Is this $150-a-month holistic primary care service the future of medicine?

this article originally appeared on fastcompany.com

With locations in New York, San Francisco, and L.A., Parsley Health is on a mission to bring “functional medicine” to the prescription-popping masses.

The doctor doesn’t quite make house calls, but this “Uber for blood” guy was the first indication that this was going to be an entirely different checkup. My Parsley Health experience started with a kindly bloodwork technician coming to me to draw a sample, pack it in his duffle bag, and drive away to the lab. The whole thing took less than five minutes—all while I was still in pajamas.

Later, I booked an in-office doctor’s visit online via a streamlined site that was more a Slack/ClassPass hybrid than any MyChart health portal. The only real work? An online medical questionnaire, covering everything from what type of birth my mother had (vaginal or C-section) to whether I ever had an eating disorder. The dozens of personal questions went far beyond the medical norm: Are you happy? Would you describe your childhood as secure? Are you satisfied with your sex life?

Once I arrived in the doctor’s office inside an L.A.-area WeWork, my appointment ran for 1.5 hours. A doctor, with my blood results already in hand, explored the physical and emotional issues affecting my well-being beyond the numbers. That can run the gamut from potential food allergies and environmental toxins to insomnia and stress.

Parsley Health is meant to foster a close, long-term doctor-patient relationship where both parties are committed to addressing the underlying reasons of health problems. This is what is termed functional medicine, a clinical approach that analyzes you “as a whole person, instead of looking at you in a snapshot of time,” says Parsley founder Dr. Robin Berzin.

When a patient complains of a migraine, a Parsley doctor doesn’t just prescribe some drugs; instead, they contemplate the issue from a holistic standpoint. Perhaps the symptoms began with a vitamin deficiency–or a divorce? Stress, for example, is one of the bigger triggers for autoimmune flare-ups.

“We look at a much wider swath of data than the regular doctor,” says Berzin, “and we look at your social factors–your relationships are probably one of the biggest determinants of health.”

While the company doesn’t shy away from prescriptions or surgery (if necessary), the staff prefers lifestyle changes through nutrition, exercise, supplements, and stress management techniques like meditation. If it all sounds a bit GOOP-y, fret not. Parsley hires traditional doctors who specialize in internal and family medicine. They also receive certification training at the Institute of Functional Medicine, where they learn alternatives beyond the prescription pad.

“Functional medicine is not Eastern medicine, it’s not integrative medicine,” stresses Berzin. “It’s just taking best practices for conventional medicine but focusing on the root causes of disease.” For example, she adds, “You’re not an insomniac lying awake at night because of an Ambien deficiency.”

Health insurance, however, has no part of this. Instead, Parsley charges monthly subscription fees—the most common being a $150-per-month membership that includes five annual hourlong visits with a doctor, five sessions with a health coach, numerous lab tests, as well as referrals to specialists. The program is not meant as a replacement for medical insurance.

“We are building a new operating system,” says Berzin. “We view ourselves as the future of primary care.”

A different doctor visit

Amid bearded, juice-slugging entrepreneurs on their laptops, I settle into the Parsley Health “office,” located within WeWork Playa Vista, California. The rooms are decorated with chic Nordic furniture and accented with Ikat wall rugs, weave baskets, and potted plants.

My doctor is not in a lab coat. Instead, Dr. Jeff Egler is in a print Oxford button-down, giving off a relaxed vibe. His coffee mug says, “Do what you love.”

When it comes to discussing issues like stress or constipation, he’s more likely to reference shows like Scrubs (“Everything is about poop”) than use formal medical terms you might not recognize.

Again, not your typical doctor’s visit.

Egler previously served as an assistant clinical professor at the University of Southern California and has a master’s degree in spiritual psychology. He tells me he prefers the Jerry Maguire approach when it comes to his work: less clients, more personal attention.

For our 75 minutes together, Egler pores over my medical questionnaire like a detective, looking for clues as to why, for example, I’m often fatigued. Everything is suspect, including my breakfast and oral contraceptives.

When I shrug off things that I consider my normal (“Eh, it’s always been like this”), he steers me back: Perhaps I feel okay now, but what about in 20 years?

“You don’t want to be normal, you want to be healthy,” stresses Egler. “In the conventional doctor world, ‘healthy’ might be described by how many complaints you have, whereas we’re more interested in looking under the hood and seeing the actual markers of health, and how are you doing with regard to those.”

We move through multiple topics–some inspired by my health goals–others just questions I’ve always had for a doctor. These range from potential food allergies (corn) to mushroom coffee (does it work?) to dissecting my exercise schedule (too much cardio, he thinks). We pore over my lab results. Nothing goes unturned.

As our time comes to an end, Egler flashes a smile, sits back, and asks, “Is there anything that we missed?”

It’s a far cry from how most doctor visits are conducted, where you’re often rushed out the door. Researchers from the University of Florida found that American doctors give patients just 11 seconds to explain symptoms before cutting them off. (No wonder women feel unheard in the healthcare system.)

Later, a health coach spends 45 minutes dissecting my daily diet and comes up with a meal and supplement plan. She even tries to remotely rearrange my bedroom to maximize optimal sleep.

This kind of thorough work is what functional medicine is all about, says Berzin. If 90% of health is dependent on social determinants, then shouldn’t your doctor know what’s going on in your life?

Mainstreaming functional medicine

“I went to medical school knowing I would do something a little bit different,” reflects Berzin.

The entrepreneur attended Columbia University medical school and practiced internal medicine at Mount Sinai Hospital. But Berzin always had a soft spot for more holistic practices. She also became a yoga and meditation teacher and served as a producer for Dr. Mehmet Oz’s radio show.

Her chief passion–understanding and overcoming chronic disease–was inspired by her grandmother, who died as a result of colon cancer during Berzin’s college years. Roughly 70% of diseases in the U.S. are chronic and lifestyle-driven, according to the CDC, and nearly half of the population has one or more chronic health conditions, such as diabetes, asthma, heart disease, obesity, or cancer.

Functional medicine has shown to be effective in treating such issues. A 2016 study in conjunction with Mayo Clinic researchers found the approach improved stress, energy, fatigue, and digestive issues, among other areas.

In 2013, while advising several health startups, Berzin saw an industry that was ripe for her vision of what medicine could ultimately look like.

The health IT space was flush with innovation that spanned wearables to software. At the same time, health and wellness hit an all-time peak, with juice bars and boutique fitness gyms flourishing across the country. The wellness industry grew 10% from 2013-2015, and is now worth $3.7 trillion, reports the Global Wellness Institute.

The marketplace, meanwhile, seemed ripe for disruption, especially with crippling rises in healthcare spending. A good chunk is related to lifestyle: 86% of annual healthcare costs in the U.S. are driven by chronic disease.

“We’re paying more for healthcare [and insurance] but unfortunately getting less,” says Berzin.

The average American patient spends 15 minutes with their primary care doctor, most of whom aren’t trained in lifestyle adjustments. That ultimately accounts for why 76% of traditional physician visits result in a prescription for a drug, adding another $3.3 trillion spent nationally on healthcare per year. (That’s for those who even see a doctor–many now just rely on urgent care or jumping from specialist to specialist.)

Having trained with (and later advised) the Institute for Functional Medicine, Berzin believed the industry would respond to a physician model that better incorporated overall wellness. She also realized tech could be used to streamline operations and increase patient-doctor engagement. Why not, she thought, utilize video chats and app messaging with doctors?

In 2015, Berzin launched Parsley Health with just one doctor: herself. In 2016, the company expanded to three clinics in San Francisco, Los Angeles, and New York City and brought on more personnel. Apart from the in-depth diagnosis and treatment model, Parsley also differs in its emphasis on technology. The entire booking process is done online, with doctor’s notes, medical records, and health coach messages available on an easy-to-navigate dashboard.

“Everyone is busy,” says Berzin of Parsley’s 100% open notes policy. “You shouldn’t beg us to fax you something. All your data should be online so that you can view it 24/7 and download it yourself. We believe you own your data.”

Additionally, Parsley built data tracking into its system to assess and compare outcomes–a method rarely found in general primary care. Before each visit, patients fill out a survey that helps the medical team monitor progress and outcomes. Over the course of a year, Parsley’s digital system then adds thousands of data points to a patient’s charts, which enable them to change course should a method or treatment show little improvement.

Parsley envisions itself as a direct-to-consumer company focused on patient experience. Since the startup is not beholden to an insurance company, it can avoid the less convenient markers of traditional medicine. For example, most healthcare providers wouldn’t consider “Uber for blood” because their billing system is based upon getting people physically through the door.

Consumers are responding, the company says. Clients range between 18 and 80, but the majority are women in their late 30s and early 40s.

“Women are the early adopters, and that’s not surprising,” says Berzin, noting that women drive 80% of healthcare spending in the U.S. “They’re the ones who take care of themselves and their family.”

The largest pool of clients includes those diagnosed with a chronic illness, such as an autoimmune disease, gastrointestinal issue, or infertility. Berzin says these are mostly women frustrated with the existing healthcare system.

“They just can’t get a doctor to listen to them or investigate to figure something out,” she explains. “They want a different way.”

The second group includes individuals who have yet to be diagnosed but suffer symptoms like bloating, migraines, or skin rashes. This type of patient usually self-medicates via late online Googling. The third group are the “optimizers,” who are rather healthy but are keen to be even more proactive, especially as it pertains to aging.

An increasingly budding category is children. After demand from parents (who were also patients), Parsley Health just hired their first pediatrician. The service will soon be available to existing members, many of whom seek different ways to deal with issues like chronic rashes or hyperactivity.

“They want to know what their kid should be eating or why,” says Berzin.

Expansion plans

This past April, the startup announced a $10 million round of Series A funding, led by FirstMark Capital, with additional investments from Amplo, Trail Mix Ventures, Combine, and The Chernin Group. Individuals included Mark Hyman, MD, director of the Cleveland Clinic Center for Functional Medicine, and Warby Parker cofounder Dave Gilboa.

Moving forward, Parsley Health intends to open more clinics across the country, as well as beef up its online content platform. The biggest challenge, says Berzin, is educating the public about the benefits of functional health.

That, and convincing people to adopt an alternative payment model. Most consumers aren’t too well versed in options beyond health insurance–or just depending on the emergency room.

“You have to educate people about how they’re already spending their money in ways that they’re not aware of themselves . . . they are already spending hundreds if not thousands of dollars on unnecessary medications, unnecessary specialists, and ‘healers,’” says Berzin.

With Parsley Health, membership equates to a little under $5 a day. That’s a small price, says Berzin, for preventable health strategies that encompass all of one’s physical and emotional well-being. These are doctors who won’t ever say, “‘We have 15 minutes with you. Here’s your prescription for drugs. Off you go.’”

“[Functional] medicine is completely inaccessible, and yet the outcomes are incredible,” says Berzin. “This should just be primary care for absolutely everyone.”