Root Cause Care: Real Life Examples
Erica Armstrong, MD, FMCP-M
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Aug 13, 2026
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.
Member #1:
"No one had ever told me how to take it"
A member came to Root with both a primary care physician and access to an employer-sponsored on-site clinic. He completed his lab work and met with a Root physician and a Root nutritionist.
He was finally told why he had hypothyroidism – it was an autoimmune condition called Hashimoto’s. Short term, he was given specific instructions on how and when to take the thyroid medication he had already been on for years. Nobody had walked him through it. Timing and administration affect absorption, and his had been working against him the entire time.
He also had a long history of depression and anxiety, managed with counseling and medication. During his Root visits, we reviewed his full medication list and identified interactions. There were combinations working against each other, and agents that were plausibly contributing to how he had been feeling.
Under medical supervision, and alongside sustained changes to how he was eating and living, he has since come off multiple medications.
He told us that he could not remember the last time he felt this good.
The impact:
A full medication reconciliation and an administration-counseling conversation take time inside a visit. In a panel where the average appointment runs under fifteen minutes and carries three to five active problems, that conversation is the one that gets deferred or referred out to a specialist, usually one who is not equipped to put the entire picture together.
Member #2
The next step was insulin
A member with type 2 diabetes came to Root already on two glucose-lowering medications, one of them a GLP-1. Over the previous two years, she had lost a substantial amount of weight and maintained that progress. Yet her A1c remained 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.
The impact:
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.
Member #3:
He was told diet wouldn’t help
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.
The impact:
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.
Member #4:
Referred by a holistic PCP
A member came to Root with rheumatoid arthritis, on Enbrel and methotrexate. Enbrel alone carries a list price around $8,000 per month. She had seen a PCP, gastroenterology, neurology, and dermatology. Her symptoms persisted.
Her concerns when she reached us: constipation, bloating, fluid retention, waking at 3 AM, joint pain, neuropathy, hypothyroidism, and chronic fatigue. She was also perimenopausal. No one had addressed her hormones.
She was referred to Root by her own PCP — a physician her community regards as holistic and integrative. That referral came after she had also been seeing a separate functional medicine provider once a year, with no noticeable change.
Our approach addressed the physical and the behavioral together:
- Removing inflammatory foods, with coaching through the transition rather than a handout
- Personalized microbiome testing and a targeted gut healing protocol
- Low Dose Naltrexone to support autoimmune remission
- Optimizing her thyroid hormone replacement
- Balancing estrogen and progesterone with HRT
Within six months she was off both Enbrel and methotrexate, and her RA is in clinical remission. She also avoided the additional GLP-1 medication her rheumatologist had proposed adding. She lost the weight without it, by addressing the root causes of inflammation.
The impact:
Her PCP is functionally trained by reputation and genuinely wanted to help. She referred out because her practice model could not deliver this. And the separate functional medicine provider she had been seeing annually did not move anything either, which points to the inconsistency across functional medicine practices outside of Root.
Functional medicine is not a label that produces results. The results come from core Root clinical processes, the visit length, the retesting intervals, the contact between visits, and a physician who does this work all day and has seen this pattern before. Run it once a year and it does not work, no matter what you call it.
What these have in common
These four members already had a primary care physician. Two had an on-site clinic available to them. The care they were receiving was appropriate to the models delivering it.
What they were missing was a layer built for reversal: enough visit time to reconcile a medication list, enough contact to run a nutrition intervention through to an A1c result, enough clinical depth to catch a Hashimoto's diagnosis that had been sitting in plain sight, and enough trust to bring someone back who had written off the system.
That layer is what employers are buying when they add Root. It sits alongside primary care rather than replacing it — and, as the fourth case shows, sometimes primary care is the one making the referral.
Clinical details shared with permission and/or have been generalized to protect member privacy. Root has thousands of cases similar to the cases noted here. Individual results vary; these cases are illustrative and are not a guarantee of outcome.
Reference:
Bell K, Parasuraman S, Raju A, Shah M, Graham J, Denno M. Resource utilization and costs associated with using insulin therapy within a newly diagnosed type 2 diabetes mellitus population. J Manag Care Spec Pharm. 2015;21(3):220-228. doi:10.18553/jmcp.2015.21.3.220
Reference:
Bell K, Parasuraman S, Raju A, Shah M, Graham J, Denno M. Resource utilization and costs associated with using insulin therapy within a newly diagnosed type 2 diabetes mellitus population. J Manag Care Spec Pharm. 2015;21(3):220-228. doi:10.18553/jmcp.2015.21.3.220