What Does a 12-Month Membership Look Like?
Sep 14, 2023One of the things that we commonly hear from providers or physicians who are opening up a membership-based practice is that they feel like it's hard for them to think about what to do throughout an entire year with a patient. They feel shorter time periods, like three-month programs or six-month programs, will actually be easier to sell and more beneficial. What I'd like to do in this video and blog today is “workshop” together what a 12-month membership might look like for somebody.
Shorter Programs
What I have found in my practice is if somebody is very young and healthy and she is just working on one thing, then a shorter program, perhaps three months or six months, might work for that kind of patient population. However, I have also found that when you do shorter time periods, you frankly don't know what you're going to uncover as you start working with somebody, and that's just from an internal environment perspective. There might be other patients who just need more time to help with the behavioral change side of things, and you might need to run alongside them at a different pace as they structure their lives around the foundational lifestyle interventions that need to happen for healing. It also can be a bit misleading to patients if they think all they need to do is a low-inflammatory diet for 30 days and rehabilitation for another 60 days to be on the right path to healing. So, I feel that the 12-month membership, especially the second portion of the 12 months, is super helpful for you to really help patients get to know themselves.
12-Month Programs
What I found a lot of times is in that second half of the membership patients will portal message me, saying something like, “Dr. Matteoli, I'm starting to get that bloating again, but don't worry. I know what to do.” So, you're really there as the support, as your patients know themselves and really get to know what they need, how they operate, what supplements to take, what lifestyle habits to keep and/or change, and what foods to eat—things that really help them feel their best.
Workshop
Worksheet Format
So today, I want to “workshop,” and we're going to do this together because if you guys do it at home, that would be amazing. Follow along as I map out a 12-month membership with you. [See coinciding video for additional guidance.] I'm going to start with three columns, and 13 rows, one row for the titles. The first column’s title is going to be “Month,” the next is “Lab Order,” and the last is “Intervention Plan.” Then the rows will be January, February, March, April, May, etc. You get the drift. The reason I'm doing this with you is because I want you to see how it does not take that long once you get in there to start to brainstorm and formulate this. Keep in mind that it might look different for everybody, and you can adjust as needed.
Signing Up for Membership: Foundational Assessment
First, patients come to see me for the initial consult, and then they sign up for the membership. (The way I teach is that we actually have an initial consult that I call the Foundational Assessment, which actually happens prior to them signing up for the membership. I do have other videos on that if you want to look.) But this visit, we're doing a blood review, blood test review. We're doing history; we're doing physical. And they're leaving with foundational recommendations, as well as initial advanced test recommendations. (We are not recommending that yet. I'm not ordering advanced testing here at the Foundational Assessment.) I'm just doing a lab review, blood work. It serves in a couple of different ways. It not only gives me objective data on what I'm recommending, but it also lets me know if this person is appropriate for integrative treatment. Or, does she need to be referred out? Is she too acute? You know that kind of thing. This person already has blood work with you.
Going Forward with the Membership
Keep reading to understand how we encourage our clients to move forward into membership by showing them, step by step, how 12-months together is the best for their health and wellness outcome.
Initial Consult - December
Let's start off with a hypothetical but very realistic scenario. It's December and a patient has her initial consult. And the patient says, “Yes, I want to move forward with the membership.” So, here I am with my 12-month membership, and the patient asks, “What are we going to do for a full year? How is this going to work?” Let's pretend that’s my initial recommendation.
This person is a 44-year old female, with bloating, fatigue, kind of sounds like IBS like symptoms, and some chronic pain. Her blood work shows suboptimal thyroid. She has some nutritional deficiencies, some elevated CRP, and some inflammation, but her liver and kidney are within normal limits. Let's just say in the beginning, I replace the deficiencies. I replace D and B12. She is low in mag and I give her some fish oil. I give her a really good multi and curcumin for her joint pain. I want to start “doing.” So, I order a stool test and a SIBO breath test to get started, based on her IBS symptoms. This is what I initially do for her, things that need to be addressed first before we do other things. I order this lab, so this would be lab resulted.
January
In January at the patient’s first appointment with me, I'm reviewing the stool and the SIBO results. I'm starting the gut-healing plan at this point, and now I'm ordering abnormal lab work. Remember, I did blood work up here back in December. Perhaps I need to repeat thyroid, and maybe I need to repeat the B12 and D. So, I'm kind of trending now to see where we are. She will then follow up with me in two months.
February
In February, she goes to see my health coach. At that point, it's whatever you think she needs. The health coach might be going over sleep hygiene, exercise, or the low inflammatory diet, et cetera, et cetera— whatever you think that she needs at that point.
March
Now it's March. I'm going to check in and see how she is feeling with the gut-healing protocol.
What I always tell our providers is even if patients say, “I've been following everything to a tee, and it's not really making much of a difference,” that could mean that the gut rehabilitation wasn't the major imbalance that was causing them to feel what they are most concerned about. It will certainly help other things, and that's okay. That's an indication; that's a guiding light. You know, we're all scientists here. All information, whether it's a quote, unquote, positive, or negative, just tells you which direction you need to go into. So then you might go somewhere else, or you might look more into your patients’ thought work, nervous system, things like that. What old patterns are your patients perpetuating for themselves?
So again, I’m going to check in to see how she is feeling with the gut-healing protocol, and I'm going to review the blood work at this point, because remember, I ordered the abnormal lab work in January. I might at this point with the “Intervention Plan” adjust the baseline supplements, based on this blood work that was reviewed. And then as far as the gut health, if I need to repeat gut testing, I will then do it here. For this person, I am just going to pretend that I want to repeat the test. Next, I move on to the stool test, which presented no indication that I really needed to repeat that. But I do want to repeat the SIBO since she’s not feeling any better with her bloating (let’s pretend that that was 50% better) to make sure we actually eradicated the positive SIBO or not. I'm going to repeat that SIBO, but I also want to move on with her stress response because this fatigue, I think, has to do with her adrenals. So, I'm going to order a saliva adrenal test here.
April
Again, now in April, she's going to my health coach, and again, any variety of health coach things that you might intervene at that point.
May
It's May. And I’m now doing the doctor's appointment. So, I'm going to review the adrenal test, and my intervention is going to be the adrenal protocol. I'll keep her on some of those foundational supplements that she might need. Then she will do that adrenal protocol. Now, for the adrenals, I typically find that might take about 90 days. This is around the time. I will also order her more blood work at this visit, if I need to. At this point, sometimes I start to look into the sex hormones as well. So for this person, I'm going to say I’m going to start to look at those sex hormones. However, it could really be anything by the time you are about 5 months into the membership.
As you know this is a pretend patient, but there are things that come up that you might do an advanced cardio metabolic panel at this point. The patient may have some bone health issues, and you might be investigating that blood work a little bit more. So, you’re just continuing to peel back layers of the onion. It could be a little bit of everything.
After 5 months into the membership, I typically like my patients to have that initial appointment with a therapist, so I’ll bring that up to my patients. This is when they start to either discuss things that they need to talk about either from their past or like managing things in their current life.
June
In June, after the patient’s appointment in May with me, she will see my health coach once again.
July
In July, this patient will see the therapist.
August
In August, my patient has the doctor's appointment with me to review the blood work. Remember my membership includes five visits with me. So, this patient has already had 1, 2, 3, & 4. So, I have one appointment left with her. Here I'm going to adjust the plan based on the blood work. I'm going to see how she is feeling once this adrenal protocol.
At this point, some people are not quite ready to be done with the membership while other people are ready to be done. They feel like they know themselves. They feel like they know what was occurring for them and what they need to do to improve their health. So at this point, I start to ask them, “Okay, do we want to move forward with more of a maintenance program?” And if my patients are interested, I will invite them into any one of my maintenance levels. Everybody gets the same membership year one, but from maintenance levels, I invite him or her in.
So, if for this person there are still issues that we haven't resolved yet, or she just doesn't need support, then I might order additional testing at this point, one more time within this membership. But then that really helps me know.
September
In September, she will visit the health coach once again to check in.
October
In October, this is my patient’s final doctor’s appointment with me. In this final appointment, I'm giving her a maintenance plan and just letting her know these are the things that I recommend trending with her PCP or primary medical team. Then you can go about it that way.
November
In November, my patient will have her final health coach appointment. If my patient decides that she wants to continue on through the year, like I said, then she can and you'll just kind of continue to order labs to support her as you peel back those layers of the inflammatory processes.
Overall
This is how a 12-month program might work. As you can see, December is blank. What I have found is that I'm seeing the patient about every two to three months. Typically, you might not see her at exactly the two-month mark, or you might see her a little bit earlier. It just depends on the patient’s journey.
The other question that you might be having is “What if you need more visits initially, or they don't use up all their visits?” I'll address that in detail in additional videos. Basically, how I handle that is my membership included five visits with myself. I found that that was a good average number. Sometimes I needed to see patients initially about every single month and they used up those five visits. If that does happen, we are very transparent and very clear about tracking. The patients know, they have used up three of their five visits, or they have used up four of their five visits. Before every appointment, they have a tracking sheet that we provide to them, and then we have a “à la Carte” visit. After they use up those five visits, and if they need another medical appointment, I always recommend what's medically necessary. I never tell them, “Oh, well, I'm not scheduled to see you for another two months.” I always do what's medically necessary. Then it's just transparent to them that each initial visit might be $199, $249, whatever you set as the price. That's really important. Also, if they do not use up to five visits in that first 12 months, then they don't use them. The visits are lost, but they do get that tracking. So, if they come in at month 10 and they use three of their five visits, then they know that if they want to complete that and see me, they don't need to schedule that. A lot of times I do like a couple month grace at the end of the year to give them an opportunity to use that up and you can choose to do that as well if you'd like.
Conclusion
As you can see, this is a cadence where you're kind of jogging alongside the patient, and you're giving time for the labs to be resulted and for the body to show change once implementation is made. You're also adjusting multiple different processes within the body. You are not, like for three-months, only focused on the gut or only focused on hormones and that might be helpful in other areas.
If you're going to address multiple systems, multiple layers, I’ve found that a 12-month program is really a nice pace. It pays for everybody, including you, your staff, your independent contractors, and it offers stability for the patient and for yourself.
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