In this week’s podcast we return to our “Success Leaves Clues” series: “Bredesen Protocol in Alabama”, featuring functional neuropsychologist Dr. Kristine Lokken, CEO and co-founder of Brain Health Institute in Birmingham, AL.
“I’m living a dream I didn’t know I had”―is the quote that defines this podcast.
Dr. Lokken didn’t know she wanted to be an entrepreneur or a functional medicine doctor until she came across Dr. Dale Bredesen and Kelly Brogan’s work, discovered the Evolution of Medicine book and enrolled in the Practice Accelerator program.
From there, she implemented what she learned to establish Brain Health Institute, and realized entrepreneurship provided the life and freedom she had always dreamed of.
Tune in to hear more of Dr. Lokken’s inspiring story and learn:
- How she started up Brain Health Institute while keeping her positions as service director at the VA Medical Center and clinical professor at University of Alabama-Birmingham (UAB)
- How practicing the Bredesen Protocol has provided her with a steady stream of new patients
- How she’s packaged her programs to maximize patient outcomes and compliance
- What types of patients are looking for help with cognitive decline and brain health
- Which aspects of the Practice Accelerator allowed her to realize her new dream
Success like this can happen in any city and any state.
Thousands of patients have bought Dale Bredesen’s NYT-Best-Selling book: “The End of Alzheimer’s”. Like Dr. Lokken, you can be ahead of the curve to deliver that type of care in your home town, and the Practice Accelerator can help you get there fast.
Resources mentioned in this podcast:
Success Leaves Clues Podcasts
Practice Accelerator
Evolution of Medicine by James Maskell
The End of Alzheimer’s by Dale Bredesen
James Maskell: So, a warm welcome to the podcast Dr. Kristine Lokken. Welcome Doc!
Dr. Kristine Lokken: Thank you! I’m excited.
James Maskell: Such a pleasure to have you here on the podcast and it’s been great through our community to be able to work with all kinds of different practices in all different parts of the country. I know you have a pretty unique practice model and practice situation. Let’s start with that. You want to tell us a little bit about sort of the evolution of the practice?
Dr. Kristine Lokken: Yeah. Yeah. It’s actually pretty exciting. It’s a very specific focus. I’m a neuropsychologist and I think there’s very few neuropsychologists in the practice of functional medicine. I’ve teamed up with an integrated practitioner, functional medicine, MD and he and I have formed the Brain Health Institute, where we specifically focus on preventing, stabilizing, and restoring cognitive issues. So, it’s a pretty specific focus.
James Maskell: Yeah that’s great and I’m sure one of the things about that niche for sure is that there’s no lack of people that need it. You’ve got the whole Baby Boomer population that is probably on that spectrum, right?
Dr. Kristine Lokken: Yeah. I think that the timing of this has been just absolutely perfect and just to talk a little bit about my journey into functional medicine … James, I just really want to give you a lot of credit. Actually most of the credit. I think you’re pretty much the reason why I stepped into this realm.
But at the risk of being kind of more ethereal, I think everything that I’ve been doing and learning up to this point has kind of lead to the culmination of the Brain Health Institute. But it was really when I stumbled upon the EVO Medicine, was it the summit in 2014? Was that the first time?
James Maskell: Yeah, the summit. The Evolution of Medicine summit.
Dr. Kristine Lokken: Yeah, so I really had no idea what functional medicine was and I stumbled upon Dr. Wahl’s TED talk and that lead me to one podcast leads to another and that led me to the EVO Medicine talk. At the time, I’m an academician, I’m a clinician, I do research. I do clinical work and I wasn’t unhappy with my position. But at that time, I started listening to a lot more information on functional medicine. I was hooked, kind of everything in terms of health psych and neuropsych, seem to really resonate with functional medicine is. I kept finding myself listening to more of the practice admin side of things.
Even though I really didn’t have a dream or a passion of opening up my own practice, I had a small private practice on the side but that was mostly for doing expert witness work for the federal defenders. It was really interesting that I just kept listening. Then all of a sudden, in the fall of 2014, it was kind of like I did a vision board on a Word document and thought about what my perfect practice would be.
After that, Dr. Dale Bredesen’s paper came out and Dr. Kelly Brogan was kind of on the scene and those two main areas in term of mild cognitive impairment and early Alzheimer’s and also in terms of treating depression and anxiety and other psychiatric phenomenon through more holistic methods, just started to resonate with me and I knew this was the direction I wanted to go. After that, everything just kind of serendipitously appeared when I needed something more it kind of appeared in front of me. Of course now, we have the Brain Health Institute that we really kind of created out of thin air.
James Maskell: Yeah that’s amazing. I think there’s something sort of elegant about just the concept of what we’re talking about. When you hear Kelly or when Dale Bredesen speak or otherwise, the fact that there’s no other solutions for brain issues that there’s no drugs that are coming down the pipeline that have any sort of chance of really dealing with these issues. And yet you see such a massive need for it in the community, not just in older people but more and more in younger people too. Where there’s neuro degenerative issues now, huge in kids as well.
It just makes sense that there would be a need for something like this and I understand the serendipity too because I feel like that since we started the functional forum just be the right people showing up, person after person to help us with our journey here. I’m very happy to hear you say that.
You said you were sort of geeking out on sort of the business model stuff. How did you sort of go from the idea, the vision board into the beginnings of the execution of the practice? Because I’m really fascinated about sort of the early days because ultimately I feel like every practitioner who decides to be an entrepreneur and build this kind of practice, they all have to go through that sort of eye of the needle where you have to go through some sort of process to understand okay, what is this going to be? How are we going to do it? At the beginning, it doesn’t look exactly like you think it should look. But ultimately you’re learning and building sort of the muscle of entrepreneurship that can end up doing incredible things.
Dr. Kristine Lokken: Yeah. Absolutely. You hit the nail on the head. Well, I think that a lot of the things that you said and continue to say and now are in your book and as part of the Practice Accelerator, just made a lot of sense to me. That you would start with a lean micro practice that you’re not going to risk it all because again I’m still 30 hours a week at my other position as the director of the rehab neuro site service here at the Birmingham VA. I’m still a clinical professor with UAB and I had no intentions of leaving that but I wanted to kind of dip my toe in and see how that could come about.
I followed a lot of your advice because it just really made sense. But it wasn’t easy because my MD partner and I had very different ideas of how the practice should look. There was a lot of give and take initially and actually we first met in November of 2015. It was interesting we met at a book club for Perlmutter’s book and just kind of jokingly said we should go into business together and then we’re like, no really we should go into business together-
James Maskell: I love that.
Dr. Kristine Lokken: … Had forms, the idea for the Brain Health Institute. By February of the next year of 2016 and then it was just a couple of just really difficult months. I think we both are great communicators and we both were able to discuss our vision and between the two of us, we kind of came up with a happy medium in terms of how the practice should look.
James Maskell: Yeah. So, how does that look? How do you marry sort of the clinician academic with the physician and come up with something that ultimately I guess the most important thing is that it works, right?
Dr. Kristine Lokken: Yeah. It’s working. That was kind of year one. We opened up in October of 2016 and so we’re just a little over a year. We had patients basically knocking on our door and encouraging us to open up. They wanted to be seen and we arguably opened a little bit too soon. But it’s working. It’s definitely working. I guess the model that we’ve followed is more of an iterative model and so we kind of started with the greatest need and to try to more perfect that part of the service as we build out other parts of the practice.
The greatest need at that time were individuals with mild cognitive impairment and the early Alzheimer’s, who were interested in the Bredesen program. I trained with Dr. Bredesen out in Navato, CA. I was one of the first people to go through his beta training in April of 2016. Then I went again in July of 2016. By that time, I had had some training and we felt like that was a great place to start.
Although, our vision is to build out six different clinics. The first one is the memory clinic, where we do offer the Bredesen Protocol but not necessarily just the Bredesen Protocol. Then next we are now building out the holistic psychology program where we treat depression, bi-polar, anxiety, other psychological disorders from more of a holistic model. Then after that, we’re going to build out a mindful eating clinic. I think there’s such a need for this because we run into about a lot when we’re really working with individuals trying to change their diet and there’s a lot of emotional eating stuff coming up. There’s just a lot of just really chaotic eating.
Using what I know from psychology in our DBT, CBT, those types of things and applying those things to eating issues and behaviors. Then the three other clinics, we’ll build on after that are going to be a traumatic brain injury clinic. That’s kind of my specialty here at the VA, so it just makes sense for us to offer more of a functional medicine model for treating TBI. Also then moving into more of the autoimmune, MS, using more of a Wahls type protocol. Then we already have had a few people go through our last clinic, the optimization clinic. Those were mostly individuals who have had a family member who has had Alzheimer’s diseases, they’ve seen that process, they really want to do everything they can do to prevent and optimize their cognitive function. We’ve also had a couple of area individuals that are lawyers that are kind of the top of their career, top of their game but feel that they’re slipping cognitively and just wanted to really do everything they can to be sharper. Those are the six clinics that we’re going to offer.
Then we’re building that out kind of slowly and kind of every clinic we’re just making sure that we have everything that we need to make sure that those individuals are having success. Then as a more of three to five year plan, as a researcher, I just can’t really take that hat off. I think that’s exactly what functional medicine needs is to have some outcome data to get published in peer reviewed journals and to just have a lot of weight behind the things that we’re doing.
I see kind of two branches to our Brain Health Institute. The second branch is going to be more research and education. With the research, we’re already collecting all this in a database. I plan to do some publications this next year. We have some outcome data from our year one patients, apply for some foundation grants. I’m pretty sure that some of my colleagues are going to be pretty interested in this data once they see the outcomes that we’re getting because there really isn’t anything for neurological issues in conventional medicine.
People are not getting better. We cannot even show stabilization. I think that’s pretty amazing. We’re [inaudible 00:11:58] that data and then hopefully off of that, I want to eventually just have this as a model where it’s not just for people who can cash pay. So, perhaps through the grants or through the money that is raised through those foundational grants or NH grants or other grants, we can provide scholarships for individuals who can’t afford this type of care but really desire this type of care.
James Maskell: Yeah. Absolutely. It’s really interesting. I love the six different sort of streams. It ultimately seems just from what I know about function medicine is that the delivery of that care is probably 80% the same across those different brands. The Wahls brand and the Bredesen plan and doing stuff with holistic psych and doing stuff with brain recovery, I mean you’re getting the fundamentals of health creation in place. There’s probably going to be some different services that are added on there but probably learn a lot about making numbers three, four, five, and six for numbers one and two.
Dr. Kristine Lokken: Absolutely and I think that’s the beauty of functional medicine is that the foundation is pretty much the same. People need to sleep. They need to eat right. They need to control their stress. All those things that have been poised to do as a health psychologist and a neuropsychologist, I mean that’s just ingrained in me. That just comes naturally. We have that foundation but then it’s very much the same across those clinics. But then it’s also this individualized approach and so we take whatever tools that person needs and really capitalize on that.
James Maskell: Yeah. It’s great. This is all happening in Alabama like I was just at a clinic the other day that was doing amazing brain work in North Carolina as well. It seems as though this is not something that’s anymore in the big cities or the coast, this is happening all across the country. The need is there and even clinicians, acumissions, and other practitioners are stepping up to say, “Look I see the need. I see that this works. There’s enough evidence out there I’ve seen in my own clinic or otherwise to step up.”
Tell us a little bit about how you’ve sort of packaged these services together. Because ultimately I think a lot of practitioners in the beginning if they’ve been in insurance before, they’re very in the fee for service mindset. Clearly when you’re dealing with mild cognitive impairment and reversal Alzheimer’s in a Bredesen type protocol, it’s not something that’s happening in one appointment. It’s a purity of time that you’re working with. What was the first version of the services and then how has that evolved in terms of how you package and sell it?
Dr. Kristine Lokken: Yeah. Again, it was just kind of feeling it out at first. But I was pretty passionate about making sure that it was more of a packaged deal to start with. Then we found that for the Bredesen Protocol, they just need so much more and so much more hand holding and a little bit longer. Kind of following Parsley Health’s model in that, it’s just not going to work. Health is a process. We’re not going to be able to do much with just an intake. We really need to do that process. Building it out from there.
So, we do package that Bredesen program as a six month package. Then for the individuals who are in more the holistic psychology and the optimization clinic, we do the intake and then a very thorough feedback session where we actually give and each individual in our clinic gets this, we do a personalized eBook where we print it out and put it in a binder. We have a binder, so they can keep adding things to it like recipes or handouts or different types of things.
For the holistic psychology program, the optimization program, we’ve just done the intake and then the feedback session. Then we kind of build it from there. But for the Bredesen program, we really felt like we just needed to just put it all up front. It’s a six month program. Everything’s included because what I was worried about is that people would go off and then not know exactly what to do and then not want to come back unless they’re in crisis. We want success. We want outcomes. Let’s just put that dollars on the table initially. They have everything that they need for the next six months.
James Maskell: Absolutely. Yeah. I definitely think that’s a great way to start and certainly just with the way the functional medicine is delivered, we’ve been helping practitioners build packages. We’ve helped them do a direct primary care kind of thing and membership. One of the things that we’ve seen is that with the membership, practitioners tend to sort of undercharge on the membership early on because there’s a lot of stuff that needs to happen early on in the relationship. It’s not like a primary care relationship where you’re just spending a few minutes here and a few minutes there, a little bit longer, having time to talk to your doctor. Behavior change is not easy on the patient and it requires real support from the people in the practice. You need to have the providers who are going to do it. You need to have the support in there.
What we’ve seen is that if you can do something like a package early on where people are committing to a period of care for a period of time up front, that’s good for cash flow and it’s good for patient retention. It’s good for them getting results. Then once they’ve seen that with behavior change and with what you’re recommending that things do change and the health improves, then there’s more like maintenance kind of packages that you can get people unto, where they can still be connected to the practice. Maybe they can be on sort of more of a retainer modeler. But that certainly seems to be something that’s emerging as best practice in the pricing and organization because like you said, if someone just comes for one appointment and they start doing things and it’s hard and then they don’t have any skin of the game, it can be very difficult to keep them in the medium turn.
Dr. Kristine Lokken: Right. Right. Yeah and you’re right, we didn’t even really know where to start in terms of pricing and for our initial patients, they were actually a lot more complicated, a lot further along than we had expected even though we screened pretty well over the phone. Most of the individuals that came in, they were fully into Alzheimer’s Disease by the time they came to us. I think now we’re educating a little bit more on getting people more in the mild cognitive impairment, early Alzheimer’s. But they required a lot of care, a lot of just the generalized work up. Now, we’ve actually doubled our prices for the Bredesen Program. We just simply weren’t charging enough for the care that they needed and that feels a little bit better that patients are really going to get the care that they need.
James Maskell: Yeah. Beautiful. So, I know you’ve been part of the Practice Accelerator here for a little bit of time and decided to do it. I know also that as things get busy and things start to work, there’s a delicate balance of being an entrepreneur of dealing with the now and building for the future. But I’d love to just hear some of the things that you’ve taken from it or what’s your experience has been. What you’ve done in 2017 and what you hope to do in 2018.
Dr. Kristine Lokken: Yeah. Yeah. Exactly. So, I was one of the ones that jumped on board with your beta program. I was so excited about it. Again, I didn’t actually have a practice at the time, that was May 2016. We were envisioning it, but we were still kind of in discussions of how it was going to look. I delved in at that time but I didn’t know what to. I didn’t know what I needed because I think the first time you had talked initially about the grocery storage wars and stuff like that. I didn’t actually have a practice. It didn’t apply to me at the time and then all of a sudden, it was just this snowball of we started and it was just kind of managing … I was still at my other practice 30 hours a week. I have two little ones and life happens. So, then I just got away from it.
But I still would continue to listen to the podcast and continue to kind of implement some of the things and started out the practice with a low overhead micro practice model and trying to keep it as efficient as possible and using the systems in place. I’ve really followed that model even though I haven’t been this diligent A plus student in the Practice Accelerator. However, though there for me, I feel like that’s the beauty of it is that when I need it, I know that I can go back to it. I really feel like 2018 is going to be the time where now year one is this viable and we’ve not had to park. This is viable. People need this. People want this. We’ve set up a practice that works.
Now, year two is really going to be is this replicable? Can we build this? Can we make it bigger? I’m really going to start to focus more in the Practice Accelerator, work on our auto responder, work on the website that’s going to really just have the things in place that [inaudible 00:21:46] recommends and just really work on that.
Yeah, it’s been hard for me to not do that overage fever, the PA and the Practice Accelerator. But it just wasn’t the time. But now I feel like it’s still there and even though I haven’t done things step by step, I think that I’ve definitely followed the model that Evolution of Medicine recommends and it-
James Maskell: Yeah. Absolutely. The lean practice is critical. You don’t want to put yourself out of business before you’re in business, right?
Dr. Kristine Lokken: Mm-hmm (affirmative)
James Maskell: Getting it and making sure that there’s need for it. Then yeah, it’s about building efficiency. I mean, ultimately we know that the reason why we started the Practice Accelerator is because we saw from the IFM survey and from other sources that it’s sustainability in the long run is down to efficiency. Can you stop everyone from burning out? Can you create a predictable experience inside the practice? One of the things with having these packages as you start to build these packages, so like a six month packages that you have now, if you have a six month package, it’s about creating a predictable experience inside that packages. It’s a predictable experience for the providers. But there’s also more of a predictable experience that you can create digitally as well, through getting all of that stuff that’s in the binder and now putting it out in a digital format. So, that people can have it or having both.
In these podcasts, that we’ve heard over the last few months here, you’ve heard doctors talking about, okay, how do we create a predictable experience with people as they’re going through the program? I can tell you that getting those kind of things in place, getting the structure in place, the billing in place, getting the acquisition in place, all of those things together are going to mean that once you’ve done that once for the first program, these programs, two, three, four, five, and six that you’re talking about you don’t have to recreate the wheel. You know that your people are coming in. They’re going to have a six month experience. It’s going to be a certain focus but having a new patient neuro degeneration package. Okay, this starts on this day. Kick it off. It’s a 180 day auto responder that you can put emails at certain times to check in with people, see how they’re doing, organize communication with them. When you’ve done that, setting up these other programs, it’s much easier. That’s what we see for practitioners.
Ultimately, there’s not a get rich, quick scheme. This is building practices that can serve hundreds of thousands of people. Look at the places where all these doctors come from. Your practice in Alabama and we’ve had Wisconsin and Idaho and Alaska. This is not the big cities. This is happening in cities and towns around the country.
I guess, I’m just really excited to hear that the lead business model has allowed you to get this far and very exciting times ahead. I think that this niche of functional medicine is really an exciting one because you’re dealing with people who have the money to be able to pay for the services. There’s a massive need for it and the quality of life improvements are really measurable from the people who go through. What’s been some of this sort of emotional highlights for you in 2017, as far as the kind of results that get you coming back every day to do this?
Dr. Kristine Lokken: Oh, yeah. Well, one it’s that I’m living a dream that I didn’t even know I had. I mean, it’s really cool that … I’m just such a health nut personally, always have been. My mom was and so that just kind of was a personal passion and something that resonated with me. Again, why I kind of insisted on doing both health psych and neuro psych. In the early ’90’s, when I was in graduate school, much to my professors to grim, they were really wondering what health had to do with neuro and to me, it just had everything to do with it. This is the perfect way to carry out both my personal passion and my professional passion. How cool is that?
Also, being an entrepreneur, this has been just really fun to be creative, to kind of think about different ways to address problems. I really have been just kind of shocked at how much fun this has been for me to kind of carry out this part of my career that I have no training in and that I really didn’t think I had interest in. But yet, it’s really fun.
But then the other part is that seeing these patients stabilizing or getting better and seeing hope, where there was no hope. We’ve had a couple of patients come in where we were just really not sure of we could even offer anything for them because they were far along. They were just so unhealthy and now they’re coming back in, six months later and they have a spring in their step. Their color is different. Their families are saying that it’s not consistent. That they’re being able to form new memories here and there. I mean, these are patients where Alzheimer’s Disease doesn’t get better. If we’re seeing some stabilization and some improvement in memory or just betterment in quality of life, that’s really cool.
I think the biggest thing though is the domino effect, where we may or may not have a great effect on the patient. But that caregiver is doing so much better. Their husband, their wife, their daughter. Then you see your work affecting people that you haven’t even met. When they talk about, “Oh, our granddaughter is doing this too,” or, “I talked to this person at church and they’ve changed their diet.” I think that is the really cool part is that you can just touch so many lives without them even having to be in your office. I think that domino effect of health is just really gratifying.
James Maskell: Yeah. I’m glad you said that actually because I know someone shared this on their evolution of neurology forum earlier, I think it was Dr. Mark Menolascino, that caring for people with Alzheimer’s can be a trigger for Alzheimer’s because it’s hard and it’s stressful. To see that there’s a ripple effect, not just to the caregivers around, but one of the things I’ve noticed is that the older people that when they start to see big health improvements or they start to take healthy seriously and start to see big health improvements, their peers start to notice it and wonder what they’re doing. I’m sure this speaks to some sort of horizontal marketing as a result of just seeing people with that spring in their step.
Dr. Kristine Lokken: Yeah. I think also on a personal level, I want to live with integrity. I’ve always been pretty healthy. But I really upped my game and want to make sure if I’m touting the wonders of following a good diet, if I’m talking about stress management, if I’m talking about all these things, I want to live my life with integrity. I’ve noticed that I feel better. I look better. I’m a better version of myself for doing this kind of medicine and I think that’s pretty cool too, where your job kind of gives back.
James Maskell: Yeah. Absolutely. Well, look very exciting to have you here on the podcast. Thank you for being part of this community and the accelerator, it’s getting better and better with the practitioners that are coming in and just seeing the creative doctors and practitioners really flourish and also just starting to see we’ve had this success leaves clue series. It’s been really incredible just to see how any practitioners are having success and that functional medicine is thriving in this small box revolution. It was what we wanted for the beginning. We saw there was a possibility for it.
We saw that functional medicine didn’t have to come through major institutions in order to be delivered to the masses and what it takes exactly in this podcast, I just want to say one phrase that you said that was amazing. You said, “I’m living a dream I didn’t know I had.” I think that is incredible thing because I think there are so many doctors that are trapped in a job, in conventional medicine, in a salary position, and they don’t really realize what kind of freedom and excitement it would be to have their own practice doing what they love.
So, I just want to share my appreciation for you for taking that step and I hope that this podcast will cause many other people to want to take that path and just know that if you’re thinking there’s no demand for your services out there, I think that it’s really important to know that look, FM has training on the Bredesen Protocol right now. There’s millions of, millions of people that need it. You can go out and start building this practice and if you want to build something that’s going to be viable for the next five, 10, 15, 20 years of practice that you can sell, here’s a business that is ready to go. Thanks so much for being part of it. I appreciate you being part of the accelerator and being part of the podcast series. I think we can all look forward to an exciting 2018.
Dr. Kristine Lokken: Oh, thank you James and thank you for all the work that you’re doing and the work of Evolution of Medicine. It’s just been really fun to follow.
James Maskell: Awesome. Thanks Kristine. It’s been a pleasure. This has been Dr. Kristine Lokken. You can find out more about her practice, we will have the details in the show notes. But this has been the Evolution of Medicine Podcast, I’m your host James Maskell and we’ll see you next time. All right.
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