Hello, Tribe. I hope everyone is holding up in this Q1 where there is so much going on. I feel like I’m juggling 10 plates while running on a treadmill that keeps stopping and starting at random intervals. How you doing?
For a full transcript of this episode, click here.
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This podcast with Dr. Scott Conard today, first of all, I enjoyed how it came to be. Brian Uhlig, an employee benefit consultant of some acclaim, came to me and offered to sponsor a show for someone else. Not himself. I gotta say, it’s stuff like this that warms my heart. It’s this village that we have here, this tribe of Relentless folks trying so hard to stand up for and help patients. So, thanks again to Brian Uhlig.
Also (this has nothing to do with the show that follows), remember the episode with Cynthia Fisher (EP457) from December? This is the one where we talked about the growing problem of medical spread pricing. If you have no idea what I’m talking about, no worries. Just go back and listen to that show.
But if you do, Brian Uhlig was able to save $80 million for 9 clients across 25,000 employees. And he was doing a bunch of different things, but combating medical spread pricing was one of them.
Okay … so, today I am speaking with Dr. Scott Conard. If that name sounds familiar, you might remember it from the earlier episode (EP391) where Dr. Conard told, for the first time ever, his story about how he had built an amazing advanced primary care practice, only to find it destroyed basically by perverse incentives.
Yeah, it’s a dramatic and, I don’t know, pretty tragic tale actually. So, do go back and listen to that earlier show if you haven’t already.
Dr. Scott Conard talks today about the evolution of his life’s work. Right now, Dr. Conard is doing a bunch of work with Mike Adams from 7-Eleven, helping their plan members. A lot of this work is centered on and about a few pretty striking but very common insights that many plan sponsors will find in their own data. It turns out about 70%, give or take, of people who wind up costing the plan whatever the high-cost threshold is in any given plan year.
These higher-cost claimants didn’t fall out of the sky unexpectedly, 70% of them. They were actually high risk but low cost in prior years. So, the trick is to find these individuals and help them not fall into the high-risk and high-cost part of the graph. If the goal is how to best manage a population of members, a lot of that is, again, identifying high-risk patients who are currently in the low-cost zone, who, any given plan year, are gonna go out of that zone and get into the high-cost area.
So, if we’re thinking about best practices to avoid this, I’m gonna run through Dr. Conard’s list that we mostly run through in the show that follows, although some of the steps in the stepwise we cover more thoroughly than others.
Okay … so, here’s the stepwise best-practice approach to managing population health at the plan sponsor level.
1. Get the data. Not to divide everyone up into, you know, disease buckets or whatever you call them, but to run a whole-person risk score for each member. You got to treat a patient like a human being, after all, not the sum of a whole bunch of disconnected body parts.
The metaphor that Dr. Conard uses to describe this is the car metaphor, right? Like, cars are actually the sum of a bunch of different parts. If your tires are worn out, you change your tires. The end. If you’re a human being, though, it doesn’t work that way.
It is a horrible thing to hear stories about people who cannot get a needed operation because their cardiovascular markers are out of control, but they can’t take the med to control their cardiovascular markers because it’s contraindicated for their kidney disease or their liver disease. So, they get punted between doctors not talking to each other.
Miriam Paramore has a harrowing story about her father’s end of life, if you want to dig in on that and cry a tear or two. But bottom line, human beings are one system, not a coterie of disconnected parts. So, that’s Step 1: Do the whole-person risk score with the data.
2. Get members access to advanced primary care teams, and those teams should be empowered and equipped to make referrals to demonstrably excellent specialists offering high-quality, appropriate, and optimized care.
3. Align benefit designs and what you want members to be doing to ensure that they have access to get this appropriate, optimized care that we just talked about.
We don’t get into this a ton today, but I rabbit-holed on this exact topic for, like, 25 minutes last week (INBW42), so if you want to get into the moral hazard and low-value care versus high-value care whole diatribe, do go back and listen to that, yeah, rant.
Also, Mark Fendrick, MD, talked about all of this on a show (EP308) from a couple of years ago. He talks about benefit designs and optimized medical care being like peanut butter and jelly. And here’s why he said that. If, say, for example, a doctor tells a patient with diabetes to go get a foot exam regularly, so, you know, they don’t wind up needing their foot amputated.
And if the patient responds, “Sounds great, doc. But I can’t go get my foot examined. I can’t afford the co-pay of the office visit.” Then, yeah, patient loses. Doc, by the way, gets dinged on their quality scores. And the plan sponsor winds up—I was gonna say footing the bill, but that might be a terrible pun if we’re talking about foot amputations—winds up paying the bill for some pretty expensive and also pretty avoidable disease exacerbation.
So, Step 3 is align benefit designs with care pathways—what we want members to be doing. So, that’s number three.
4. Use a tool like My Personal Health Assistant, for example, or a navigator to make sure members are engaged and are navigating the healthcare system along these optimal pathways that we just talked about.
Dr. Scott Conard talks a little bit about this My Personal Health Assistant today. It’s a service his team offers that engages unengaged patients and is a needed companion to many advanced primary care efforts.
Lastly, lastly, we touch a little bit in the show today on community-run primary care. This is a community paying for primary care for community members, just like they pay the fire department and the police department.
For all the reasons that we talk about on the show, it’s maybe cheaper for a community to make sure that their neighbors get primary care so that they don’t go uninsured to the hospital for an exacerbated condition, run up a huge bill that … guess who winds up funding? Local employers through higher cost-shifted hospital prices and taxpayers, of course.
Maybe in the long run, it’d be cheaper to keep the town healthier. And it also, I don’t know, just feels like the right thing to do. There’s a town in Rhode Island doing this that Dr. Conard talks about today. In fact, Michael Fine, MD, is part of this effort in Rhode Island. Here’s an article where Dr. Fine is interviewed.
Also, I will mention Primary Care for All Americans has a free practical guide to organizing to bring high-value primary care to communities.
Dr. Scott Conard, my guest today, is founder and partner over at Converging Health. Converging Health has a data practice, a consulting practice, and also My Personal Health Assistant, which Dr. Conard talks a bunch about in the show that follows.
Today, as I mentioned, the show is sponsored by Brian Uhlig.
Also mentioned in this episode are Converging Health; Brian Uhlig; Cynthia Fisher; Mike Adams; Miriam Paramore; Mark Fendrick, MD; Michael Fine, MD; Primary Care for All Americans; Dennis Bishop; Marty Makary, MD, MPH; and Mike Tuggy, MD.
You can learn more at converginghealth.com.
Scott Conard, MD, DABFP, FAAFM, is board certified in family and integrative medicine and has been seeing patients for more than 35 years. He was an associate clinical professor at the University of Texas Health Science Center at Dallas for 21 years. He has been the principal investigator in more than 60 clinical trials, written many articles, and published five books on health, well-being, leadership, and empowerment.
Starting as a solo practitioner, he grew his medical practice to more than 510 clinicians over the next 20 years. In its final form, the practice was a value-based integrated delivery network that reduced the cost of care dramatically through prevention and proactive engagement. When this was acquired by a hospital system, he became the chief medical officer for a brokerage/consulting firm and an innovation lab for effective health risk–reducing interventions.
Today, he is co-founder of Converging Health, LLC, a technology-empowered consulting and services company working with at-risk entities like self-insured corporations, medical groups and accountable care organizations taking financial risk, and insurance captives to improve well-being, reduce costs, and improve the members’ experience.
Through Dr. Conard’s work with a variety of organizations and companies, he understands that every organization has a unique culture and needs. It is his ability to find opportunities and customize solutions that delivers success through improved health and lower costs for his clients.
07:10 How do we think about data wrongly, and how does that affect our healthcare spend in regard to population health?
09:43 What needs to be done with population health data once it’s collected.
14:48 Community in Rhode Island doing effective proactive care.
16:09 EP449 with Marty Makary, MD, MPH.
16:44 A real, successful case study.
24:08 How do we define high-cost patients?
24:14 What do we know about high-cost patients in regard to population health spend?
29:02 Why avoiding prevention in primary care only harms yourself in the future.
@ScottConardMD discusses #populationhealthmanagement on our #healthcarepodcast. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation
Recent past interviews:
Click a guest’s name for their latest RHV episode!
Stacey Richter (INBW42), Chris Crawford, Dr Rushika Fernandopulle, Bill Sarraille, Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj, Cynthia Fisher, Stacey Richter (INBW40), Mark Cuban and Ferrin Williams (Encore! EP418)
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