, which is that, that some people totally run with your protocol. If you are listening to this and you’re a practitioner, you know that there’s a percentage of your patients that you just give them the protocol and they run with it. And then there’s other people that really struggle with implementing new things, and that’s really a personality type more than anything else. In fact, most of the most sophisticated clinics that I’ve seen do some personality typing to understand how they should interact with this patient.

The beauty of the group is that those front runners actually inspire the rest of the group, because they go in, they take action. And then as the group develops over a period of initially 12 weeks, but now 24 weeks, you actually see those people starting to make significant impacts on their health and reporting that back to the group. And then the rest of the group are able to see that and now feel motivated to get over that hump. Christina, I know one of the things I wanted to ask you, because you’ve been in the middle of all these groups, to, I guess dive a little bit into that, and to, what are practitioners that aren’t putting patients in groups missing by not having that peer-to-peer delivery of value?

Christina Tidwell: Yeah, well, I think the way that we’ve structured our groups is we’ve put a big focus on behavior change and implementation, how I spoke about this before, but really, from this coaching side of things, it really is, our role is less about delivering information, or a lecture series type of format, and is really about getting people to learn behavior change as a skill, which is not often a skill that we are taught, I certainly was not. And so we teach them these tools, because oftentimes when we encounter people, the story will be, oh, I’ve tried everything, or that doesn’t work for me, or I don’t have any willpower, or all these different stories will come up.

And what we really focus on, and how we deliver these groups, is really empowering people, no matter where they are at to really understand the things that have stood in their way towards achieving health, and really help them to put these behaviors and practices into action, because again, we can have all the information in the world, and we do at our fingertips, we have so much information, but it really is about getting this consistent support to make it a reality and to make it feel sustainable in your life. So the first thing that we do is really focus on that, and all of this we deliver in an evidence based program.

So we have our evidence based pillars of health and interventions that we’ve developed with coaches and registered nurses and physicians to really make sure that we’re delivering something very, very high quality, and we are able to continue to measure these outcomes as we go along. So we’re able to consistently improve and tweak and really tackle this challenge of improving behavior change and reversing chronic disease, and shifting these outcomes in a really big way. So the groups are just this fantastic way to be able to deliver it for a lot of the reasons that we’ve already shared about people being able to see themselves in another, and people being motivated by everyone else around them. So it’s this twofold, of being able to get this really targeted support that can sometimes be missing around behavior change, but also having that magic of the group and community come into play like we talked about before.

James Maskell: Absolutely. And I guess just to contextualize the outcomes that Barclay and Christina spoken about, one of the missing factors that I’ve seen in functional medicine is that very few people are tracking their outcomes appropriately, and through delivering a consistent program now across many different clinics, we’ve been able to see that 75% of people who experience depression, or fatigue, notice a significant increase, a decrease in fatigue and depression over the program, that number is around 60%, between 60 and 70 for anxiety and for pain, which is a big deal, because pain is driving so much of what happens in healthcare. And then also, some of the underlying mechanisms like sleep, all improving through this broad spectrum, bio-psychosocial intervention. So it’s really exciting to see that.

And the beauty of the model and the way that we’ve created it at HealCommunity is that these outcomes can become your outcomes. It’s exciting to hear that the Cleveland Clinic is doing amazing and getting great outcomes, or Parsley Health, or these other groups that are tracking their outcomes, but ultimately, we wanted to create something so that these outcomes could be experienced by both functional and integrated medicine doctors currently, but also the big blue ocean of conventional medicine, where there are significant problems. And COVID really brought to the forefront many of these problems, we knew that chronic disease was a big issue and it became acute during COVID. We knew that polypharmacy was a big issue and it became acute during COVID. We knew that behavior change was a huge issue and lifestyle, patients doing the lifestyle, but it became huge during COVID, because all of those were massive comorbidities and have led to really disastrous outcomes with an acute infection.

And so, for patients, we are starting with those people who really want to make a change. And there has been a significant number of those who realize that deficits that they had and comorbidities that they had were making them more likely to suffer from COVID. So thank you for sharing that, Christina, I think that there are really obvious reasons why patients love this, they get this high touch care, virtual care, the access is there. I want to pivot a little bit to talk about doctors, because ultimately we know the plight of the modern physician, doctors don’t have time, they can refer out to nutritionists, they can set up these things, but ultimately we’ve seen that, that integrated care model hasn’t really caught on in the bigger structure.

And I guess, we’re seeing such high levels of physician burnout, especially now during the pandemic I saw the other day that one in five health professional has quit their job over the last two years for a range of reasons. So you’ve got burnout and all those kind of things, and it’s become, again, even more acute. Barclay, now that you’ve had a chance to interact with some of these doctors, what is your thinking about the role that these groups can play in the mental state, or the day-to-day life of physicians?

Barclay Burns: I had the opportunity to interview a lot of doctors through this PhD work, and work that I’ve done consequent to then, and you can just feel the doctors just yearn for progress in their patients. And so if you’re working in this group setting and your patients are actually growing and thriving, and it’s scaling the physician’s time, the provider time, when you feel like your time is more valuable, or that it’s being utilized, or spread out across a group of people in a way, but there’s something that happens to the morale of any professional when their lives work actually gains traction in the patients. There’s just something that happens psychologically, sociologically when you see this progress.

And so to know that you have groups of people who are progressing by the month, there’s such a positive reinforcement to your own professional identity, because identity is such a driving force sociologically about what happens in medicine. And if your identity, as a care provider, as somebody who helps heal people, is validated and reinforced by people in your patient population improving and getting better and feeling happier, and less anxiety and fitter, then there’s this win, because you’re just feeling much more validated in that identity that you strive for, it’s professional every day.

James Maskell: Absolutely. Yeah. Christina, you’ve been in the trenches doing these groups, but also interacting with the health professionals that we partner with in different ways. So I know in every case, these doctors have prescribed these groups, recommended them to their patients to take them, but then you’ve also had some of these doctors in the groups themselves showing up as a patient, as opposed to a practitioner. Then you’ve had doctors and nurse practitioners in the group facilitating the insurance billing side of things. What does this mean to doctors, and what do you think it does to them when the outcomes are like this, and there’s also this dependable layer of care that maybe has been missing from the clinic? Because my feeling is that doctors want to do this, they want to be providing regular care to people, checking in, helping people when they’re struggling, but just the very nature of the system that they operate in makes it very difficult for them to do that kind of care. And I’d love to get your thoughts as someone who’s been on the inside in all of those different iterations.

Christina Tidwell: Yeah, definitely. In all the different areas in medicine I’ve worked in, the common theme is that we all get into this because we want people to heal, just like Barclay was saying, the intention coming into this is you really want to be able to help your patient. And now it’s getting, as someone that’s dealt with chronic disease myself, it’s getting more and more complicated to be healthy. And so what used to work as maybe a one doctor, one problem, one solution thing just doesn’t work when it comes to chronic illness. And so being able to really see whether it was working in the hospital, and seeing doctors and practitioners really wanting to be able to provide more, but also working with doctors and nurse practitioners in these groups that we’ve been delivering, the common theme is we need more. And what’s been great is we’ve been able to be an extension of care for them, because I think just as much as we want to care for patients, we want to care for these practitioners too, and be able to help them achieve these outcomes.

So what the sentiment or feedback that we always get from practitioners is around it feeling so good to be able to offer this type of support, it’s always like this is so needed, but I don’t have time. I don’t have capacity or resources or ability. Another thing I wanted to mention too was one huge thing we’ve learned in delivering these groups is that it does take a significant amount of support and logistical support to be able to execute. And so the average practitioner in their clinic, they don’t have time to do all of that, they just don’t. And we spend an average of two hours onboarding someone into our program to really get them set up with technology and everything they need and feel really welcome. And then, ongoing support each week through phone calls and connection from our support and, or from our coach and our support staff in order to make them feel really comfortable and held and safe and supported in this.

So it takes a massive amount of support to deliver these things, which we’ve learned. And that’s been something we’ve been able to take off of the physician’s plate, and be able to support them with, which has felt really, really good. And yeah, we’ve had doctors go through the program with their patients as well, which has been fun to do. And just to be able to see the collaboration has been really cool as well. And for these practitioners now to be able to see the results first hand, I think has felt really good, going back to what Barclay was saying as well, feeling more involved, being able to see those wins and see those aha moments and be in the session, and see that with people feels really good.

James Maskell: Yeah. Yeah. I just wanted to follow-up on that, because I was on Dr. Jeff Geller’s virtual group conference recently, and just noticed the degree to which most people, what was holding them back, most doctors holding them back, was the administrative lift that was required to bring. So having a group as a leader in the practice, having onboarding people, customer service team, charting, all of that stuff needed to be done. And that was overwhelming for a small, or a busy practice, because there just wasn’t enough there.

I’d say the other big lift, and the other thing that obviously we are doing at HealCommunity is building a super robust technology and ultimately, yes, you can run a group possibly on Zoom, and a Facebook group, but it’s not really medicine, and there’s obviously huge problems with Facebook generally as a medical medium. So, Barclay, I’d love to come to you because this is your area of expertise. I think one of the thing that we recognized early on was just that how much value the patients got from each other. And I’d love to just get your thoughts on how that plays out from a technology point of view.

Barclay Burns: Well, it’s an interesting thing, technology allows, in a simple way, the groups of people can come together now from the comfort of their own home to have a fairly intimate experience. Technology’s really, it’s a really interesting tool, because it’s a facilitator and it becomes catalytic, and it’s a catalyst. And so as people get to know each other in these settings facilitated by a masterful coach, then they’re able to come back to the technology and interact with each other in these rich and compelling ways. And so part of it, what you do with technology is you make sure that it’s structured in such a way that you facilitate relationship and connection. And once those seeds are planted and they start to grow into roots, the most interesting little nudges here and there can keep that alive and growing.

And the technology is structured in a way to allow for this continuation of connection building, relationship building, the sharing of wins, the sharing of struggle and those kinds of things. And we are continually growing and emerging that as we learn from patients on what, and clinicians, and coaches as to in this group of these people coming together, learning how they behave and interact in such a way that it is super compelling for them to continue on, on a regular basis. And technology allows for that really easy facilitation.

James Maskell: Yeah. Yeah. I really, I get that. I think we’re just at the very beginning of understanding that, but Christina, what have you noticed on the technology as it’s evolved as to what’s possible to facilitate along those lines?

Christina Tidwell: Yeah. So what has been really helpful is we have a community chat hub and a portal, and a place where our clients and patients can all come together to communicate with each other. And they’re also able there to communicate with the coach and have that kind of touch point and support really whenever is needed. And then we are also, our technology is also able to connect our system and our clients and our coaches with the practitioner as well. So what’s really helpful about that is that a lot of times you can outsource to different programs, health promotion programs, or exercise programs, or weight loss programs and things like that, but our technology is really able to allow us to be really seamlessly integrated into our patients’ lives and also practitioners.

So again, they’re able to feel like they’re a part of it, a part of what we’re doing. And again, it comes back to really being an extension of the clinic’s care, and not only our outcomes being your outcomes, but really just being able to engage in this partnership. So it feels really good and seamless for both the practitioner and the client as well as feedback we’ve gotten too.

James Maskell: Absolutely. Well, thank you both for being part of this conversation, we’re super excited to share, HealCommunity as not only a sponsor and partner at the Evolution of Medicine, but a project that I’ve been working on for almost two years now to really fill a huge gap in the market, which is that the friction that is present for doctors to end up facilitating functional medicine to their patients, and for that functional medicine to then stick and for people to get better at scale, there’s many, many friction points, some of which we’ve talked about here today, and that ultimately we want to release some of that friction. And what’s most exciting, I think is, yes, we’ve been able to work with doctors and clinics that bill insurance and be able to be an extension of their care, and work with people in Medicare and workers comp and commercial insurance that don’t have a lot of access to functional medicine, but most excitingly starting to really integrate with organizations that have much bigger patient populations.

Some of those include allopathic clinics, that know that their patients are unhealthy, know that they’re not doing the lifestyle, know that they’re lonely, but don’t have a way to solve for that. That’s one piece that’s exciting. And what’s also exciting is start to then integrate with other players in medicine that are interested in keeping populations healthy. And that’s really where I see the future of where this is going, is functional medicine groups as population health. So it’s been an absolute honor to work with both of you, Barclay, as my partner with this, and also Christina, as the first coach that I hired, and now the head of coaching, and seeing you step into mentoring these other coaches. And so for those of you who are listening, we’d love to hear from you if you’re a physician, or a clinic that bills insurance, we’d love to chat with you, but also I just want to put this out to any practitioner who’s listening.

Imagine what the impact would be on your local community if five new allopathic clinics started to deliver this baseline level of accountability and lifestyle delivery? What would be the impact on the community? What would be the impact on your practice as a functional medicine leader? And for those of you who are expert listeners to the podcast, and listen to every episode, if you combine what we talked about last year about building communities and practitioners in every city, and then we also combine what we’re doing here with creating scalable systems for allopathic providers and others to deliver this baseline bottom of the matrix lifestyle interventions, we hope that over the next few years, we can radically increase the amount of functional medicine care, the number of patients that have access to it in cities around the country and around the world.

So, thank you so much for listening in, this has been the Evolution on Medicine Podcast. If you want to find out more about HealCommunity, go to healcommunity.com. You can put in your information there. We’d love to hear from you. Thank you so much to Christina Tidwell and Barclay Burns for joining us. This has been the Evolution of Medicine Podcast, 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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