How Forum Health is combining the old way of thinking about health with new technology

Steven Loeb · June 28, 2019 · Short URL: https://vator.tv/n/4e3e

The company, which launched earlier this week, operates integrative medicine clinics and an EMR

Healthcare is changing, not just in the way it is being delivered, with an increase in telemedicine services and specialized clinics, but also in just what we think of as healthcare. There has been a shift away from the traditional way of thinking about ourselves, not just as a collection of individual parts, but ourselves as a whole. It's almost like a throwback to an earlier age of medicine. 

Now comes Forum Health, which formally launched earlier this week, a company that is taking this trend of thinking of ourselves holistically, and combining it with new technologies.

The company consists of three parts, the first being its integrative medical practices, called Forum Health Partners, along with Forum Health Technology, a provider of Power2Practice electronic medical record (EMR) software, and, finally, Inwell Biosciences, a line of professional-grade dietary supplements. Together, these three parts, the clinics, the technology and the suppliments, are meant to give patients a deeper understanding over their overall health.

Forum Health Partners already has two practices: Agenixs in Chicago, which is led by Paul Savage, MD, and, Whole Health Utah in Provo and West Jordan, led by Andrew Petersen, DO. It was announced that Drs. Savage and Petersen will be serving as co-chief medical officers of Forum Health, alongside Shilpa P. Saxena, MD.

Craig Weston, CEO of Forum Health, spoke to me about why he believes integrative medicine is the right approach, the problems he sees in the current healthcare landscape, and what it will take to change the current thinking about medicine. 

VatorNews: What is the problem that you have identified and how are you solving it with Forum Health?

Craig Weston: The focus of healthcare moving into a wellness space is something that we feel is very necessary. Unfortunately, the way we view the world, and where landscape is, is that our current system, conventional medicine, is very much based on acute, episodic care. We’re very good at doing short-term interventions, so if somebody gets into a car accident, or somebody has an acute illness, we generally address those things very, very well. The challenge, I think, lies in the fact that those systems are not very well developed for chronic care management, and according to the CDC and the NIH and the different research and government groups, 80 percent of the national spend is going towards chronic care. That’s really what Forum Health's doctors are good at.

We focus on an area called integrative and functional medicine, so really what our doctors do is they take kind of the best of both worlds; they take the best of conventional medicine, with the reductionism philosophy, where you have the scientific method of saying, ‘What, exactly, is it that’s affecting health?’ and they bridge that the eastern kind of methodologies which is the mindfulness, the Arabetic, the Chinese traditional medicine, those types of approaches. What we find is that if you can merge those two together, you generally end up with much better outcomes, and you also end up with the ability to prevent and predict health and disease states. Our current medical system is very much based on disease clarifications; in fact, our entire reimbursement model is based on disease classifications. What we don’t know is what health looks like, and that’s something that our doctors are very good at.

To give you a little background on Forum Health, in addition to the theory behind it, most of our doctors were trained at some of the top universities. They are MDs and DOs, and they come from emergency medicine, family practice and internal medicine, those are the three major groups that our doctors come from. They have spent, generally, a lot of time in those fields, and then they realized that seeing 16 to 20 patients a day, giving 12 minute consults and then writing prescriptions, really doesn’t get to the root of the issue, so they tend to opt out of those types of interactions and go for something a bit more personal where they can spend a lot more time with the patients. Forum Health is looking out at the universe of these types of doctors, and we’ve identified that there’s about 30,000 of these types of doctors in the United States, with about 10,000 of them that are have truly made the jump. Oftentimes, they do not currently accept insurance, so they’re cash-based, concierge doctors who usually offer very, very high-end care. What we’re doing is trying to consolidate those different doctors and say, ‘Look, you all are doing incredible clinical work but, on the back end of it, the running of the business of a clinic is hard.' They've got insurance issues in terms of their own personal insurance, in terms of dealing with HR issues, marketing, trying to get the message out, is a hard problem that a lot of these doctors just don’t have any training on how to solve. So, what Forum Health is trying to do is just create a unified message and a place for these doctors to get together to share their experience, share their clinical know-how, to create a new approach to medicine.

I shouldn’t say ‘new’ because this really how doctors were 100 years ago, prior to the advent of the massive pharmaceutical industry as well as the HMO world, where doctors listened to the story of their patients and were involved much more on a personal level with it. That’s what we’re going back to, with the advantage of now using technology and using a lot of the advances that we’ve had, so we think that in the next 10 to 15 years this is actually where medicine is going because we all know that just managing symptoms doesn’t work. We’re trying to give these doctors the tools to go after the root cause.

VN: Walk me through how Forum Health works. How does it help the doctor?

CW: There’s two ways that we’re doing this. As part of Forum Health, we have an EMR that we purchased called Power2Practice, which is probably the largest EMR that is used by the functional and integrated medicine community. It currently has around 500 clinics representing about 1,200 practitioners, and so we really are a technology-enabled healthcare company. What we mean by that is we’re going to use the learnings from the EMR, and from all of these different doctors, to say, ‘This is how we feel the best path forward is for care.’ But it also allows us to do testing within the different clinics and say, ‘These integrated medicine doctors are treating Parkinson’s a certain way, and they’ve got ideas from other clinics that are doing it through the EMR.' We can start gathering the data, and really start looking at trend analysis and saying, ‘When these patients took this supplement, in addition to this prescription, here’s what we’re actually seeing the blood work looks like.’ So, we feel like the aggregation of the data is really going to help us educate and illustrate the best path forward. So, this EMR allows us to get the data in and have us look at it and help really doctors understand what the data is telling us from the patients.

On the other side, regarding what a doctor looks like who joins our group, we are actively acquiring practices that are in this space. For a doctor that is doing this on their own, it is hard to be a single doctor on their own island, and, oftentimes, with this type of medicine, other physicians don’t understand it. If you say, ‘I’m a functional medicine doctor’ they don’t know what that is, that’s not necessarily a specialty that they’re familiar with or that was in medical school. So, oftentimes, they’re by themselves and they say, ‘What I look at is gut health, I look at detoxification, I look at lifestyle.’ These are all words that the traditional doctors, or conventional doctors, will say, ‘I don’t know what you’re talking about, because when I see my 20 patients a day I get into what is the symptom and what is the prescription or the procedure that I can immediately write that will address the symptomology?’ Our doctors, again, want to get to the root cause, so our thought, and our approach, is to go to these individual practitioners, who may be struggling with the business side of their practice, and we can come in and say, ‘Look, we’ll handle your front desk, we’ll handle your scheduling, we’ll handle your billing, but, on the clinical side, you do what do, which is treat these patients, spend time with them. We just want to help automate and relieve the non-clinical burden.’ That’s really what we’re looking for, and to give these doctors a place where they can talk to other like-minded individuals, who are also out there doing similar type things.

To give an example, there’s a great doctor, Dale Bredesen, who wrote a book called The End of Alzheimer's and he likens Alzheimer's to a roof that has a lot of holes in it. He said, ‘Conventional medicine will say, ‘You’ve got 30 holes in this roof, why don’t we focus on plugging three of them, and study those three, and then see what it does.’ But Alzheimer's is multi-factorial, in that there’s a lot going on, and unless you get to most of those holes, you’re not going to see significant progress in the disease.’ That’s something that these doctors do in general. When you talk about health, and all the information that’s coming out on the microbiome, the affect it has on pretty much everything that’s in the body, the fact is the microbiome is very unique to every individual and there’s all this science that comes out and says, ‘What type of food is good for you?’ It turns out it’s going to be based on you, your epigenetics, your microbiome, and all of these different systems and how they play together. It’s the same thing with health; when a patient comes into our system, we look at them as a very unique individual and when we create these treatment plans, we want to know the history and the story of the patient, all the way from how were they birthed. Were they a c-section baby or vaginal birth? Because that affects the microbiome. Were they breastfed or were they not breastfed? Again, all of these things make a huge different. Have they had a massive infection? Have they been on long-term antibiotics? Are they married? Have they had a divorce or have they had the death of a sibling or a parent? All of these things affect the patient’s health, so when we talk about health oftentimes we want to reduce it down and say, ‘Well, if I do this one thing I’m going to be better,’ but it turns out that it’s not that easy, it’s multi-factorial and, again, these doctors are really, really good at getting those treatment plans together.

Our goal, in the long-term, is to really allow the patient to engage with the physicians on a very personal level, but move it to a technology-based engagement. Once we know what the goals are of the patient, and we can get a real deep phenotype understanding of who the patient is, we feel like that is where the deep learning and the deep AI can go in and start customizing and saying, ‘Based on your microbiome analysis, and based on your epigentics and your genetics, here’s some activities or some foods or some other things that we think will be the best for you.’ The systems can start doing a lot of the touching of the patient, whereas right now all of this being done via human, and that’s a good thing because humans need empathy, and that’s the other part that we’re really trying to look at through our doctors. Sometimes people just need to be heard and listened to and that’s as critical as anything else the doctor does. So, we certainly never think that that will be replaced by technology but maybe some of the interactions, or even maybe 60 or 70 percent of the interactions, can be automated. If I just want a prescription, I don’t necessarily need to talk to the doctor, unless there’s some change in it, but if I just need some additional medication then I can get that done through a system, it doesn’t have to impact the doctor. So, what we’re looking to do is use data to really get a better understanding of the patient, and then provide the touch points that the patients want, because there are some patients who will just want to talk to people and that’s okay, and there are going to be other patients who just want their sensor, the Apple Watch and their Oura Ring that tells them their biometrics and then an email or a text that tells them what they should be doing. So, our goal is really to try and meet the patient where the patient wants to be met and, again, the business strategy is really go out and aggregate these different medical clinics that are trying to do this on their own, bring them into the fold and help them on the things that they struggle with, which is usually the business operations.

VN: Tell me about why Agenixs and MD Whole Health Utah are good partners for Forum Heath.

CW: Agenixs is Dr. Paul Savage out of Chicago who’s been doing this type of anti-aging functional medicine for 20 years, and then Whole Health Utah, which is Dr. Andrew Petersen.

Dr. Savage really focuses on hormone health, sexual health. He deals with concierge medicine, clients who have money, who have reached the end of their careers, they’re looking to optimize their health, that’s really where his forte his. Dr. Andrew Petersen is one of the nation’s foremost doctors in chronic disease. He has quite a few patients who deal with chronic infection and inflammation. So, about 60 to 70 percent of his patients are very much high touch. He teds to be the doctor that people go to when they just can’t get better; in fact, the average number of doctors patients have seen prior to Dr. Petersen is eight. So, by the time they hit Dr. Petersen’s doors they’ve been to some of the best facilities in the nation. We see patients from the Mayo Clinic, from Johns Hopkins, and really what Dr. Petersen does is he digs into charts and spends time. It’s not that the doctors in these other systems aren’t good, because they’re generally very good, but they’re also specialists. If you have a chronic problem most you’re going to have a stomach issue, you’re going to have brain fog or headaches, you’re also going to have a rash and you’re also going to have some weird fungus growing on your toenails. Well, it turns out that all those things are actually related, but in our current medical system, because of reductionism, we have specialists who will say, ‘Well, I can look at your gut,’ or, “I can look at your brain,’ or you can go to a dermatologist for the fungus, but nobody looks at the individual as a whole. What our doctors do exceptionally well is look at person as a whole and say, ‘How are all these things working together and flowing together?’ It’s basically a system approach to health for the person; we consider the person a system and all of these systems are interdependent and intertwined with each other.

So those are our first two acquisitions.

VN: When you say acquisitions, what does that mean? Do the doctors work for Forum Health?

CW: We’re set up as what’s called an MSO, or a managed services organization. In a lot of states a non-physician is not allowed to acquire a practice so what we say is, ‘We will acquire the non-clinical assets. So, you’re going to continue to be a doctor, we will not impact the way that you do medicine, in terms of we don’t make recommendations on that, but we standardize the scheduling, the non-clinical side of things.’ So, we acquire everything, we create a contract for the doctors to work for Forum Health, and they have financial benefits to doing it. Doctors can find jobs all day long, so this is more of a lifestyle choice for them to say they’re joining a group that has similar goals and they’re trying to change healthcare, because that’s really what it is.

If all of these doctors don’t join together to change healthcare, then we’re just going to continually push the same problems until it breaks the system. Alzheimer's alone, the latest government statistics show that it’s going to cost the system $1.1 trillion by 2050. That, by itself, is enough to basically bankrupt our entire medical system just on that one disease state. We feel like there are approaches that can be very helpful to that, but, again, if you’re just one doctor in one community making these approaches, they don’t get much airtime, they don’t get much credence, but we can aggregate 1,000 of these doctors, and then have the data behind it to say, ‘Actually, as we implement these strategies, here’s what we’re actually seeing.’

There’s a large conversation happening nationally between double blinded clinical trials, or placebo controlled trials, and real world evidence. What they’re finding is that real world evidence might be as valuable, or more valuable, than these double blinded, placebo controlled trials. It is our belief that we should combining both of them. Currently, within these 1,200 practitioners, we have one million patients so we’re starting to see significant data trends and strategies with how these types of doctors approach medicine. So, we feel like that gives us a leg up in terms of what we’re trying to accomplish because we’ve been doing this for so long in terms of our acquisition of the EMR. Forum Health is new, but the DNA of the business is Paul Savage, Andrew Petersen and the team at Power2Practice. Paul has been doing his for two decades, Power2Practice for eight years, so we feel like we’ve been in this space for a long time, it’s just starting to mature to the point where society is moving in this direction. Everybody I talk to about what we’re doing, they’re like, ‘Oh, I have a doctor that does this,’ or, ‘I know somebody that goes to this doctor and they look at things differently than conventional medicine.’ So, I really do believe that society is moving this direction because I think people get a little bit frustrated when they do to their doctor and they have eight minutes and the doctors are getting frustrated because they’re spending all their time having to input information into an EMR so that the billing through insurance will get done. That’s where the disconnect has been forcing these types of conversations to happen.

VN: What kind of ROI have you been able to calculate so far? Do you have hard numbers you can share?

CW: I can give you myself as a personal example. I didn’t even know this type of medicine existed; I was running a software company about eight years ago and was to introduced Dr. Petersen. I sat down and talked to him and said, ‘What do you do?’ He said, ‘Well, I’m an integrated medicine doctor,’ and I said, ‘I don’t what that is, tell me what is.’ And he said, ‘I look at body as a whole, so I look at your sleep patterns, your diet, your movement, your mindfulness, in addition to all of the western-based reductionist methodologies, so I’ll run labs on you and try to get a sense.’ So I said, ‘Okay, why don’t you do that for me?’ I had spent about 10 years building a software company, I had semi-retired from that and had spent three or four years doing charity work, and I had been traveling internationally fairly extensively. So, he ran my labs, and he came back and said, ‘You’ve got some issues. Your cholesterol is high, your adrenals, meaning your hormones, are significantly imbalanced. And you’ve got an autoimmune condition that we really need to get in front of.’ I said, ‘I didn’t think I was in that bad shape.’ At the time I was 36 or 37 years old. He was like, ‘You’re not right now, your body has enough backup systems that you’re still able to function.’ My A1C was 5.6, my fasting blood glucose was 125, so I was literally on the borderline of type 2 diabetes and had no idea. I'd always been fairly athletic, in high school I was an athlete, and I’d continued to be semi-athletic, but over the past 15 years of running these different companies and doing this charity work I didn't watch what I ate, I just did the normal American thing and my health was starting to slip through my fingers. He was like, ‘We have got to get in front of this.’ If I look at where I was five years to today, right now I’ve lost probably 35 pounds from when I originally walked in the door, my fasting glucose is roughly 90, which completely in the normal healthy range, my A1C is at 5.1 My health is significantly better now than it was five years ago, so I became an evangelist of this type of medicine. Everyone in my neighborhood, everyone in my family, now sees these types of doctors because the benefit to the patient is the outcomes are significantly better.

We have a patient who has advanced and very aggressive ALS. He was diagnosed by two neurologists at the University of Utah and one at Duke. He’s had it for about year now, and at the time, a year ago, he was given 12 months to live. In fact they gave him the manual that said, ‘Here’s the cranes you’re going to have to buy to get you into bed, here’s the wheelchairs you’re going to have to have. You’ve got an incredibly aggressive form of this, you’ve already lost so much strength in your extremities over the last three months.’ He came to us and said, ‘I don’t think I’m going to die from this, I’m going to figure this out. What can you do?’ So we started with the basics and said, ‘What in body’s systems can we optimize to help the body recover?’ So, we started looking at his hormone health, we looked at his infection panels, we looked all of these types of things, and we optimized each of those components. That man is still alive. I think it’s been 13 months. He has returned to his doctor at Duke, and his doctor said, ‘You’ve had no progression of the disease. What are you doing?’ And when our patient tells him he’s got like 35 things on his list of things that we’re doing, his doctor says, ‘Which one of these is it that matters?’ The patient comes back to us and asks that same question, and we’re like, ‘We don’t know. Maybe it’s all of them, maybe it’s 10 of them. We don’t know but we’re willing to try.’ We’re willing to go there and look at the latest research that’s out there. We’re early adopters, is a good way of putting it. If we see research that looks valid and it looks like it’s safe for the patient to try, and the patient agrees that it’s something they’re interested in doing, we’re game to address the problem. That’s one of the things that’s very different from our doctors from others.

A challenge with a lot of these doctors is people go to them and pay fairly high fees. It’s cash out of pocket, but they get exceptional care and these doctors provide exceptional results. Our goal, with Forum Health, is to consolidate those results and actually have a publishing strategy to say, ‘We’ve taken 400 cases like these ALS patients, or like a Parkinson’s patient, or a chronic infection patient. Here’s what we’ve done, here are the actual biomarkers that were tested via the blood work.’ And really put rigor behind it because, again, most of these doctors right now are doing this with just a gut sense and their 20 years of training to make a difference. And what we want to do is create a library and a data set that shows that this type of medicine is real and incredibly effective.

VN: Who are your competitors? What separates Forum Health from them?

CW: The competitors that I see in this market are really the status quo, and I hate to say that because I know it sounds like a cop out, but it really is. There’s a mentality competitor which is, 'We already know everything.' Whenever I read articles where people are questioning and saying, ‘This isn’t science-based medicine,’ my first question back to them would be, ‘As soon as understand everything about science, let me know, because then you can say this is not science-based medicine.’ There’s an arrogance to a lot of the status quo, which says, ‘Because we don’t understand it doesn’t mean it’s true.’ Right now, there’s a lot of drugs on the market that we actually don’t understand. In fact, ibuprofen, we still don’t really understand what it does. We know that the outcomes are a certain thing, but the mode of activation we don’t quite understand.

The other part about it is that this is large enough market that, while are companies that are trying to come up with similar things, I don’t really see them as competitors because I think they’re more synergistic. In my opinion, any company that is trying to accomplish what we’re doing is good for the market. There’s a great group called Parsley Health that’s out there that is doing incredible work; they’ve got offices I believe in New York and California, with great doctors and a great concept. Look, the market is so large, and the need is so great, that, yeah, they’re competitors but I want to see them succeed because I do believe that is they succeed then we’ll succeed. We’re going to run into a shortage of doctors in the next 10 years, just based on demographics, so we’ve got to get together to work on this problem, and this is something that I am a true believer in. Forum Health got it’s name because this is too big of a problem for any one group to say, ‘We’re in front of this, we’re going to close everybody else out of the market and try and own this.’ This is healthcare, this is the largest employer in America. It’s a $3.7 trillion industry. This is something that we all need to get our heads together on and say, ‘We need to this out and figure it out together.’

So, truly, the competition I look at is close mindedness and that is something that is a real issue. There are doctors that we talk about on this that are very dismissive, there are people, whether it’s in government or systems, who say, ‘This is hocus pocus.’ But I have to tell you, I have been doing this for five years and I have seen people make significant progress. The other thing that I always laugh about is I’ll ask doctors who are  sometimes very eminence-based, they’ve got all the degrees, they’ve got all of the recommendations, and I’ll ask them, ‘Do you believe in psychosomatic disease?’ And, almost without exception, the doctor will say, ‘Absolutely.’ So I say, ‘You believe people can cause themselves to become sick?’ ‘Absolutely, no question, that is 100 percent.’ ‘Do you believe in psychosomatic healing?’ And they all take a second and then they equivocate and we say, “Well...’ I believe the body has a huge capacity to heal itself; really, what our doctors do is they optimize the biology so that the body can heal. The reason we evolved the way we did is because there are multiple stop gaps and fail safes within the human body. Meaning, I might have high blood pressure, but that doesn’t kill me. It’s my high blood pressure, it’s my clogged arteries, it’s all of these other things that contribute to a heart attack. We would never have evolved as a species if we only had one point of failure, so evolution has created this incredibly robust system that allows us to survive. For us to say, ‘Health is a single point of failure, we can do one thing to create health,’ I think is a farce and it’s a wrongheaded approach. But, again, reductionism teaches us that. The scientific method says, ‘Let’s reduce everything down to the single protein that folded a certain way and that’s going to be cause of cancer.’ Well, it might be a contributing factor but my guess is there’s lots of other things that are also contributing t it, and that’s just how biology works. What really excites me about our approach to this is to say, ‘We want to change the conversation.’

Again, I’m not trying to skirt the question on competition, but I really, truly do believe that the competition is just having people understand that this is available because I think if health systems truly understood these doctors and what we’re trying to accomplish at Forum Health, they would absolutely embrace this type of approach. Again, taking myself as a perfect example, had I not been introduced to Dr. Petersen five years ago, and changed my lifestyle, most likely I would be on insulin right now as a type 2 diabetic. And we know that in 10 years I’m going to have issues with circulation, maybe in 20 years I’m going to have amputations, I might have blindness issues. All of these things I have avoided because I got in front of it. My doctor said, ‘You know what? Change your diet.’ So, now I do intermittent fasting, I eat once a day and my glucose levels stay completely consistent throughout the day. I actually wear an in-arm continuous blood glucose monitor, not because I’m type 2 diabetic, or even prediabetic, but I wear it because I’m interested to see how what I eat effects my blood glucose levels. I have an Oura Ring which gives me real-time data on my sleep quality. I have to tell you, I understand that if my sleep quality starts to drop, I’m going to be two to three days out before all of the sudden I’m going to feel like crap. So, if I start noticing that my resting heart rate variability starts to become unstable, or my temperature starts to increase in terms of my body temperature, these are all just indications for me that I have to be more conscious of own health. I feel really good after having done this for four or five years. I don’t think I would have been able to say the same thing had I continued down the conventional approach to medicine, which is, ‘Don’t come into the doctor until something is really broken.’ By that point getting somebody fixed is a real problem and it’s very expensive, so our approach is to get involved earlier in the system and really work with the companies that are trying to change the conversation with healthcare.

VN: What will success look like for Forum Health?

CW: I would love to see us move from a reactionary type of medicine, an episodic type of medicine, to a preventative and predictive type medicine, where we actually listen to the patient, we listen to the story of who they are and what they want to accomplish, and we supplement that through wellness. It’s not just medicine, it’s this overarching view of, what does your mentality look like? Are you happy in your relationships? Are you happy with your connectedness to society? We are physical beings but there is something else to it, whether you want to call it a spirit or an essence or whatever your terminology is, there is something to humanity that is unique.

In five to 10 years, I would love to see medicine go back to this holistic view because, if you look at the history of medicine, Descartes was an incredible scientific mathematician who basically said, ‘The body is a machine, and when something goes wrong with the body, we can fix it like a machine.’ That started the reductionist mentality as saying, ‘What can we do on a very specific level to intervene with it?’ but it also separated us out from our consciousness. Western medicine ran down the road of reductionism and we’ve taken it too far, we need to pull back and say, ‘Two plus two, in terms of a human, equals five.’ It doesn’t equal four because there’s something more there and until we acknowledge that as a system, I think we’re going to be behind the ball. What this type of medicine does is it takes the individual into account, and it really, truly does look at the individual holistically as a group of systems, and says, ‘Each one of these systems has to be in balance in order for you to flourish.’ That’s what I would look for.

There’s a great word that comes from a Greek background, eudaimonia. Nobody ever lets me use it because you can’t spell it, or say it, but it means ‘human thriving.’ There’s really not a word in English that matches it, but the closest thing we’ve got is this idea of human thriving, which is what I would love to see our system enable our patients to really achieve. This sense that everything is in balance. We’re all going to have issues, that’s just the nature of humans. We’re all going to have stresses and these other things, but if we get the biology right, if we can get the mental state right, if we can get the emotions in a good place, the resiliency is going to be significantly better. That truly is our goal at Forum Health, to help our patients get to the point where they feel good and they thriving in their lives.

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