This Evolution of Medicine Podcast, Coaching and Functional Medicine: A Match Made in Value-Based-Care-Heaven, features KNEW Health’s Director of Coaches and the founder of The School of Applied Functional Medicine, Tracy Harrison, MS.
Tracy first appeared on the Functional Forum with her “Future of Functional in Five: Health Coach Keys to the Future” in December 2016 (watch it here).
In this interview, Tracy talks about the value she’s seen in KNEW Health’s experiment of creating a new practitioner: the physician-supervised functional-medicine trained health coach.
Tune in for all details, plus some invaluable tips for doctors and health coaches, including:
- Why Tracy believes strongly that functional medicine science alone is not enough to transform people’s health, and how health coaching helps facilitates the behavioral changes necessary to get sustainable results
- The key role health coaches play in helping practitioners prevent burnout, focus on root cause resolution and run a profitable practice
- An insider look at KNEW Health’s physician-supervised, functional-medicine-trained health coaching model—and how this could rapidly transform the future of medicine
- Why “Tier Two” patients are often the ones who benefit most from health coaching
- The inside scoop on what KNEW Health is looking for when hiring health coaches
- …and much more
If value in medicine is outcomes divided by cost, then the functional medicine-trained health coach could become the most valuable provider in medicine. Want to learn more about how health coaches could help streamline your practice? Click here to listen and subscribe to the Podcast today.
Resources mentioned in this podcast:
Announcer: 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 transform your practice and the health of your community. Now, here’s your host, James Maskell.
James Maskell: Hello and welcome to a very special podcast. This week, we feature Tracy Harrison, who, as well as being the leader of The School of Applied Functional Medicine, is also the head of coaching at KNEW Health. In this podcast, we spoke about a number of things to do with the future of medicine, KNEW Health, the genesis of it, where it’s going.
She shared some incredible tips on how to be a great practitioner, how to get hired by KNEW Health. And also, we talked about the role of the physician-supervised functional medicine trained health coach. I think it’s a really valuable half an hour for anyone who’s passionate about the future of medicine.
Thanks so much for listening and enjoy. So, a warm welcome to the podcast. Tracy Harrison. Welcome, Tracy.
Tracy Harrison: Hey, James. It’s great to be with you again.
James Maskell: Great to have you here on the podcast for your debut and very excited to be able to talk to you today. So, we first came into contact back in 2016 when you came to do one of the future of functional and fives down in ABC Home in New York that have been at Robert Kennedy and actually every time the forum comes up there’s a picture of Robert Kennedy, you can see the back of your head because you’re standing up in the front row.
Tracy Harrison: That’s great.
James Maskell: So, you’re on there. But that talk was I think, when Gabe and I were starting to think about what we wanted to do with KNEW and we just wanted to get back in touch because obviously we knew the health coaching was a big part of the future of medicine. We wanted to be really part of facilitating that and just really loved the energy and the message that you brought there.
Just to sort of share maybe as a starting point, some of your journey towards being the person that started The School of Applied Functional Medicine and how you’ve ended up being sort of an educator in the space.
Tracy Harrison: Yeah, it has been an amazing journey. Actually I had a 17 year career in corporate high tech, which was very exciting and fulfilling. But it hit that point that a lot of people do I think where despite how lucrative and exciting things might be, you start getting that itch. That little bit of boredom, ready to learn something new and I felt like there was another calling in me and I ended up going to INN after I had quit my corporate job when I wasn’t sure what I was going to do next.
Health coach training was definitely interesting to me. But I remember the day that Mark Hyman was on stage at INN and started talking about functional medicine and what he had been able to achieve with his patients by getting at this inner connectedness of systems and nutrients and lifestyle and history and genetics.
I still remember every hair on my body seemed to stand up and pay attention because as a scientist by training, this was a type of medicine I’d never heard anything about. I got deeply inspired and ended up becoming a health coach myself. Setting up a business that once I started adding functional medicine know how to it, courtesy of Mark’s recommendation and mentorship, things really took off like crazy. Because once you add the focus of functional medicine science to kind of the art of health coaching, it’s an incredibly powerful combination.
So, I built a full practice with a waiting list. And about a year and a half, a lot of great success, and started reaching out to colleagues in the area. I was in Boston at the time and we started getting together for networking, which turned into potluck breakfast in my kitchen to learn clinical tips that I had been learning at IFM and through some other functional medicine training and started teaching classes because people wanted to know. They could really see how being able to support clients with health coaching by using that honing lens of functional medicine in terms of what to educate clients about, what particular recommendations might help them to get breakthrough results and really find major progress as opposed to minor progress.
So, of course, health coaches, many of them were really hungry for this information. They’re very passionate and talented about doing the coaching, but were missing the structure that functional medicine provides for how or rather what to coach about, how to focus it. So, classes turned into a school and now here we are, seven years later and it’s been a great ride.
James Maskell: Yeah, absolutely. One of the things that you mentioned there that I thought I want to just ask you about was one of the things that struck me when I saw functional medicine for the first time and saw the matrix was just a prioritization system. A system to be able to prioritize. You could do all of the things. What should you do now? What should you do first? And what should you do next?
Ultimately, I’d been searching for that for the eight years that I’d been in integrated medicine before I came across functional medicine because I just thought everyone’s doing it differently and if we really want this to be a standard of care, there’s no standard. Everyone’s doing it, what are we going to do? You have to have a standard for it to be a standard of care and so, that was again just something that popped in.
I’d love to just talk into that and obviously now so you’re seeing in functional medicine all the functional medicine leaders you’ve got to have a health coach. You’ve got to change behavior, information’s not enough. So, it seems like there’s this incredible cross-pollination between behavior changed coaching and sort of prioritization of what to do that comes together in the functional medicine health coach ship. It’s really powerful.
Tracy Harrison: Yeah, totally. That’s very well said. In the model that I teach and I’ve seen be successful over and over and over again, the goals of health coaching are education, inspiration, and empowerment, which is something that to your point functional medicine physician can do an awesome workup, do all the right lab test and everything else. But I’ve had plenty of clients come to my practice having had a great workup, lots of awesome data; but they haven’t done anything. They didn’t understand in strongly enough what was at play in order to inspire them to do anything differently or maybe they had a short-term lifestyle change and then they went back to their own habits.
So, I just believe strongly that functional medicine alone is not enough. I mean, I know there are people that are going to disagree with me, but I think the science alone is not enough. That’s the functional medicine is the what. But if we don’t have the coaching to get to the how that actually enables people to not only make change but sustain it, then all the great science in the world is not really worth anything if it doesn’t help people get better.
James Maskell: Yeah, a 100%. I completely agree with that. That’s why I see this incredible convergence. I gave a talk at the first FMCA graduation, I feel like the health coach trained in functional medicine if you look at value in medicine being outcomes divided by costs, you can see that the functional medicine trained health coach is possibly the most valuable provider in medicine. Mainly, just because the cost is typically lower than a doctor and if you can really get patient engagement and get them to participate the outcomes are always better especially in the long term.
Tracy Harrison: Yeah, totally. Totally. I also am sensitive to … I have many friends who are functional medicine practitioners of various types and I think it’s so key to the success of the healthcare team, just this self-care of the practitioner. If you’re trying to do it all, in terms of all of the intake, all of the assessment, all of the building, the practice work, and then you’re trying to do all of the patient communication followup, accountability, everything else, there’s no way one can have a profitable practice. Certainly not without burning out.
So, I really do believe the health coach is the linchpin for that. To your point, when they’re trained in functional medicine and they speak the language, they understand some of the inner connectedness of the science, then they’re not a drag on the medical team at all. In fact, they’re often the glue that really holds things together. So, I’ve seen it be really transformative and a number of medical practices and certainly here at KNEW Health, we’re seeing it working already.
James Maskell: Absolutely. So, let’s get into that. So, we started 2017, I connect with Jeff Gladd. He spoke at the March forum. I’m like okay, I think we try and do this. We should try and build something that could facilitate in transformation and particularly integrate with make this kind of care available to more people. Jeff was such a great choice, just because he’s a leader and he’s innovative and he’s also built a practice in Fort Wayne, Indiana, which is really like middle America.
Then I put you and him together. I mean, ultimately at this point in your career, you didn’t really have to do KNEW Health. You could just be mainly on vacation and running your little school or big school. Why did you decide that this was an important next step for you in your career?
Tracy Harrison: Yeah, that’s a great question. Because I also have my own practice still. But yeah, the last thing I needed was a new project. But KNEW Health for me is the one thing that needs to happen because it’s proving out the model that health coaching I think can be the lead interface with the person needing the benefit of this science in a way that’s affordable. Affordable for practitioners, affordable for people at large because functional medicine has been incredibly successful so far. But given the typical rate of pay that it requires to be profitable, it’s not sustainable. It’s valid and accessible to such a small component of even the American population and obviously this is something EvoMed is really taking on in terms of teaching a profitable model.
But for me, KNEW Health is about validating and expanding. In fact, exploding the role of the health coach. And also as we’re already getting excited about taking that to the place where people can get insurance funding for health coaching because the benefit is that big. The power of that model is that strong.
So, for me James it’s like a values thing. This is part of my calling, my mission. I’m passionate about health coaching. I’m passionate about functional medicine. I want to be a part of and more than happy to put my passion and my effort behind getting this movement off the ground and started because I really do believe it’s the future of healthcare.
James Maskell: Awesome. Yeah, no, totally. It’s been great to be able to just get to know you and work with you over the last year. So, let’s talk about a new, very complexly worded position in health care, which is the physician’s supervised functional medicine trained health coach. This is something I guess that we sort of came to having played a little bit in the sandbox together after a while. My feeling is that this is the position that changes medicine because it adds what we just spoken about into a position where we could actually bill for insurance and we could sort of mitigate the downside.
The downside risk of having a non-licensed provider doing the health coaching is that what if you miss something and it’s acute and them, the person has an issue and then you get blamed for it because you didn’t see it because you weren’t a nurse or whatever. That’s the worry and that’s the first thing that goes off in many people’s heads is you were dominated by fear. But ultimately what we saw is that there’s a way and I think this is what we discovered, there’s a way to be able to mitigate that downside and keep all the upside.
Tracy Harrison: Yeah. Very well said. If we’re specifically looking for … First of all, a seasoned health coach that has some experience, some really proven success, who already has some really substantial training in functional medicine. Speaks the language, understands the inner connectedness of typical systems and symptoms that are at play.
Then we put them through some targeted additional training with regard to protocols that Dr. Gladd has penned for what are the specific lifestyle interventions that are most appropriate and applicable for certain type of disease dynamics? And whether that’s certain types of lab work or a certain prior diagnosis it’s a way of standardizing the types of intervention that can be done especially when we’re working with that kind of core group of people what in KNEW Health, we’re calling Tier one and tier two.
People who are trying to prevent disease or who are in those early wake up call stages of nothings been diagnosed but a number of lab markers are trending in the wrong direction. This is the perfect place for the well trained health coach to be using those protocols, so they’re not to your point running willy nilly with all sorts of different solutions. We’re operating in a very consistent way and there’s case oversight and there’s awesome exchange that’s happening between the coaching team and the medical team for guidance and insight escalation where appropriate.
Then I think the piece that you and I were speaking of earlier that I’m so excited; when we bring the referral network for the functional medicine practitioner into that, then that’s really completing the picture. Because when a case is acute or needs direct medical oversight or there’s medication management involved, it’s a perfect opportunity to refer into the practitioner network and have them involved as part of the team. So, that the physicians aren’t doing the straightforward lifestyle work that’s very easy for a coach to do, they can be involved in the more complex cases where their skillset is really critical.
James Maskell: Yeah, absolutely. I feel like what we did at the beginning that was critical to KNEW Health is realized that the average functional medicine doctor or the average functional medicine practitioner is sort of doing two things simultaneously like lifestyle, execution, and root cause resolution.
And ultimately this was a super inefficient way to do it and that there’s a limited number of doctors and they’re more expensive and they have not as much time. And then you have coaches who are less experience and have more time and there’s more of them. And ultimately, this is what [inaudible 00:16:05] needed and by separating out those two roles, we create something really much more effective and efficient.
One of the things you mentioned tier one, tier two, and tier three. I just want to explain that. On the tour this summer, we’re going to be talking a lot about that.
Tier one is just sort of healthy and sort of not getting more unhealthy, which we hope is most of the population. But as we’ll talk about soon, it’s not necessary
Tier three is the super chronically ill, poly pharmacy, needs a doctor, needs a workup, which is basically where functional medicine has been plagued for the last 25 years in there. But ultimately the most important segment of society is really this tier two because if they get health coaches and start to be better behaviors, they go back into tier one and their lifetime cost is way less and their quality of life goes way up. And if they’re just left to their own devices, they probably end up in tier three.
Can you just share a little bit about the early days of identifying and isolate those people? And be like okay, let’s get those people. Let’s see if we can get them to go up.
Tracy Harrison: Well and to your point even the initial protocols that we put together, they’re just perfect examples of that. So, the person who’s just gotten this wake up call where they’ve been told they have pre-diabetes and they feel like they’ve been hit by a truck out of the middle of nowhere, I got pre-diabetes. They’ve got a little fear. They’ve got some strong motivation. They want to make that go away. So, certainly every functional medicine practitioner knows there’s a fairly consistent set of interventions that work to reverse pre-diabetes. That doesn’t surprise anyone in functional medicine.
And so, the work to work on stress, work on diet, work on inflammation in order to reverse that dynamic, it’s very straightforward protocol for that. And to your point, the typical average functional medicine physician, their skillset is not best focused on explaining over and over again what insulin resistance is and how magnesium is involved and how carbohydrates are involved and how omega 3’s are involved and how stress is involved.
But these are standard things that health coaches can be very well educated in how to work with. But most importantly how they teach the client that it matters. Coaches have the skill. They have the art of building rapport and understanding and exchange and communication and boosting compliance because they have that knack.
So, pre-diabetes is a perfect example. A lot of early stage IBS is a perfect example for that. Some simple hormone imbalance is your typical kind of menopausal, perimenopausal type of progression and the symptoms that come with that, PCOS type of dynamics. There’s a number of things that would fall into that tier two bucket that are just well implemented from a standardization prospective and tier one if they get worse, if they’re unexpected things.
It’s an easy referral to a well skilled practitioner that can give them the closer medical supervision. So, yeah the goal is to really tackle that tier two where there’s a lot of motivation and a lot of potential savings both in terms of like quality and healthcare dollars and send them back up to tier one before they become tier three.
James Maskell: Yeah, that’s really where the rubber hits the road. And as we’re seeing from now our first big clients were taking a whole employer, there are a lot more people in that tier two than we think. And it’s very clear that, that’s where the leverage is. Obviously, there is leverage in tier three too if you get people off expensive drugs. You can get people back to tier two back into tier one from there. That’s where the most value is.
But most insurance companies and people who pay the bill understand that tier two goes to tier three and they become costly and they’re not even sure that there are ways to get back to tier one. It’s working pretty consistently. So, I know now we have a half dozen coaches that are coaching under you. What’s the journey being from being the coach to now helping those coaches? I know you’re not scared of growth either.
Tracy Harrison: It’s been an awesome journey for me. We’ve hired coaches who have a variety of different types of training because there’s a number of great coaching schools out there, functional medicine advanced training platforms out there. So, we purposely tried to choose coaches from a variety of different backgrounds and it’s awesome to work together because we really formed a bit of a family. Everybody’s supporting each other learning from each other.
And back when I worked in the corporate world certainly I was a manager of large organizations for a number of years and I really enjoyed the mentorship, the leadership aspect of running an organization. And so, it’s fun for me to be back int that role. I know it’ll be before we know it that we’ll be talking about having hundreds of health coaches.
We can see really quickly how that’s going to expand exponentially and you and I both well know that kind of operating on the frontier of the future of healthcare can be a lonely place. It’s wonderful to have the family within KNEW Health to really build rapport and connection and everybody’s on the same page and batting for the same team. So, that’s been really rewarding for me and-
James Maskell: Absolutely. We’ve had a ton of people apply to be a KNEW Health coach. Why don’t you just give everyone the inside scoop on what you’re looking for when you’re hiring Tracy?
Tracy Harrison: Yeah. No, that’s a great question. I’ll take the opportunity for those who are listening to say, I really appreciate and I’m grateful for all the interest. I think that’s a wonderful affirmation for what we’re doing. Certainly, what we’re looking for are seasoned health coaches. Not necessarily people who have years and years of experience. But not people who have just completed their certification programs. We’re really looking for coaches who have worked with ideally a minimum a couple of dozen clients and had some good success. They’ve got some good testimonials. We want people who have had good, solid health coaching training. At least a six month program, either with a practicum or some good, like I said experience under their belts.
But then we want people who have some significant functional medicine training. Now, this is not I read a book, I went to a weekend course. But whether it’s Functional Medicine Coaching Academy or Andrea Nakayamas’ program or School of Applied Functional Medicine, Chris Kresser’s training program; there’s a number of them out there that are really great for giving that rich, solid overview of functional medicine science to health coaches. We really want that substantial training.
James Maskell: Beautiful. Yeah, no it’s great that … I think almost it’s timely that at that sort of the exact moment that we need tons of them. A few years before there were people who worked out. It’s a great combination of functional medicine, anatomy, physiology and obviously big fans of Andre and Sandy and various others who have educated them. Obviously, there’s people like you who came to the IFM training as well and there’s a lot of expertise out there and it’s just about sort of organizing the demand and supply in different directions.
While you’ve got a lot of people watching this who probably have their own practice and run their own clinic doing it. From all your years experience, what are some tips clinically for all of those practitioners that will be just operating a private practice? Maybe we’ll refer to them. Maybe they’ll just be doing their own thing independently. Maybe they’ll be part of a new vision.
Ultimately, they’re all going to benefit if KNEW is super successful because we’re going to putting the idea in a lot of people’s mind about functional medicine and that will have an any cosis of wide effect. But what are some great clinical tips that you have for anyone who’s watching this, who’s trying to do root cause resolution medicine effectively and is maybe at the beginning of their journey or just maybe looking to always improve?
Tracy Harrison: Well and that’s a great question and James something I see, even in our school with the physicians and nurse practitioners who are working in a more kind of clinically intense way. I think very often in functional medicine we’re excited about the esoteric science and details. We go to that detail before we address the foundational things.
So, we focus on toxicity and detox before we look at hydration and normal bowel movements. We look at should it be vegan or ketogenic before we’re just focused on let’s eat real food. As opposed to something that’s cardboard like. I think sometimes there’s a sort of cart before the horse type of thing and again this where I think coaching is so powerful because coaches can very well implement a lot of the foundational functional medicine lifestyle choices and help people with sustaining that in a very powerful way. I think it’s important to not get to esoteric too fast.
Then a second thing, I don’t think is news to anyone, but just something I see a firm day in and day out, disease begins in the gut. It’s amazing to me how often the root causes of things are truly in the gut and always, always keeping in mind that we are not what we eat. We’re what we digest and absorb and get through cell membrane.
It’s not just a matter of diet. I’m stunned at the number of people who have hypochlorhydria, not enough stomach acid to bring on board minerals. And people with pre-diabetes who have pancreatic insufficiency and so they’re not breaking down their foods very well. Or brush border damage and so they’re not optimally breaking down or absorbing nutrients. I think so many modern lifestyle practices are thrashing the gut that I believe strongly that if a practitioner just masters that part, that alone will transform patients lives.
Again, do we focus downstream on the liver or the joints or the brain without considering how the gut is preventing our best intended efforts from making a difference? I think we always need to come back to the gut.
Then the third thing I would mention is something that we teach about a lot, that I believe in very strongly, which is the body follows the mind and the placebo effect or the nocebo effect is working all the time. I believe even really passionate, loving functional medicine practitioners can at times use fear as a motivation tool, a communication tool. We’re creating a nocebo effect through a therapeutic encounter that is fear riddled and really interesting science about just how powerful our release systems are and that we help someone to triage biochemical imbalance in their body all day long.
But if we don’t further help them in ourselves or via someone on our team to deal with their stress, deal with their belief system, sort through their fears; odds are the body’s going to come right back around and get sick again as a reflection of that belief system.
So, again that coaching aspect, that rapport building, helping people to just see the truths in their lives and developing a supportive positive belief system is good medicine. It’s hugely powerful. I think most practitioners would be shocked to learn just what we’ve seen in clinical study that’s about placebo effect, sham interventions, this type of thing and just how powerful the therapeutic encounter is. What is said, what’s not said, whether we’re talking from a glass half full, glass half empty perspective that is powerful medicine. Those are three things I would share just off the top of my head.
James Maskell: Yeah, super valuable and ultimately if we can empower a health system with those three things at the center of it, it’s going to be so much better than we have right now. We have a system where it’s definitely not looking at the gut as being connected to anything and it’s creating those nocebo as mainly the whole plan. That’s the whole system is built on that, which is insane to say out loud.
So, anyway Tracy it’s been such a pleasure to have you on the team, get to work with you. I know that this is going to go local this summer. If you are in the area, we’d love to have you come and join us. Tracy will be speaking at a number of events on the tour including the events in North Carolina. We’re going to be taking this to the people, taking it to companies, taking it to the people.
I guess, one last question Tracy. I’ve got a crazy idea that we should form our own alternative to health insurance. And in that crazy plan, everyone has access to a physician certified functional medicine health coach, what do you see as the potential of that provider to control costs in the median term in a pool of people?
Tracy Harrison: I think it’s massive. I think it’s utterly massive because one day we will get together and actually do a study on just how financially valuable the impact of health coach intervention is and it will blow people away. I mean, as we know we’re already seeing interest in this aerospective of doing the math, doing the study but I think it’s hugely powerful.
This is the one thing that’s going to solve healthcare from a cost perspective. From a corporate perspective, given health care’s the number one operating expense for the vast majority of companies. I think it’s not just promising, I think it’s necessary. I think it’s as the saying goes this will be because it’s an accessible pathway right now that actually fully has the capability to solve the dilemma in front of us.
James Maskell: Beautiful. Well, thanks so much for being part of it. Look forward to seeing you on the tour. High five from me over in LA. I’ve been here with Tracy Harrison. She runs The School of Applied Functional Medicine. We’ll have all those kinds of links in the show notes and she’s also the head of coaching at KNEW Health. It’s been an absolute pleasure so far and I know Tracy we’re just getting started.
Less than a year ago, we hadn’t even really come up with a plan and now it’s happening. So, thanks so much for everything and being part of the team and so much to go. Thanks so much for being with us. I’m your host, James Maskell. This has been the Evolution of Medicine podcast. Thanks so much for watching and we’ll see you next time.
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