How Root Complements Primary Care

In our last article, we outlined how primary care and Root are built for different jobs, and the reason Root produces the outcomes it does is that we focus on being functional (root cause) medicine specialists.

This is easier to visualize how Root helps beyond primary care coverage in individual cases. Below are four members. Two of them had a primary care physician and an employer-sponsored on-site clinic when they came to us. One had stopped seeing his PCP entirely. The fourth was referred to us by her own PCP, a physician the local community considers integrative.

None of these stories involve a doctor who did anything wrong. They involve care models that were built for different work.

A member with type 2 diabetes came to Root already on two glucose-lowering medications, one of them a GLP-1. She had lost a substantial amount of weight over the previous two years — real, sustained work. Her A1c was still above 9.

Her PCP's next step was to start basal insulin. That is a reasonable decision inside a conventional model. An A1c that high on two agents indicates escalation.

She came to Root first. Over the following year, working on nutrition and lifestyle with our team, her A1c came down into the mid-6s. She has made no medication changes and has been able to avoid insulin.

From an employer cost perspective, patients who added insulin experienced roughly four times the rate of hypoglycemic events and higher diabetes-specific pharmacy and utilization costs than patients managed without it, and published analyses put insulin-treated type 2 diabetes at close to twice the annual total cost of care. (1) Getting her A1c into the mid-6s kept that escalation off the table.

We also identified Hashimoto's, which had not been diagnosed previously. Her TSH has come down from double digits into the normal range, and her thyroid antibodies are trending down as well. 

In conventional primary care, an A1c above 9 on two medications, in a member who had already done two years of hard work, reads as treatment failure. Inside that conventional model the answer to treatment failure is another agent. We went looking for a reason instead, and there was one sitting in her labs.

Starting insulin would have brought her A1c down without touching the thing that was making her A1c hard to bring down. She would have carried undiagnosed autoimmune thyroid disease forward with her, along with everything that follows from leaving it untreated, and she would have carried a new medication as well.

Finding it required a comprehensive workup at intake and the visit time to ask why she was stuck. A quarterly PCP/DPC appointment is enough contact to titrate insulin. It is not enough to run that workup, or to support the nutrition changes that followed it.

This member had tried blood pressure medication and had side effects. When he raised diet questions with his PCP, he was told that diet was unlikely to move his numbers meaningfully. Due to the difference in philosophy, he declined further follow-up with his PCP.

Unfortunately, this outcome is common when primary care is not equipped to handle nutrition advice. He was a person who had concluded that the visits were not producing anything he could use.

He started with Root instead and stayed. Within months, he had lost weight through changes to his diet, and his blood pressure had moved from the low 150s over the mid-80s into the low 130s over the low 70s.

Two other things surfaced along the way. He completed colorectal cancer screening, and precancerous polyps were found and removed. His ferritin, which had been low, has roughly doubled into the normal range.

What changed that was finding a care team who took his question seriously and could answer it with a plan. Nutrition is first-line therapy for hypertension in the guidelines, and he had been told it would not work for him.

Once he was engaged, the rest followed. His low ferritin came out of a comprehensive workup rather than a targeted test. He agreed to colorectal cancer screening he had been avoiding because he had a clear reason for why it was needed (low ferritin), and the polyps that were found and removed took a meaningful amount of future risk off the table.