What does it actually take to build a functional medicine program that thrives inside a conventional health system?
In this live episode from the Institute for Functional Medicine Annual Conference, James Maskell sits down with Laura Sandquist and Kate Otremba, who’ve spent six years building a large integrative and functional medicine program within Allina Health, a conventional health system in Minnesota.
Laura and Kate share the infrastructure they built to make it work – smart phrases, practice guidelines, and templates that help clinicians translate their functional medicine training into daily practice within the constraints of RVU requirements and insurance billing. They discuss how they addressed access issues through nutritionist-led and practitioner/nutritionist co-led group medical visits, and how a two-day CME training for primary care providers and specialists helped build trust and drive more referrals and holistic thinking across the system.
The conversation also covers their new venture, Whole Health NP, launched to help other practitioners bridge the gap between learning functional medicine and actually applying it – and why this whole-health approach extends well beyond integrative nursing to physical therapists, psychologists, and beyond.
Whether you’re a clinician, health system leader, or someone building functional medicine programs of your own, this episode offers a grounded, practical look at what it really takes to make whole health work at scale.
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About the Guest:
Laura Sandquist, DNP, APRN, A-GNP-C, FMCP-M and Kate Otremba, DNP, MN, APRN, CNP, FMCP-M are co-developers of a large integrative and functional medicine program within Allina Health, a conventional health system in Minnesota, where they have worked together for six years. Their work includes building clinical infrastructure such as smart phrases and practice guidelines, launching nutritionist-led and co-led group medical visits, and developing a two-day CME training for primary care providers and specialists to build trust and collaboration across the system. They have since launched Whole Health NP, a company dedicated to teaching practitioners how to translate functional medicine training into real-world practice.
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About the Host:
James Maskell is a healthcare entrepreneur and founder of The Evolution of Medicine. For over 20 years, he has worked to scale functional medicine through community-driven models, group visits, and practitioner infrastructure. His work focuses on moving medicine upstream – toward prevention, lifestyle intervention, and systems-based care.
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Transcript:
I think whole health to me really means being able to look at the whole picture and hold the complexity of somebody, and being able to integrate not only like a conventional approach, but also bringing in integrative and functional principles and looking at what are all the possible interventions that I could use from many different disciplines, and how do I put together a very collaborative team to care for a patient?
So it’s this ability to hold the wholeness and the complexity, and then make it very practical into a plan that somebody can actually do. Hello, and welcome back to The Evolution of Medicine podcast. We are coming to you live from the Institute for Functional Medicine’s annual international conference.
We are speaking to leaders and innovators, speakers, people who are taking functional medicine into places that it has never been. And I’m super excited today to connect in person with people I’ve spent a little bit of time on Zoom with over the years. We have, uh, Laura Sandquist and Kate Otremba, leaders in the implementation, uh, of bringing functional medicine into whole health systems.
So let’s talk a little bit about your journey to get here and, um, and how you ended up speaking here and, and sort of what started this all. Yeah. Well, what started this whole thing is that Kate and I have been working together for the past six years to develop a really large integrative and functional medicine program within a conventional health system in Minnesota.
And it’s throughout doing that work we’ve learned a lot of lessons of what works, what doesn’t work, and we wanted to present to really help other people know how they can implement this into systems because it can be a challenge. Yeah. Different challenges than before. And this year I hear that 40% of the attendees work inside health systems, which is a new sort of growth area for IFM, so it’s probably, probably good timing for you to be here.
What were some of the, the key lessons that you shared in, in your talk and, and what has been the response from the, the community here? Yeah. The main areas we have focused on, um, sharing with people attending here were how to build an infrastructure so that you can thrive within the conventional system, ’cause the conventional system does have some constraints, like you have to meet certain RVU requirements to be sustainable.
You need to chart in a particular way to be able to bill through insurance. And you wanna make sure you don’t burn out your practitioners because of those constraints. And sometimes too, you have a limit on how much time you have with patients versus a private practice where you can call your own shots on the time.
Um, so within those constraints, what we were trying to show people is kind of what is the infrastructure you need to build. And so some of it is clinical tools that clinicians can use right at their fingertips as soon as they get into practice for translating what they learned in the Institute of Functional Medicine into the day-to-day.
So we developed smart phrases, um, practice guidelines, and other templated things within their day-to-day practices that really helped it work. And then we also, um, found that it was so popular within the system that we needed to, um, deal with that access issue, so we started group medical visits as well, which is something you had supported us in doing, um, learning that whole process.
And so we have also successfully launched, um, two different types of group medical visits, some that are nutritionist only-led and then some that are practitioner and nutritionist co-led. Um, so those have been kind of the main infrastructure we’ve built to make this possible, and I don’t know if you wanna talk about how we also kind of made ourselves known within the system too with the, the training.
Yeah. You know, ’cause, uh, when you’re in a system too, you need to really develop trust with the primary care provider and specialists, and that can be one of the biggest barriers. And so we created a two-day CME for primary care providers and specialists, physicians, MPs, PAs. Yeah. And we offered that six times over two years.
Yeah. Two-day conference that just gives them the basics of taking an integrative and functional medicine-formed approach, and that was really effective to gain trust and just help to spread that across the system. What was unique about Allina Health that made it a good fit for this to sort of flourish within it?
Yeah. Well, Allina Health actually has had an integrative institute since 2003, so they’re pretty early adopters. And so when I came to the system in 2016, there was a really nice stage set to be able to do this work. So I could take what had been built and then continue to move that forward. Um, but I would say even after all those years, there was still room to- Yeah
for people to understand, you know, what is an integrative and functional medicine. So those doctors take that training that you did, and then you find them more likely to refer across or to actually run their own group visits? How did that work? Yeah, mostly we saw an increase in referrals and collaboration, um, reaching out and saying, “I have some tough cases, and I’m k- kind of stalled on where to go.
What might you guys have to offer? How could we partner?” Um, we also saw them doing more integrative things in their practice, so starting to think about magnesium for constipation or breathwork exercises for their patients, not just an SSRI. So we also felt like it shifted how they were thinking, um, more holistically and from that whole person lens as well.
Yeah, that’s super cool. Um, so yeah, I wanna, I wanna actually have, uh, yeah, I’m glad to, to reconnect because, you know, at the, at the process that I got very excited about the potential for group visits. I sort of convinced myself with a book, and I, I just wanna say fro- from my perspective is Just how wonderful it was for me to feel, like, validated that you guys were excited about doing it and, and that we got a chance to, you know, start the journey together.
You know, I think I can say learned a lot. Like, I never really integrated with the health system in any way, and didn’t really understand what I was getting into, right? Um, and it, it’s a lot different than, you know, than organizations where practitioners can just make their own choices and do it. Um, but I, I hope that the time that we spent together, you know, maybe accelerated some things, maybe supported some things, and that, you know, when I saw you guys on the list saying that, “Hey, we’ve been successful and we’re gonna show you how to succeed,” I was like, “Yes.”
Yeah, it was a great, it was a great, um, experience to, you know, to, to go through that process and understand. And it was like it would get my… It would get me excited, uh, all the time because I just felt like, uh, we were breaking new ground and, and, uh, bringing something in that could solve the equation that everyone wants to solve, which is like how do you do this on insurance?
How do you actually move the needle? And so yeah, love to, love to understand, um, you know, some of the, some of the things that are resonating, um, since you’ve been here. Uh, we had a, we had a guest who I just interviewed who said that that was their favorite talk of the whole time. She was a nurse, so she’s probably biased.
Um, but, but yeah, what, what has been the resonance here and what, and what do you think is, uh, is possible moving forward? Yeah. Well, I think, you know, one of the best things about being at the conference is just connecting with other people doing the same work, and just learning from them what’s working and what’s not working.
And so that’s what I find, you know, most valuable- Mm-hmm … about this conference. Yeah. Yeah. And we’ve also had a lot of people approach us on these billing questions, and so it’s been really nice to be here and be able to say, “Yes, this is doable. This is how you do it.” Um, and it’s definitely inspired us to think about maybe a course that would teach people on how to do that as well.
So, um, I think another thing we’ve noticed is a lot of people saying, “Hey, I, I understand functional medicine, but how do I translate it into practice?” And that was something we saw when we built our very large team, is we had to kind of give people some support with bridging that gap. And so that’s why we launched our new company, was to just help teach people how to start to apply functional medicine in practice, and that’s something we’ve been hearing here at the conference too.
So we’re excited to build that network and, um, share what we’ve learned about how to translate this all into practice as well. Yeah, share a little bit more about that because I, I, I think that when you start doing this, you start to realize, oh, there’s a missing piece here. You know, people who are going through different trainings are missing this key part that we’ve learnt from being in tension with the problem for a while.
What, what was the, the starting point where you looked at each other and said, “We gotta do this”? Yeah. Yeah. Well, I think, you know, after we’ve trained, you know, about 24 people in on how do you do this, we, we just saw the need, um- And kind of the desperation of someone who has the training, but then someone’s in front of you, and you think, “How do I piece this all together?”
And really needing that additional mentorship and support. And so we knew it was a need, and we’ve done it a lot the last several years. And so that we just thought, “We have to do this for more people. We can teach this on a broader perspective and just help make that transitions easier.” And also, I think not only those functional medicine trained, but we get a lot of requests of people who say, “You know, I’m really interested in taking an integrative and functional informed approach or a whole health approach.”
Um, but they feel that doing an entire training in functional medicine might be too overwhelming. And so what are the basics that you could do in a primary care setting or a specialty setting, especially within a system? How do you do that practically? And we’ve figured that out over the years, and so that’s what we wanna be able to share.
Cool. And that’s called Whole Health NP. Why, why NP? What is special about the NP, and what is special about the NP, what they can bring to this transformation of medicine? So I just wanna take a minute to talk about the incredible mission partners that we have here at The Evolution of Medicine that have made this possible.
So first and foremost, I wanna thank- Fullscript and Fullscript Journey.So Fullscript’s been an amazing partner for 10 years. We only pick partners that can help us achieve our vision and help you achieve your practice vision.
And Fullscript have been an incredible partner for a decade, but their new offering Journeys, this is why we called it The Evolution of Medicine Journeys, is allowing practitioners to combine the relationships that they have with the newest technology to sell direct-to-consumer lab testing, and use it as a funnel to bring into your practice, and it’s a game changer for the whole industry.
So go to goevomed.com/journeys, and you can get started on building the Journeys for your practice, an optimal way into your practice. We’re gonna have some conversations about it. This is a game changer. Next, Genova. Genova, um, have been fans of The Evolution of Medicine for a long time. We’re big fans of them, and they now have a lot more specialty testing.
They have a lot more tools, and it’s a key part of, uh, understanding the body ecologically. So go to goevomed.com/genova to find out more. Come on over here and I wanna show you about the other mission partners. You know, if you’ve been following us for a while, you know that these are organizations that we trust, that add a lot of value.
Freedom Practice Coaching. Um, I have been sup- supported by them since the beginning and, you know, so many of the issues that practitioners face in building a successful practice, scaling a successful practice, come down to having the right support with people who have been there and done that. Go to goevomed.com/fpc.
Um, BigBoost Marketing. Uh, Uli and his team are the best in the business when it comes to really understanding how to market your functional medicine practice. Go to goevomed.com/bigboost and see how they can help you. And then what you’re gonna be hearing a, a lot about is the formation of clinical networks.
And ultimately, TruNeura is our first effort at that, which is to build an integrated clinical network, combining independent practices from across the country into a network that can reverse cognitive decline. And if you go to goevomed.com/truneura, you can get a demo. You can see what it means to be part of an integrated clinical network.
That’s mentorship, that’s software, and that’s making it easier for you to get incredible outcomes in a disease state where there are no other options. So thanks to our mission partners. Let’s get back to the content
I’ll, I’ll let you add to this, but essentially because, um, a lot of our lens is from the nursing lens and we think it lends very well to what functional medicine also has to offer, so we’re, we’re essentially blending the two, so that’s why we wanted the NP for nurse practitioner. Yeah. Just to, um, essentially signal that there is a bit of the nursing wisdom that is also infused in the way we teach people how to be in front of a patient and where to start applying the functional medicine principles, also supported by the principles of nursing.
And I don’t know if you’d say any more to- Yeah, yeah. We’re both trained in integrative nursing, which is a specific type of nursing, and that aligns really well with functional medicine philosophy. So we found combining that is a really great synergy. And so many nurse practitioners and nurses kind of just get this way of thinking, and so we wanted to really just, like, highlight that this is a skill that nurses and NPs have.
And it’s- it can be kind of unique, you know, to our profession. A lot of other people can do it as well, but nurses are fabulous. Well, I didn’t tell you I was gonna do this, but I’m gonna put you guys on the spot right now. ‘Cause I just interviewed Tracy Gaudet, and, uh, we have a great relationship, and one of the things that she’s worried about is that the use of the word whole health will not represent what whole health really is.
So as a test that you have to answer is what does whole health mean to you? Yeah. Big question. Um, I can start. Yeah, go for it. Yeah. I mean, I think whole health, to me, really means being able to look at the whole picture and hold the complexity of somebody, and being able to integrate not only, like, a conventional approach, but also bringing in integrative and functional principles and looking at what are all the possible interventions that I could use from many different disciplines, and how do I put together a very collaborative team to care for a patient?
So it’s this ability to hold the wholeness and the complexity, and then make it very practical into a plan that somebody can actually do. Yeah. And specifically looking at the person as not just a bunch of body systems that may or may not be dysfunctioning, but also someone in a context, right? So relationships, environment, all of tho- their spiritual connection, their sense of purpose, all of those things potentially impacting their health on all levels, you know, spiritually, psychologically, and physically.
Good news. You passed the test. All right. That is whole health. And, uh, you know, we were joking about the idea of, of being, you know, that, that- Um, I, I– we were talking about things being dressed up as whole health that aren’t because it’s sort of about the now, and it’s a new, new word in that. And, um, I think we, you know, in the same way that, that functional medicine is having to now set standards for what functional medicine is and the certification because, you know, there has been the use of the word functional medicine in many different ways, which I think is healthy for this emergent movement that we’re part of.
But now it’s sort of like trying to, you know, give people confidence that when this word functional medicine is used or functional medicine certification is, that there’s some sort of like foundational standard. And, you know, in the same way we’re talking about that is like, what is whole health? And whole health is really about the rehumanization of medicine.
And so I’m really glad that, you know, you came together with that answer because I feel that, um, you know, if– especially if you have the, the background in, in integrated nursing, I mean, that’s really, uh, you know, where this all came from, and that’s the, the foundational elements for it. So I’m excited to, you know, to see that moving forward.
So who are the, who are the kinds of groups that you’d like to work with? If I, if I– if you could wave your magic wand, who would sign up that you’d be like, “This is the dream”? Well, as far as, you know, practitioners that will wanna train, even though we’re coming from an integrative nursing perspective, we really think any practitioner could use the knowledge of how to take a whole health approach.
Yeah. And if everybody on the team has that perspective, then things tend to flow and work better together. So it’s really anyone, physical therapists, occupational therapists, acupuncturists, speech pathologists. And we could go on and on. Yeah. There’s so many people. Right. Even psychologists. Like, we’ve- we’ve had a lot of conversations even with a, a local clinic, um, that is a psychology clinic, and they were saying, “Gosh, we really want our clinicians trained in this model because sometimes you’re sitting with someone and you know you’re at the end of what you can offer from your skill sets.
But if I had a bigger sense of all the picture and the connections, I might know who I need to refer them to and really keep them on their path towards healing versus stalling with me.” And so we see it valuable to anybody who’s working with people in the healing realm. I can really see the need for that in mental health because- Right
you know, if you are a talk therapist, there’s only so much talk therapy you can do, but if you have a range of physiological factors driving your mental health conditions- Exactly … then, you know, you need that support, and that might be, um… You know, I, uh… There’s so many obvious examples, but let’s say something like PANS in a kid, right?
You know. Precisely. The kid goes off the, you know, off the reservation, and you don’t know why, and it happened rapidly. Mm. And you don’t find out why that happened, well, now that could be a lot of pain and suffering for something there’s quite an elegant solution for. Right. But it could also be, you know, what’s happening in the home and trauma and, you know…
There, there’s, there’s so many range of things that it could be. And when you find it and when you deal with it because you got the right team together- Exactly … it’s such a elegant- Mm-hmm … long-term, you know, whole health solution. Right. While you can only do talk therapy, you sometimes realize… And I’ve, I’ve spoken to a number of, uh, people who are, um, you know, psychologists and doing mental health, where it’s just taken one patient for them to send someone to more of a whole health approach, come back and seen everything, say, “Now you see it in every patient.”
Exactly. And you click to- Exactly. Right. Exactly. So, um, is this s- so now with the, the new organization, does that mean that, um, Align is fending for herself now without you, or are you still in there part-time? Um, w- they’re… Laura’s gone, so I am fending for myself without Laura. I’m still the clinic lead as of right now.
Um, and yeah, they’re kind of looking at the, the next steps for, for the clinic and where we move into the future, and focusing a little bit more on prevention. Okay. So if you come back in a couple of years back to IFM and we do this again, tell me where, where things are at at that moment. Yeah. I mean, I’m, I’m hoping that more people are able to access some of the things we’re teaching, and that we’re seeing more functional medicine in the conventional system, um, successfully, and insurance-based access for sure.
Anything else you’d add? Yeah. Yeah. I would… I- my dream is just to see everybody in healthcare taking this whole-health informed approach. Yeah. You know, it doesn’t necessarily have to be in-depth functional medicine, but I think if we could get everybody coming at care with that perspective, we will see transformation in the healthcare system.
Mm-hmm. I mean, it, I, I guess maybe just a, a, a word on that because the real transformation that I think that you understand and that you’re facilitating is not easy, right? There’s a lot of mindset shifts that have to happen. There’s systems that have to change. There’s, you know, there’s a whole sort of ecosystem of changes that, that have to occur.
Um, is there anything that you, you know, would like to, uh, to, to share on some of the things that you feel might be, be helpful for other people who are considering this shift? I find that a- at least from our experience doing the education series at Allina, was that when practitioners could experience this type of care themselves, that was really transformative into their buy-in.
And so, I mean, that’s definitely something I’m hoping to see more of, is people seeking this out for themselves who are already clinicians and understanding the value. Yeah. And I would like to see the incentives change for insurance. You know, we’re still stuck in a fee for service model, and the, really the system probably won’t change much until the incentives change is really what I learned.
And so if we can see a shift somehow there, that would be really meaningful. Mm-hmm. Can organizations that profitably sell tertiary care get behind prevention in a meaningful way, or is that just, is that a, um, is that just too big of a, of a structural incentive to overcome? I think they can. Mm-hmm. Uh, they just have to want it.
Um, and I mean, we’ve proven with our clinic that it can actually be profitable. Um, and so it’s just a matter of having the people with the training, the right philosophy of care in there and given the opportunity. Well, look, thank you so much for your leadership. I’m really grateful to get to meet you in person and to be able to thank you actually for the, the time that we spent working together.
Um, you know, all of these lessons inform where I’m going. I’m not… I’m just feel like we’re just getting started with the transformation. The functional medicine whole health revolution hasn’t really happened yet. We’re still right at the beginning of it. But I see that all of the sort of battle scars along the way inform, you know, what has to happen next.
And I, um, you know, as much as I hoped that at this moment, you know, we would have found a way to help 100 health systems deliver, you know, to deliver group visits at scale, I can tell you that the problems of loneliness are not getting any better, right? The problems of disconnection are not getting any better.
The problems of, like, implementation, um, into systems are getting better, but the problems still remain, and it’s like a huge population that needs help. And so, um, it’s grateful, I’m grateful to be on your team. Likewise. Yeah. Great to see you. Wonderful. All right, well, this has been the Evolution of Medicine podcast.
We’ve been here live from the Institute for Functional Medicine, and these two have been educating this community about what it takes to build successful practices and to deliver whole health in a large health system environment. Check out Whole Health NP and, uh, if you, uh, if you’re interested in finding out more, um, we’ll have all the details in the show notes, uh, for you to get in touch.
Thanks so much for tuning in, and we’ll see you next time. So we are here asking practitioners about their practitioner journeys, and the reason why is because Journeys is a new product from Fullscript. Journeys allows you to set up your own lab offerings as the top of the funnel. Give the patients what they want.
They want to know about themselves, and it’s the easiest way to bring them into your practice. We have all types of practices from across the country that are building their own unique lab panels for their own unique practices, selling them to their community, and acting as a great funnel into their practice.
This is a massive innovation. I think this will accelerate the evolution of medicine. You can go to goevomed.com/journeys to find out more. Set up your own journeys in half an hour and transform the health of your community. Go get ’em. So that was the podcast. What an epic session. Thank you so much for tuning in to the Evolution of Medicine podcast.
We will be back again next week. And thanks so much for tuning in, and we’ll see you next time
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