Welcome to the Evolution of Medicine podcast! In Part 4 of our Group Visit Series, we talk with Shilpa P. Saxena, MD, functional medicine practitioner, educator, group visit pioneer and creator of the Group Visit Toolkit. In this episode, Dr. Saxena discusses her decision to practice the group visit model, the inspiration behind the innovative Group Visit Toolkit, and how she practices functional medicine efficiently and effectively. Her wealth of knowledge and enthusiasm for her work are inspiring and made for a brilliant conversation that will empower you to start implementing group visits.

In an energizing 30 minutes, Dr. Saxena shares her experience implementing group visits in her practice in Lutz, Florida and discusses the creation of her Group Visit Toolkits. In addition to sharing her own experiences, she points to the need for greater efficiency in functional and integrative medicine practice, and demonstrates how the group visit model provides this solution for both practitioner and patient. Highlights include:

  • How to make the transition to the group visit model
  • The catalysts for creating the Group Visit Toolkits
  • How group visits make the practice of functional and integrative medicine more efficient
  • How to harness the power in the dynamic that occurs when people come together with a shared health goal
  • Where you can learn more about implementing group visits in your practice and resources to get started
  • And so much more!

Resources mentioned in this podcast:
lifestylematrix.com
lifestylematrix.com/gvtcurricula
goevomed.com/group-visits
goevomed.com/gvt
drshilpasaxena.com

James Maskell: Hello and welcome to the podcast. This week, we feature the group visit guru herself, Dr. Shilpa Saxena. She has been delivering group visits in her practice for almost a decade. She is the creator of the Group Visit Toolkits that are sold by the Lifestyle Matrix Resource Center. That’s the sponsor for this podcast. She is a wealth of knowledge, and we had a great conversation. She talked about how necessity is the mother of invention and how the group visit came across and came along and how she was able to create it combining group visit concepts and functional medicine. We talked about efficiency, how to deliver efficient functional medicine and how the group facilitates that.

James Maskell: Then we just talked about what are some of the biggest obstacles to implementation. She’s been teaching this to practitioners for a long time, so there was so much good stuff in that. I hope you’ll really enjoy this segment. Enjoy.

James Maskell: Welcome to the podcast, Dr. Shilpa Saxena. Welcome, doc.

Shilpa P. Saxena: Hello James, always a pleasure to be around and chat with you.

James Maskell: Yes. Well, I’m really excited too because we get to talk about our favorite topic today. Just to give a little context, I was speaking for my third time at the Heal Thy Practice conference in 2013. Dr. Saxena and I was one of the keynote speakers speaking about cardiometabolic disease but also about this group visit functional medicine model that she had created. I sat in the back of that conference, and I just thought, “This is the future of medicine.” We had a great dinner that night. We connected with some like-minded doctors and all the way through the Functional Forum content right from the beginning.

James Maskell: Almost every time I could grab you, we’ve had a chance to speak about group visits. I spoke about it in my TED Talk. I used one of your graphics in that, because I just felt very clearly that this was the future, and so I’m excited to have you here on this series on group visits, because in the functional medicine world anyway, you’ve been doing this for a long time, and you’ve helped a lot of other practitioners to do it. I’m really happy to have you here and to be able to do this together.

Shilpa P. Saxena: Thank you so much, James. It’s really been an honor to not only know about this information from previous people who have been using concepts similar, but then to have a team of people in the functional medicine and integrative medicine network who get it and who are ready to call out to others and say, “Come join along. It’s the right thing to do not just for providers, but more importantly for patients, employers, insurance companies.” I mean, it’s just a win, win, win.

James Maskell: Absolutely. Let’s get into it. Everyone has an interesting origin story about the first time they ever did a group visit. I know that you have a similar one, too. What was the first trigger to get you to try and do something different than the way that you’ve done it before?

Shilpa P. Saxena: Yes, so my background started in 100% insurance-based conventional medical practice that slowly as I learned more and more functional and integrative medicine started bringing in lifestyle medicine. The word got out in my community. I hired a nurse practitioner at the time. It was a physician assistant actually when I began group visits. The reason why they began is because she became pregnant, and she was going to take three months off. Well, we had 4,000 patients, and I myself had two young children.

Shilpa P. Saxena: I thought, “Oh my goodness, how am I going to take care of all these patients by myself?” I started researching in family practice management. I can’t be the only person who has this problem. I came upon this concept of group medical appointments, also called shared medical appointments, and Dr. Edward Noffsinger was the one who had made it more familiar in conventional medicine, but the standard format he was promoting had a conventional edge to it. I see people come in and they overhear other people’s visits and maybe get a point or two of knowledge, but I thought, “My goodness, what if we adapt this to functional integrative medicine?”

Shilpa P. Saxena: I bring everybody who could benefit from the elimination diet into a room. I would get 16 to 20 people, and I would take care of them. That saved me oodles of time with individual appointments with those 16 people, because I saw them in 90 minutes. The necessity was how am I going to survive these three months seeing 4,000 patients. I did it with topics like diabetes, high blood pressure, osteoporosis. What ended up happening is when the three months were over, everybody enjoyed them so much that they asked for me to continue them.

Shilpa P. Saxena: That’s how it was born, this adaptation of a conventional medicine time-saving tool that I use it to be able to teach hardcore lifestyle medicine in long pockets of time, so people get the information they need and they get it in this socially supported format.

James Maskell: Absolutely. There are so many things that I feel when I hear you talk about it. One is just the efficiency of it, right? One of the things that we’ve been really focused on at the Evolution of Medicine is trying to adapt functional medicine to be delivered efficiently enough that it can make it to more people. Can you just talk to that for a moment as just one segment of it? I feel like, ultimately, the big chunks that take up time in integrative and functional medicine, one is the deeper dive and asking better questions of going deeper with the patients.

James Maskell: Then the second is obviously the educational component. I just always thought the educational component is super inefficient if you’re just doing it one on one during doctor’s time, and so we’ve been trying to drag the whole industry forward into thinking about different ways to do it, but the group is just such an elegant way of delivering that. Can you talk a little bit about the efficiency side first?

Shilpa P. Saxena: Absolutely. I am all about efficiencies. My maiden name is Patel, so if you’ve ever heard of us, we generally like to get things done and in the most resourceful way. The first kind of category of efficiencies is clinical. Just like you mentioned, it does not make sense to explain, for example, the elimination diet in detail to 16 people individually when you can explain it to all of them at once. The other thing that happens efficiently is that when questions are asked during this 90-minute experience, you get far less calls to the health coach and to the staff about “What did she say about grapes? Was it allowed?” because they’re all being answered in bulk and during the group visit.

Shilpa P. Saxena: Clinically, it’s been shown that not only is it efficient, but they get better outcomes because they actually understand what’s going on. Financially, to see 16 insurance-based visits or cash-based visits in 90 minutes and actually give them 90-minutes’ worth of content and education and support is financially much smarter, because otherwise, you’d have to see them for five minutes at a time, and you cannot teach the elimination diet for example in five minutes. I mean, you would have to give a handout, and we all know that giving a handout is not going to make behavior change.

Shilpa P. Saxena: That’s what group visit’s really great at is the actual behavior change that gets the patient the result on their autoimmune disease or their IBS or whatever. Then operationally, you see in most doctor’s offices the doctor is running from room to room. The staff is chasing the doctor, providing labs or checkout. When people are in a group visit setting, they’re all getting the same instruction and the same guidance, and so there is an efficiency flow that happens with vitals and for charting, because it’s all the same stuff with little tweaks for each patient.

Shilpa P. Saxena: But the education is by far the bulk of the visit. It’s much more operationally efficient for staff to get 16 visits done when they not homogenized, but when they gel together on a focused topic.

James Maskell: Absolutely. It’s a huge piece. I appreciate you sharing that. I think you’re such a great communicator of it too because ultimately, there are so many things. I can remember seeing the heads nodding of practitioners as they’re sitting listening to this because all of that stuff that you’re taking away is the annoying part of practicing medicine, right?

Shilpa P. Saxena: Absolutely. I mean, as physicians, we want more time with our patients. Hey, patients actually want more time with us. We actually want to affect change and create some real healing. That’s what most doctors went into the business for, for that fulfillment. The connection is there. The collaboration is there. The consistency of their clinical understanding is there. It’s all a win. What’s exciting is that because these patients do better because they actually understand what’s going on, insurance is happier because they’re using the system less because they’re not as sick, if you will.

Shilpa P. Saxena: That actually makes it cheaper on the patient in the long run as well. It really gets every player in the health network in a winning scenario.

James Maskell: Beautiful. Efficiency is of the big parts of it, but ultimately, I feel like the most important thing that the group structure creates, and I’d love for you to talk a little bit more into this, is behavior change is hard. Behavior change is hard, and it’s not any easier in integrated medicine. Maybe you have more time to spend with people, and you can come up with a more robust plan rather than just like, “Hey, diet and exercise.” You could say, “Hey, diet and exercise, and here is this plan.”

James Maskell: With the group, now, you have a real community that is starting to be facilitated. I love for you to just talk into it a little bit about that, because ultimately, what is necessary for the transformation of healthcare is facilitating behavior change at scale in an affordable, accessible manner. There are tweaks of this all the way through this series that have shown me that this is the way that we’re going to get it done.

Shilpa P. Saxena: Yes. A simple way of saying that in my mind is knowing something does not equal doing something. In many practices, whether they’re conventional, functional or integrative, we believe by just passing on the information with a handout or giving a link that now that they know, for example, the elimination diet, they can do the elimination diet, but most people know they’re supposed to exercise and they’re not exercising. Most people probably know they need to probably eat more vegetables, and they don’t eat them.

Shilpa P. Saxena: The knowing is not equal to the doing, and that is where the magic of group visits is, because there are some dynamics that occurs when people come together for a shared goal, and they get to share their struggles. What’s interesting is that me as a physician maybe speaking about a topic that helps reverse, let’s say, autoimmune function, dysfunction, but if I have a room full of people who also have autoimmune disease, and they’re all brainstorming and asking questions, there’s some unique power of self-efficacy that comes into each one of those patients because now they have this group of peers.

Shilpa P. Saxena: They’re like, “Oh, you’re like me. Oh, I see. If you can do it and you can foresee a solution I can see, I can do this, too.” You know this situation. I’m a physician and I tell my husband to do something, and he’s like, “Ah!” but if some other person who he relates to says it, he’s more likely to listen. That’s just human nature, and we’re using that psychology in the group setting that when you have a peer group of people you can relate to, and you get the right information, that combination leads to this empowerment and the actual transition from knowing into doing.

James Maskell: As you’re saying that, I’m thinking about my daughter. I have a six-year-old daughter who’s an only child. Obviously, see she has school peers, but we have a friend, who’s a friend of ours has a daughter who’s two years older than her. We were recently in Costa Rica, and my daughter jumped off a 12-foot platform into a river. She would never have done that had she not seen the eight-year-old do it 10 times in a row because they live there, and she does it all the time. There’s two or three examples that I’ve seen over time of her doing things that she would have been frightened, downright terrified, to do had she not seen someone who is in a peer environment doing.

James Maskell: As you said that, it just made me think of that because ultimately, there’s that wiring right from the beginning. Ultimately, medicine was such a private thing. Everyone’s having their own very private medical experiences. There’s no opportunity to see wisdom and courage being delivered by other people who are their peers who are suffering with the same issue.

Shilpa P. Saxena: Absolutely. The other thing that also is important is that sometimes doing some of this behavior change modification is just challenging, and you don’t always ascend beautifully. There are falls and struggles, and sometimes, it’s very real to hear someone say like, “You know what? I tried to do that elimination diet, and I couldn’t do it, and then two months later I decided I’m going to do it again, and I figured it out.” It also gives them some degree of humanity and dignity to know like, “Okay, I’m not the only person who’s scared about this, or I won’t be the first person who ‘fails’ at it.”

James Maskell: Yes.

Shilpa P. Saxena: There’s something powerful about that.

James Maskell: One other thing that I’ve heard as well is that, and I think this is really, really super powerful information. One other thing that I’ve heard is that peers become even a more credible source of information than the doctor, where the doctor, people…I remember interviewing Terry Wahls, and even though Terry Wahls had reversed her MS and she was trying to replicate that in the VA, she said that other peers who had the same sort of reversal were even more credible than her even though she’s a physician because it was just so relatable.

Shilpa P. Saxena: I think, sometimes, physicians, although well-meaning, can be perceived as different. You don’t understand you have access to X, Y, Z, or you live in a different environment so you don’t know what my life is like. Whatever it is that patients put on maybe a leader persona and say, “You don’t understand.” I mean, it’s sweet that you’re trying, but you don’t understand creates a block when it’s from the knowing to the doing, but if they see and identify with someone that they can say like, “Oh, so you’re just like me. You have three kids. and oh, you’re also a working mom, and oh, your husband is not supporting you on this or is supporting you on this.”

Shilpa P. Saxena: Now all of a sudden, it becomes more real and they can’t walk away from it as easily as they can if it’s just a single doctor giving an order, like, “I order you to do an elimination diet” or prescribed even. It’s different.

James Maskell: This is a perfect embodiment of the shift happening in medicine, where it’s a shift from this paternalistic structure to a different type of structure. I’m super excited about it. What are the topics that you have found most relevant for…? If your average family medicine doctor has such a range of issues coming in, what are some of the topics that you’ve found have the best combination of interests and then effectiveness for getting people’s attention and facilitating change?

Shilpa P. Saxena: I would have to say in the functional medicine world, anything related to the gut and microbiome is going to attract people, because we know that it’s at the core of many chronic inflammatory diseases. It’s talking about leaky gut or food allergies, talking about how auto immunity is many times stemming from a gut dysfunction. Even just explaining you are what you eat, something like that will get many people in the door. The other segue to that is anything nutrition, because the standard doctor is not receiving nutrition education wants to be able to deliver it.

Shilpa P. Saxena: But I think because they don’t have the tools and the training, give sometimes a, for lack of a better word, lip service to diet and exercise but can’t really get into the nitty gritty and motivate. That’s where some of the resources that we’ve created could be useful, so nutrition, gut, anything related to inflammation, so like an anti-inflammatory food pyramid or anti-inflammatory lifestyle, I find that to be very on the edge of people’s minds, like, “I need to know this,” because they’re hearing this word “inflammation” everywhere.

Shilpa P. Saxena: The other big grabbing topic is things related to stress and its effect on hormones. Hormones is another anti-aging. It doesn’t have to necessarily be anti-aging like plastics and aesthetics kind of anti-aging, but people I think are very tuned in to this notion that stress is wearing them down at a faster rate, and they can see like, “Oh, I’m not going to feel so hot in my 50s, and I’m going to apparently live to my 80s. I really want to make my last 30 years a bit more productive and vibrant.” Let’s see what the stress topic is about.

James Maskell: Beautiful. I love that. All right, so now that you’ve got reasons to get people in and you’ve got people in, you know how to gel that group, just a little bit on the provider’s side. I know that you’ve run a one-provider model and you’ve run a two-provider model. Can you just talk us through the differences between what you found for best for stopping, and what are the best ways to engage the group to participate?

Shilpa P. Saxena: I think the ideal scenario is if you’re billing insurance. Now, that’s the big caveat. If we’re talking about insurance, billable group visits, the ideal scenario is to have two providers. Now, only one of them has to be able to bill insurance. That could be MD, DO, nurse practitioner, physician assistant, somebody at that level. If you have that person, this specific billable provider just needs to have face-to-face contact for as little as five minutes with those 16 people, and do maybe a targeted physical exam.

Shilpa P. Saxena: That is the actual visit that you are billing for. Let’s say that they saw a person for five minutes, but in front of them, in front of that patient, there has been an educator, a health coach or a nutritionist or maybe another physician in the practice who really knows their nutrition. That person is educating for free basically for the other 85 minutes, but you’re billing insurance for that five-minute face-to-face encounter with a billable provider. This is completely known that that’s what’s going on, not only known that Medicare and the American Academy of Family Practice recommend this.

Shilpa P. Saxena: It’s not really some sneaky process to get around. I really think it’s important for providers. It’s almost too good to be true, and so they feel like, “Oh, I’m not gonna do anything illegal with insurance. It’s absolutely legal and promoted.” With a single provider, you have to be able to simultaneously teach and do some physical exam, or what I tend to do is do a 60-minute educational session, and then the 15 minutes before and after, I do quick physical exams for my face-to-face requirement.

Shilpa P. Saxena: I might have maybe 12 people if I was the solo person in the room.

James Maskell: That’s cool. What have you found is the first five minutes, people are skeptical? They’ve never done it before. Are there some things that you do early on to try and connect the group and make sure that they get the most out of it? What are some things that you learned along the way how you’re doing your 50th group visit than how you did your first?

Shilpa P. Saxena: The first group visit, I thought I had to be perfect in front of my patients and say all the right things and know all my answers. I didn’t want to look stupid in front of them, especially on a topic, so I was a little nervous that they may ask me a question that I may not know the answer to. I thought that making everything run 100% smoothly was how they were going to value the whole group visit. What I came to find out at the 50th, honestly I found it out on the second and third one because these patients love these providers.

Shilpa P. Saxena: They’ll go up, and they’ll just say, “Thank you so much for giving me this information.” They want 90 minutes of information. They want 90 minutes of connection with you and the other peers in the room. There, I thought it was all about me. What I quickly realized was like, “No, it’s about the information, and it’s about the connection.” So long as you are working to really understand like, “What is this person really trying to figure out here? How can I make this information relatable to them and what they’re trying to accomplish with their RA or with their knee pain or whatever?”

Shilpa P. Saxena: Then that’s the value proposition they’re looking for. Quite honestly, there is no way a provider can be in front of people all the time and have every single answer. Most patients find that very human that a physician can say like, “You know, I don’t know the answer to that, Sally. I’m gonna find out, and I’m going to give you a call after this group visit is over in the next couple of days.” I think that that was the biggest “aha.” The other thing is that I thought I had to be a proficient lecturer.

Shilpa P. Saxena: I thought I had to speak eloquently. I realized they just want a conversation. They don’t want to be talked at. They want to be conversed with.

James Maskell: No, I think that’s a huge distinction and super valuable. Well, look, I really appreciate all of your insight on running the group because ultimately, it’s really valuable for everyone who’s listening and other practitioners, but I want to change tracks here because unlike some of the other group visit people that we’ve spoken to on the series, you’ve gone a step beyond and actually created a solution for other doctors to start running their group visits, and that’s the first time we met, the Group Visit Toolkit that is available through the Lifestyle Matrix Resource Center.

James Maskell: They are the sponsor of this whole podcast series because we wanted to make it easy. If I’m getting people fired up about doing group visits, I want them to go and do it. Ultimately, I know that for all of the reasons and maybe some of the reasons you can share with us, maybe we can stop there. In your experience, why are other practitioners and other doctors that you meet initially skeptical or resistant to running a group, and what happens once they start doing it?

Shilpa P. Saxena: Great questions. You’re anticipating the needs of the people who are getting jazzed about the potential, but then they have that standard, like, doctor hesitancy and potential analysis-to-paralysis. The first thing to note is that when I was doing these, there is a certain love that I have for creativity and patient education. These PowerPoints that I’ve created and these visit forms that I’ve created to be able to make insurance billing literally, like, a one-minute process, I’ve done because I don’t see why a provider should have to recreate something that I’ve already figured out and have found to be working.

Shilpa P. Saxena: These PowerPoints can either be used by the provider to do the talking, or the PowerPoints can be played as a video with my voice, or they can be done with my face, whatever the provider thinks is the most suitable for him, her, or the patients. The visit form is basically a visit note that has the HPI, the review of systems, all the different little check marks that you need to have a patient do primarily during the visit, so 90% of your note is written by the patient during that visit.

Shilpa P. Saxena: The videos that have the PowerPoint and me talking, they serve as an excellent training for those providers who feel like, “I don’t know what I would say.” You know what, you could just parrot what I say until you come up with your own shtick, or you can take the PowerPoint slides and make your own verbiage that applies. It’s actually training providers and their staff on these functional integrative medicine topics. We give you all the resources, but then because we’re functional medicine-minded, we know that every office has its own kind of systems and nuances.

Shilpa P. Saxena: We have with Group Visit Toolkit and LMRC an entire implementation team who will work with each individual office to understand, “Tell us about your dynamic, and let’s show you how to use these resources specifically with the strengths and challenges that you have in your setup with your patients.”

James Maskell: That’s one of the things I’ve had a chance to meet and connect with dozens of doctors who have used the Group Visit Toolkits. Another doctor in this series, Cheng Ruan, just talked about how much time it saved him to learn the things that he would have had to learn anyway, but learn them a lot quicker, and also just have the right structure for it. What are some of the things that as you’ve gone through this process that you’ve learned about this process of getting doctors and practitioners up and running?

James Maskell: What are some of the best things that you could pass on to other practitioners about running these groups?

Shilpa P. Saxena: I think the biggest obstacle to implementing a group visit is the physician’s mindset or fear. I always liken when I lecture to a provider during medical school or in residency when you have to deliver your first baby or do your first unnerving thing that you think, “I’m not trained to do this,” and so once you deliver your first baby, the second and third is completely cake, but what made it difficult for you is to get over the mental hurdle of thinking, “Can I deliver this baby?”

Shilpa P. Saxena: What I would tell people is it’s like, “Listen, if you’ve made it through your professional training, you are amply qualified to do a group visit. And the fact that the patients love you and want to come learn from you is kind of another filter instead of people who are going to think you’re a rock star anyway.” What I find is that usually, the provider feels like they’re incapable. I would just say, “Stick your neck out. Act like a tortoise. Put it out there and just do it once.”

Shilpa P. Saxena: What many, many of the people who buy the Group Visit Toolkits and do it say is that it was one of the most refreshing clinical experiences they’ve ever had, because they got to actually connect with their patients. They got to facilitate behavior change, and they were able to get this empowerment in their patients, which they can’t always do easily in 15 to 20 minutes or even an hour segment. I think most of them look back, just like when you deliver your first baby and say, “Oh, that wasn’t as bad as I thought it was going to be.”

James Maskell: Absolutely. Now, I resonate with it with a couple of things you said that for sure of just the transformation of the practitioners doing the group visits. It’s one thing that you have the patient going through right there in their hero’s journey, right? They come here across this big tests. They’ve got this diagnosis. Then they go into the dark night. Then they find a mentor who’s probably either you or the other people in the group. Then they’re fighting through it, fighting through the challenges and coming out on the other side.

James Maskell: That’s a really powerful metaphor and that’s really what’s happening time and time again in these practices, because the doctor is choosing not to be the hero but to actually facilitate the growth in the hero who’s the patient, but on the other side of that, there’s also this heroic story for the practitioner too who sees their patient’s not getting better and see them failing at behavior change and seeing them struggling with what they know they’re meant to be doing and seeing them in a journey of self-sabotage, because doing the things over and over again that have got them into the position where they were chronically ill and to then be frustrated with the system and then having to go on your journey and to find people like yourself who are then like mentors in this process.

James Maskell: It’s happening at multiple places and multiple times. Ultimately, I guess I just want to share my appreciation for being that guide to those providers, because ultimately, what I’ve seen is that whether they’ve been forced into it or whether they’ve just decided to do it because it sounds cool, the transformation in the practitioner is really significant, so much so that I think that once you’ve done it, you almost can’t go back because you’ll be sitting there in an hour. Let’s just say you do your group visits for a long time and then you’re like, “Oh, I’m going to start a concierge practice. I’m going to spend an hour, an hour-and-a-half with my patients by themselves in the appointment.”

James Maskell: I could see that that would be terribly unfulfilling, because ultimately, you just realize, like, “This person’s not listening to anything that I’m saying.” They checked out 20 minutes ago and the chances of them activating on this and doing it is so little without this experiential factor.

Shilpa P. Saxena: Social health is key, and you just cannot get that on a one-to-one appointment. It’s not to say that you should do all group visits. You should use a nice combination of individuals and group medical appointments, but you know what’s interesting? While you were talking, James, I realized the root of the word “doctor” comes from the Latin words “to teach,” and so it’s interesting that I think the word “doctor” or at least the perception of the word “doctor” has changed over time, and it really took on this like god-like persona for a while. Thank goodness, it’s coming back down towards teacher.

Shilpa P. Saxena: In my culture and many cultures, teachers are really the prized people in a society. If we could go back to recognizing that that’s what our goal is with patients, is to teach them how to take care of themselves, we’re really in alignment with the root of our profession.

James Maskell: Absolutely. There’s not a lot of time to teach in a regular system. You can’t be a teacher in seven minutes. I think that was some of the root of the frustration, of the depression of the frustrations of medicine is that what they actually get to do and what they thought they were going to be doing are very divergent, and it’s because of insurance reimbursement and the system and everything, the way that people find themselves in. Look, I really appreciate you sharing that. Obviously, this podcast is sponsored by the Group Visit Toolkit.

James Maskell: Thank you for creating these kits. Do you want to just for everyone who’s listening share what the kits are, how they work, what’s included, how many of them there are, and what is the best starting point for someone who’s fired up about starting a group visit functional medicine practice?

Shilpa P. Saxena: The Group Visit Toolkits are basically a turnkey system for you to be able to implement group visits in a very short period of time. The cost of them is designed so that when you do your first group visit with even five people, you’ve paid for it and everything you get after that for future group visits is all just extra for you and your team. The goal is for group visits and the LMRC implementation team to really revitalize your practice, to build a healthier practice clinically, financially and operationally because we want providers and patients to see what can be accomplished.

Shilpa P. Saxena: Group Visit Toolkits are just trying to be the resource that puts those two things together and makes the magic happen. Again, it’s just a matter of checking out the website and seeing all the different resources that have been created so that you don’t have to, and you can just get to it with a very short lead time and really low price.

James Maskell: Beautiful. If you want to find out more about the Group Visit Toolkits, you can go to goevomed.com/gvt. One of the reasons why we decided to partner with the Lifestyle Matrix Resource Center for the Functional Forum and for this podcast series and bring them on as an exclusive sponsor was because I just realized last year that I wanted to spend however long it took to popularize the group visit and to make it cool and fun and interesting and something that practitioners would want to do.

James Maskell: We had our first conversation about this, I remember the first Evolution of Medicine Summit, Shilpa, 2014. We probably just had exactly this conversation again five years later, but ultimately, I think it’s been in the background, and I think we’ve had a lot of things that we’ve been trying to evangelize on, right, two folks from medicine, have a micro practice, practicing efficiently, and there’s a lot that’s been going on. We’ve got some of those pieces in place. I think that 2019 is the Year of the Group. We’re trying to take it all the way.

James Maskell: If you’re listening to this, if you’re a doctor, obviously, there’s an easy starting point for you to get a Group Visit Toolkit, and start doing group visits. If you’re another type of provider in a practice and maybe you’re not the decision-maker, and you’re looking to bring lifestyle medicine into your practice, what a great way to be able to do this, and the Group Visit Toolkit is everything that you need to be able to learn how to build the insurance and how to organize it and how to make money doing it.

James Maskell: I will tell you that in one of our other sessions, they’ll tell you that at the Cleveland Clinic, the group visit is the only part of their insurance billable functional medicine practice that’s actually profitable. The one-on-one part, it’s not profitable because they’re spending more time than they can bill insurance for. Then if you’re just someone who’s in system generally, you’re an administrator or otherwise and you’re frustrated and you want to take part of it, what a great way to put this to management to say, “Hey, we should start doing these groups, because ultimately, the patients like it.”

James Maskell: The providers like doing it. It’s profitable and it’s the future of the delivery of care to the underserved. Very, very clearly, if you didn’t listen to this series with Dr. Jeff Geller and Mikhail Kogan, listen back to those, because ultimately, that is where the rubber hits the road. We’ve already seen it be so successful. Shilpa, I want to thank you for your leadership in this space. I’m really excited that we’re going to get to work more and more together over the next few years as we go on this journey to try and popularize the functional medicine group visit.

James Maskell: My own feeling is that if we can make group visits cool and something that needs to happen in the system, then ultimately, it can just be the train that functional medicine rides in on into the rest of the system, because you know, the need for behavior change is at scale. The need for a care that gets to the root cause and focuses on lifestyle is necessary, but I just can’t see how we can get it to everyone in a one-on-one model. Thank you for everything that you’ve done and thanks for being part of the podcast series.

Shilpa P. Saxena: Thank you so much, James. Always a pleasure to work with you and thanks for being the voice behind the group model.

James Maskell: Of course. Check out Dr. Shilpa Saxena. She practices at Lutz, Florida. You can check out her practice there, and you can check out the Group Visit Toolkit at goevomed.com/gvt. This is the Evolution of Medicine podcast, and it’s part of our Group Visit Series. I’m your host, James Maskell, and we’ll see you next time.

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