The Affordability Equation: Unlocking Budget for Quality Supplement Protocols

Making high-quality supplements accessible is an essential part of creating successful, sustainable care plans. In this expert interview, Julie Bolter draws on decades of experience in functional medicine to explore strategies for balancing clinical recommendations with real-world budgets, improving patient adherence, and helping practices deliver better outcomes through collaborative care.

• Presenter: Julie Bolter, Co-Founder and Vice President of InteFusion.
• Key Themes: Supplement affordability, patient adherence, practice success, collaborative care, and health coaching.

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The Affordability Equation: Unlocking Budget for Quality Supplement Protocols:

Transcript

Dr. Sandi: Well, welcome to the Supplement Summit, Julie.

Julie: Thank you so much, Dr. Sandi. It’s fantastic to be here. I’m so excited.

Dr. Sandi: So, let’s start at the very beginning, that is with Metagenics. So, I got to say, I was thinking about this. And even when in my 30s in the ’80s, who knew from supplements it was like Centrum Silver, one a day, Flintstones for kids, but really didn’t. When you walk into a store, you didn’t see. There was no Whole Foods. Whole Foods wasn’t around back then. But in a health food store, I used to shop at these local health food stores. There’d be a few…an aisle, maybe. Now, it’s half the store. So, I’d love for you to talk about those early days, like founding Metagenics. What was the impetus to found this company? How do you see those early days? What was that like in terms of regulation and quality control and marketing to practitioners? I’d love for you to talk about those things.

Julie: How fun. How fun to go back and tell this story, and actually my family’s legacy. So, thank you, Dr. Sandi, for inviting me to speak about this. And it was a very interesting time. My family was actually representing a company in the late 1970s. And I think this story really tells the story of quality in the supplement industry as a whole. That company had been sold. And they were using animal-grade raw materials in their products. And my family…I have four older brothers, my parents, myself. My family had moved from Wisconsin to Southern California, and were representing that company.

And I was in high school at the time. I was a junior in high school. And I remember my family coming together around the dinner table. And the CEO, my oldest brother, had gone and assayed the products, and found that they were using…the original company was using animal-grade raw materials in their products at that time. And the conversation was around, okay, what do we do? Do we all go our separate ways, or do we start our own company with the quality standards that are integrity and morals and what we believe in?

And so, that’s how Metagenics was born in 1983. The name Metagenics means a new beginning. And it was based upon the quality and assaying the raw materials, and making sure that what was actually supposed to be in those products was in the product, and the label represented it correctly. And ultimately, it was about the patient getting results. So, doctors would recommend the supplements. And it was about their reputation and the patient actually getting well. And that was the passion and the mission behind Metagenics is genetic potential through nutrition.

So, that was a time period where no one knew the word probiotic. I don’t even think that was in existence, which we just had the most amazing presentation from Tina about probiotics. Vitamin C was controversial at the time. There was a lot of really, really basic industry…basic information in the industry. And people really were not aware. You could not buy a drink that had any active nutraceutical type ingredients or herbs in it. It just didn’t even exist in the marketplace.

So, it was very, very basic. Back at the time, Metagenics was the first company to represent a probiotic. We had the exclusive to distribute the NCFM strain of lactobacillus acidophilus back in the ’80s. I don’t know if you remember that. But it was a very different time. And there was a lot of…lack of information, really, in the general public around supplements and what they were used for or why you would even take one.

Dr. Sandi: Yeah, absolutely. Well, kudos to your family for being trailblazers. And what are some of the things that you’ve seen in the industry in terms of quality control? Because that’s an area that I think health coaches play a very central role in providing education. Of all the myths out there, but also if a practitioner is recommending one brand versus another, what’s the difference? Why should we be so concerned and not just go into a discount store or get something through Amazon?

Julie: Yeah. That’s such a great question. Well, I think it’s really all about the results. We want to take a product that is going to produce the results that we’re expecting. And so, quality is critical. And for example, meeting label claim for the ingredients that are in that formula so that you get the desired results.

Another thing is just how is a formula created? What are the ingredients? And why were they combined in the way that they’re combined? And what does the research say is the amount of the active ingredient that produces the desired result? And in order to get that result, you have to take that quantity of that substance in order to produce that result.

So, it’s very critical to understand what you’re taking, why you’re taking it, and what the desired amount is that you need to absorb in order to get that desired result so that you can get well. And the difference between a product that you can buy in a drugstore versus a product that you’re going to find in a practitioner’s office or recommended by a physician, there’s a big, big distinction between them, and a big difference in quality, and a big difference in the efficacy of that product, how well it works.

Dr. Sandi: So, one of the themes for this time together is affordability. And we’re going to talk about that. But many people will look at cost only. And so, they’ll get a list of recommendations of supplements from their functional medicine provider, integrative provider. But they’ll tell the coach, well, I found this cheaper version. I can’t afford this. And so, they’ll go to those sources. They’ll pick up something at Costco because it’s affordable. It’s cheaper. But how can you counter that as a…if you’re a practitioner or a coach?

Julie: Definitely great question. I think it’s really important to educate that patient on the substance that you’re wanting them to take and the quantity that is recommended in the product that you’re suggesting that they take so that they get the desired effect. And we used to say, the most expensive product is one that you take and either does not work or you do not absorb. So, a patient may assume they’re saving money, but they actually may have very expensive toilet water if they do not absorb the substance, the product, the combination of ingredients that they have chosen to go rogue and take on their own.

It’s very critical that the patient understands that there is research, thought, and design that is behind the product a health practitioner is recommending, and that that result they may get in a much shorter period of time with less cost if they take the product that’s being recommended. So, they’re not always saving.

Dr. Sandi: Yeah. Can you talk about kind of the behind the scenes at Metagenics? If you were to tour the facility and look at everything that goes into manufacturing a supplement and the research behind it, or if you’re rolling out new products, for example, but everything that goes into the…and your family had dealt with when they were running Metagenics.

Julie: I wanna say that my family…my brother, Jeff Katke, he was the CEO, sold Metagenics in 2009. So, I’ve been out of the supplement industry for a bit now. However, I can share with you what it was like when I was there and intimately involved in those details. But I think that the biggest thing is it started with the formulating.

So, Dr. Jeffrey Bland is the father of functional medicine, was the chief science officer at Metagenics. And we had people like Lyra Heller, who was a medical anthropologist and herbalist who you know well, and many people who had a very deep understanding of the supplement industry and would look at…first, it started with looking at all of the research. And then it was about sourcing the raw materials that were going to provide the active ingredients, and finding the proper herbs or finding the proper probiotics, etc. That was the most important process.

Then combining and manufacturing those ingredients in a facility that met the quality standards in order to produce a product that once it was labeled, actually had the ingredients that was stated on the label active in the product until expiration or beyond, and so that the patient would get the benefit from that product.

So, it was really a very comprehensive job. And the passion and mission behind Metagenics was always to serve the patient’s best interests. And the integrity came from thinking of that patient, taking that product and the result they were going to get at the end of the day, and the reputation of the physician or provider that was recommending it. So, that was always the focus and always the mission. And staying true to that was a true north. That was always how we were able to provide and become one of the largest providers of nutraceuticals in the physician market up until that time.

Dr. Sandi: It’s such a fascinating story to see the list of players who were involved with starting Metagenics and had such a critical role. And Lyra is a key member of our faculty, having taught many of our coaching programs, our webinars. And Dr. Bland, of course, is one…very, very key supporter. I believe Deanna Minich, I think, was also in Metagenics. Yeah.

Julie: There’s too many to name.

Dr. Sandi: Yeah. An all-star list. And my introduction, I think it was in the early ’90s, maybe I had seen a nutritionist in the Chicago area. And she turned me on to Metagenics products. And my first introduction to functional medicine, there was a Metagenics seminar. You did a lot of educational programming, and it was near O’Hare Airport. That was my first encounter with Jeffrey Bland. Of course, I barely understood a word he was saying as a psychologist, but the rest is history.

I wanna speak to something. We had talked about this when we chatted earlier. And that is, sometimes, I think there’s a myth out there. You just mentioned Metagenics being acquired in 2009. There’s a myth that, well, I’ll never recommend that company again or use it myself, because they sold out. Should you comment on that myth?

Julie: Yes. Well, I would say that the concern must be about quality, that a person would assume that now the quality will be less, the product is not as good, etc. And I am not intimately involved at Metagenics, but I can tell you, myself, my family members still take all of those products. And you can…just from our very history of the origin story, you can really tell when something works or when it doesn’t work.

I would say that even when maybe the investment firms who acquire companies take over, in my opinion or my observation, their desire is to maintain the quality because, obviously, that’s what made the company successful. And I understand that there is a change in this industry as a whole. And that’s also what people sort of…the original people who we call the OGs that were involved in the very beginning, I understand that the mixture of feelings around all of that. But I can see attending the Institute for Functional Medicine AIC meeting, the fact that so many more people are exposed now and the knowledge around functional medicine is becoming really mainstream, is really an advantage to really… What’s the expression? The water raises all tides.

Dr. Sandi: Rising tide lifts all boats.

Julie: Exactly. So, hopefully, there’s some advantage in that way that we can all benefit from a collective who are all trying to produce a very good quality product for all patients.

Dr. Sandi: Yeah, absolutely. Such a good point. So, I’d love to talk about FirstLine Therapy, which was a part of Metagenics. I went through it. And actually, FMCA has its roots in FirstLine Therapy. Can you talk about what the impetus was to develop what that program was, how it was taught? And I’d love to expose this to our audience if you’re not familiar with that program.

Julie: Yes. It’s one of my favorite things. And I’m so passionate about diet and lifestyle counseling. And FirstLine Therapy was designed to address the lifestyle and dietary issues that patients have that lead to chronic illnesses. So, we are all on the health continuum, and we’re either headed on the highway toward disease or hopefully health, the other direction. And diet and lifestyle counseling, we found, was the most important piece of the puzzle to get patients to change what they were doing, to change the direction of their health on that health continuum.

So, FirstLine Therapy was created to have that one-on-one direct contact with the patient to get them to implement the recommendations of the medical provider, the physician, the nurse practitioner, whoever was seeing that patient in order to get the patient to actually carry out and change their lifestyle to address cardiometabolic disorders, diabetes, blood sugar disorders, gut issues. And it was really designed to have that time with the patient that was going to create change.

And ultimately, it was how I got into the business I am in now, which is medical insurance billing. There was a physician in the area we live that was very effective in implementing that program, and he gave his patients a choice. I can give you this drug or I can have you see my nutritionist for diet and lifestyle counseling. And 99.9% of those patients chose to see the nutritionist. They wanted to change their lifestyle, they wanted to feel better, but they needed someone to teach them exactly what to do and how to get there. And that’s where it was transformational on patients’ lives.

It was actually more impactful than I could have ever even imagined because what happens in a practice that has this system in place and helps people get well is…and when you can use insurance to help pay for it, the patients are motivated, they make changes, they get better, and they refer their friends. And so, it is the best marketing a practice could have, and it’s super impactful in a patient’s life.

So, it’s really something that, obviously, I’m incredibly passionate about lifestyle and dietary changes and to help patients get access to that kind of care and practices that are doing this is really, really meaningful and has been my work over the last 23 years.

Dr. Sandi: Our summit is about supplements. And our talk right now is about Metagenics, a supplement company. But what we’re really talking about, where the rubber meets the road is lifestyle and the role of diet and lifestyle change which is the zone of the health coach. And looking back at FirstLine Therapy…which I went through. That was back in probably early 2000, something like that. I don’t remember exact dates, but it was before founding FMCA. But that was Lyra Heller and Monique Class, Kristi Hughes, our core educators at FMCA, really the ones designing that program. I remember I first heard Kristi on stage talking. She was part of the FirstLine Therapy as one of the educators.

So, the idea of a supplement company recognizing that the magic is not just take this supplement as we’ve been talking about today, but it is really a supplement to what’s most important which is diet and lifestyle change.

Julie: Exactly. There’s also that issue of speaking to the health coaches that the physician has a limited time with the patient, and you were speaking about it earlier today. And that time with the health coach, that time with that person who can listen and hear all that the patient has to share and spend the time to teach them lifestyle modification, how to eat, what to eat, really makes such a big impact.

And you’re all about collaborative care. This is a model that we find to be the most successful in our practice consulting, where a physician does only what the physician can do. And then he’s got mid-levels and other ancillary providers that can carry out some of these other areas of care that are very important, critical to the success of the patient, and also to the success of the practice.

Dr. Sandi: Absolutely. So, let’s address this affordability issue. So, what are you seeing with your company, with InteFusion? What are you seeing in the practices? And certainly, we can look at the affordability of supplements because they are expensive and, for many people, might be out of reach. And so, can you address affordability?

Julie: Definitely. In our business, where… It’s called InteFusion. We’re a medical insurance billing company. We deal with all different kinds of practices, but we deal with practices who are contracted with the payers, Medicare and PPO payers. So, affordability in our world means that a patient can come in and utilize their insurance for time spent with the patient, and they pay a copay for that. And therefore, they have more money left over there in their pocket to spend on the cash services in a practice.

So, it’s really about developing multiple revenue streams, a revenue stream from insurance, a revenue stream from cash for cash services, a revenue stream from supplement purchases. But when a patient can offset some of those expenses by using their insurance, they’re able to afford some of the other things they need, maybe even functional lab testing or something like that.

So, that’s been…our model is to help providers develop that multiple revenue streams appropriately and safely and accurately so that they can utilize the benefit of the patient’s insurance. Then the patient can afford the supplements.

I would also say one other thing in my experience, Dr. Sandi, is that anytime you can make the fast…and I know that you’re…this is…you’re intimately involved in this on a daily basis. But from my perspective, on the other side of consulting with practices, anytime the practice was able to make the quickest change so that the patient felt a difference immediately, that’s where they had the powerful how. They created a why and now the patient’s asking, how do I do this? What do I do next?

And so, regarding affordability, I always think that that’s the most direct method to get a patient to value what you’re offering because we all know many people are walking into a Starbucks and spending $5 to $8 or $9 or $10 on a coffee. So, a couple of those a week and you’ve already bought your supplements. So, I really think it’s about creating that value that if the patient understands why, then they want to know how. And they can find…most of the time, they can find the resources.

Dr. Sandi: Absolutely. And they also don’t need a hundred supplements. They don’t need to…especially with affordability, there’s… Go back to the basics. There’s no cost to being out in nature, to morning sunlight, to getting better sleep, to taking a walk. I mean, you don’t need an antidepressant or St. John’s wort for depression. You just go out and take a walk, and that’s better.

And one of the things that health coaches can do so well is help them get back to basics. So, supplements, yes, if it’s needed, if they have specific conditions to be addressed, but also showing the value. And that could be a really quick win. Like, hey, every time I’m feeling despondent, oh, I’m gonna go out and take a walk. Well, I feel much better. Or I went to sleep earlier, got…keeping consistent wake time hours.

Julie: Exactly. That’s so true. And I even think, just blood sugar, people don’t know what to go… They have cravings, and they don’t…they’re craving sugar, they’re craving carbs because they do not know how to balance their blood sugar. Just balancing the blood sugar and teaching which food will help them feel better, gives them the biochemistry to make a better psychological choice as well, to be like, yes, I do have the energy to go take a walk. I am going to put the effort into something else. And that’s what the health coach, the dieticians, and the clinical nutritionists are able to help those patients make those choices, which are invaluable.

Dr. Sandi: Yeah. And affordability in someone who might be eating a lot of ultra-processed foods, which are more expensive than going back to basics. And Liz Lipski used to teach and she teaches for us. And she would have people time, like how long it takes you to order a meal and get carry…versus doing some really basic cooking and the cost differential there as well.

We first talked at a conference. It was when you described the success that you were getting with coaches as lifestyle educators, and that this would be a way to get in the door of a practice that might be insurance-based if you are assuming that role, as opposed to health and wellness coach.

Julie: Yes. So, there is a role for a qualified healthcare provider in a medical practice that’s contracted with insurance to do lifestyle and dietary counseling to address medical problems and bill it to insurance. So, there are ways to help a practice, be more profitable, see more patients, help patients make those lifestyle changes, and utilize their insurance for that time spent with those diet and lifestyle educators. So, that is something that we can help any practice with. There’s a lot of misunderstanding around it. There’s a lot of misinformation. It’s following the billing guidelines for the payers, and making sure that you’re meeting the requirements of the licensure in the state that you’re practicing in.

Dr. Sandi: That really is a great way to explain to doctors how they…the services of a coach could be reimbursible.

Julie: Definitely. We offer a free consultation with any practice that wants to discuss, is this an opportunity for them? How could they do this? We handle all of that process. We can do an audit for the practice to look at their current services. How would it fit in? What would be the financial benefit to them? How would it work and how can they be compliant within the payer guidelines? And we’d be happy to help anyone to evaluate that because there is a lot of misunderstanding. And we’re just really trying to change the paradigm. It is not true that insurance does not pay for functional medicine. Insurance does pay for the treatment of medical problems. And depending upon how you’re addressing those, whether it’s with a drug or whether its diet or other lifestyle changes, insurance does pay for that time to address those problems. So, we’re happy to help.

Dr. Sandi: And to be clear, the practices that you consult with, these are functional medicine practices as opposed to more conventional.

Julie: Yes. We actually consult with the conventional practices that are transitioning to functional medicine and want to incorporate integrated functional medicine. And we are very much specialized in the functional medicine arena because we do speak the language of functional medicine and the language of insurance.

Dr. Sandi: And we also have a proposed CMS ruling on the table regarding the potential in 2027 for health coaches to be reimbursed and using the codes that are in existence, which are right now transitional codes. So, I think it’s very promising to look at the insurance world. This will open doors for the field of health coaching.

Julie: Definitely. And just that the eyes are looking in that direction and the awareness is that this is a really valuable part of a clinical practice is very, very exciting and super important for all of us.

Dr. Sandi: And what you’re saying in terms of the affordability of supplements, if it’s…this is the way that you lower their healthcare costs to see functional medicine providers and health coaches so that they can have that money in reserve for using supplements as needed.

Julie: Exactly. If you don’t have to spend $100, $200, $300, $400 on the time spent and you can pay a $20 copay, you now have a fund to pay for your supplements, pay for your functional labs, do other things that are needed in order to get well.

Dr. Sandi: Yes. So, there are no questions I see, but if anyone wants to, we have a couple minutes left. So, yes, Caroline, very interested in what you’re discussing about billing payers for lifestyle coaching. I’ve worked in healthcare finance for decades, and I’m transitioning to coaching.

Julie: Absolutely. I would say that I would… In fact, let me…I’ll share our contact information. And I’m happy to consult with anyone who wants to evaluate their practice, their circumstances, and see what the role might be. But in the traditional sense, where we work with medical practices, MD, DO, NP, and PA practices, and they hire the qualified lifestyle educator that can do the diet and lifestyle education, and work underneath the umbrella. And then we do the medical insurance billing for those practices, but that’s the typical setting that we’re working in.

Dr. Sandi: This is such…it’s so exciting, which is why when I met you, it was at the A4M conference. This is fantastic because it will really expand the ability of coaches to serve more people. And as we’ve talked about earlier…and I’d love to share…have you share your thoughts. Coaches who are being marketed to, you can develop a supplement protocol and do labs. But this, I’m assuming these are not going to be the kind of health coaches we’re talking about that will be working collaboratively with providers, with doctors.

Julie: All right. This is physician-directed, physician and mid-level-directed medical care, where they are prescribing a treatment program that the diet and lifestyle educator is implementing with the supervision of that medical provider in a specific setting. So, there’s compliance that needs to be met and documentation that has to be done in order to meet the requirements. But it is very, very successful, and it’s very…it’s profitable and also incredibly helpful to the patient.

Dr. Sandi: Yes. So, this was the model at Metagenics for FirstLine Therapy. This is the way to go to grow your business where you get referrals from doctors through cash base. But also, if you wanna work in practices, there’s growing opportunities and to be aware that there are programs out there that are skirting the regulations, that are promising you that you’re gonna be a jack of all trades. But what we’re hearing from our presenters today is that is not the way to go, that when you work collaboratively, everybody benefits.

Well, thank you for being with us, Julie. To be continued. It’s been a pleasure to get to know you, to hear about your mission. And thank you for taking us back in time to those early days. We’re so grateful to everybody in those early days of Metagenics, the courage of your family to start this company, and bring on so many renowned educators and chief medical officers.

Julie: Thank you so much, Dr. Sandi. It’s great to be here, and I appreciate your passion and mission with the FMCA. And the quality that you produce in your organization is unparalleled. And so, I’m honored to be invited to be here today. And thank you for letting me tell my family’s story.

Dr. Sandi: Thank you. Thank you so much.