EP462: Managing Populations of Whole, Actual People Who Are Not the Sum of a Bunch of Different Body Parts, With Scott Conard, MD

This podcast today is with Dr. Scott Conard, founder of Converging Health. You might remember him from the earlier episode (EP391). 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.

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.

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. 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. 

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Episode Transcript

Stacey Richter (00:02):
Episode 462.
" Managing populations of whole,actual people who are not the sum
of a bunch of different body parts."Today I speak with Dr. Scott Conard.

Tom Nash (00:21):
American Healthcare Entrepreneurs and Executives
You Want to Know, Talking.
Relentlessly Seeking Value.

Stacey Richter (00:29):
Hello tribe.
I hope everyone is holding up in thisQ1 where there is so much going on,
I feel like I'm juggling 10 plateswhile running on a treadmill that keeps
stopping and starting at random intervals.
How you doing?
This podcast with Dr. Scott Conard today,first of all, I enjoyed how it came to be.
Brian Uhlig, an employee benefitconsultant of some acclaim,

(00:52):
came to me and offered tosponsor a show for someone else.
Not himself.
I gotta say, it's stuff likethis 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 patientsSo, thanks again to Brian Uhlig.
Also, this has nothing to do with theshow that follows, remember the episode

(01:13):
with Cynthia Fisher from December?
We'll link to the episodein the show notes.
This is the one where we talked about thegrowing problem of medical spread pricing.
If you have no idea what I'mtalking about, no worries, just
go back and listen to that show.

stacey (01:27):
But if you do, Brian Uhlig was able to save $80 million for nine of
his clients across 25,000 employees.
And he was doing a bunch of differentthings, but combating medical
spread pricing was one of them.

Stacey Richter (01:42):
Okay, so today I am speaking with Dr. Scott Conard.
If that name sounds familiar, you mightremember it from the earlier episode.
Where Dr. Conard told, for the firsttime ever, his story about how he had
built an amazing advanced primary carepractice, only to find it destroyed
basically by perverse incentives.

(02:03):
Yeah, it's a dramatic and I don'tknow, pretty tragic tale actually.
So do go back and listen to thatearlier show if you haven't already.
Dr. Scott Conard talks today aboutthe evolution of his life's work.
Right now, Dr. Conard is doing abunch of work with Mike Adams from
7-Eleven, helping their plan members.
A lot of this work is centered onand about a few pretty striking, but

(02:26):
very common insights that many plansponsors will find in their own data.
It turns out about 70%, give ortake, of people who wind up costing
the plan whatever the high costthreshold is in any given plan year.
These higher cost claimantsdidn't fall out of the sky
unexpectedly, 70 percent of them.
They were actually high risk,but low cost in prior years.

(02:51):
So the trick is to find these individualsand help them not fall into the high
risk and high cost part of the graph.
Again, identifying high risk patients whoare currently in the low cost zone, who
any given plan year are going to go out ofthat zone and get into the high cost area.
So, for thinking about best practicesto avoid this, I'm going to run through

(03:11):
Dr. Conard's list that we mostly runthrough in the show that follows, although
some of the steps in the Stepwise wecover more thoroughly than others.
Okay, so here's the Stepwise bestpractice approach to managing population
health at the plan sponsor level.
So, step one.
Get the data.
Not to divide everyone up into, youknow, disease buckets or whatever
you call them, but to run a wholeperson risk score for each member.

(03:36):
You got to treat a patient like ahuman being after all, not the sum of a
whole bunch of disconnected body parts.
Miriam Paramore has a harrowingstory about her father's end
of life, if you want to dig inon that and cry a tear or two.
But bottom line, human beingsare one system, not a coterie
of disconnected parts.

(03:56):
So that's step one.
Do the whole person riskscore with the data.
Step two, get members access to advancedprimary care teams, and those teams
should be empowered and equipped tomake referrals to demonstrably excellent
specialists offering high quality,appropriate, and optimized care.
Step three, in Dr. Conard's stepwisebest practice approach to managing

populations of patients (04:18):
align benefit designs and what you want members to be
doing to ensure that they have accessto get this appropriate, optimized
care that we just talked about.
Dr. Mark Fendrick talked about thison a show from a couple of years ago.
I'll link to it in the show notes.
He talks about benefit designsand optimized medical care being

(04:39):
like peanut butter and jelly.
And here's why he said that.
If, say, for example, a doctor tells apatient with diabetes to go get a foot
exam regularly, so, you know, they don'twind up needing their foot amputated.
And if the patient responds, sounds greatdoc, but I can't go get my foot examined.
I can't afford the copayof the office visit.
Then, yeah, patient loses.

(05:00):
Doc, by the way, gets dingedon their quality scores.
And the plan sponsor winds up, I was goingto say footing the bill, but that might
be a terrible pun if we're talking aboutfoot amputations, winds up paying the
bill for some pretty expensive and alsopretty avoidable disease exacerbation.
So step three is align benefit designswith care pathways what we want members

(05:21):
to be doing, so that's number three.
Number four, the fourth thing in ourbest practice stepwise to managing
populations of patients is to use a toollike My Personal Health Assistant, for
example, or a navigator to make suremembers are engaged and are navigating
the healthcare system along these optimalpathways that we just talked about.
Dr. Scott Conard talks a little bit aboutthis My Personal Health Assistant today.

(05:45):
It's a service his team offersthat engages unengaged patients
and is a needed companion to manyadvanced primary care efforts.
Lastly, lastly, we touch alittle bit in the show today
on community run primary care.
This is a community paying forprimary care for community members,
just like they pay the firedepartment and the police department.

(06:07):
For all the reasons that we talk abouton the show, it's maybe cheaper for
a community to make sure that theirneighbors get primary care so that they
don't go uninsured to the hospital foran exacerbated condition, run up a huge
bill that guess who winds up funding?
Local employers through highercost shifted hospital prices

(06:28):
and taxpayers, of course.
Maybe in the long run, it'd becheaper to keep the town healthier.
And it also, I don't know, justfeels like the right thing to do.
I will mention Primary Care forAll Americans has a free Practical
Guide to Organizing to Bring HighValue Primary Care to Communities.
Dr. Scott Conard, my guesttoday is founder and partner
over at Converging Health.

(06:49):
Converging Health has a data practice, aconsulting practice, and also My Personal
Health Assistant, which Dr. Conard talksa bunch about in the show that follows.
Today, as I mentioned, the show issponsored by Brian Uhlig, and here is
my conversation with Dr. Scott Conard.
Dr. Scott Conard, welcometo Relentless Health Value.

Scott Conard (07:07):
Hey, I'm so excited to be here, Stacey.
Let's change the world.
What do you say?

Stacey Richter (07:10):
Let's do it.
Okay, so let's run through some typicalpoints to ponder and maybe conventional
wisdom and for sure, that conventionalwisdom might be correct, I'm not
implying otherwise, but most peoplewill say that the first step to doing
population health or one of the firststeps is going to be to get your data.
You need the data to be able to gaininsights to figure out what to do.

(07:33):
For example, Wow, do we have alot of musculoskeletal spend and,
um, I recorded a podcast, which isgonna go live in a couple of weeks.
Turns out these days, 6 percent oftotal costs for most health plans
are emergency room visits right now.
So basically, get the data andthen get a bead on what's actually

(07:53):
happening in that planned data.

Scott Conard (07:56):
I'm having a strong visceral reaction to what you just
said because I think it's indicativeof the way we think about data wrong,
not the way we think about it right.
So it's interesting whatyour emergency spend is.
It's interesting what your musculoskeletalspend versus your cardiometabolic
versus your cancer spend is, but a humanbeing, we've got to throw the actuarial

(08:17):
accounting approach away and we've gotto engage a whole person risk strategy
because the person who's got the backpain is obese and they have diabetes
and the person who has a cancer alsohas COPD and they have atherosclerosis
to their lower extremities and so whatwe do is we come at them with this
diabetes and hypertension solutionand they're like, excuse me, I'm in

(08:37):
hospice with stage four lung cancer.
It's like, are you kidding me?
Or hey, you can get a hundredpoints if you go walk a 5k and we
have a corporate sponsored one thisweekend, would you please sign up?
And they're like, I just had neck surgery.
I can't feel my left arm.
And it's just embarrassing.
It's, uh, the, Dennis Bishop usedto call it the Easter Egg Hunt,
where we give people points if theygo do things, regardless of the

(09:00):
human being that you're talking to.
So, so what's interesting to me inthe data that you alluded to was,
one of the challenges as a humanbeing it has to address in order to
lower their health risk and thereforedecrease their likelihood of having
a clinical event and increased cost.
What do they need to do to becomehealthy and decrease their illness?

Stacey Richter (09:22):
So what I'm understanding you say is that it's
not just like a whole bunch of.
You know, we're dividing people into the

Scott Conard (09:29):
It's allopathic medicine.
It's like people or a car.
You've got a carburetor, you'vegot an engine, you've got
tires, you've got upholstery.
And we're going to talk abouteverybody in your company's engine
looks like this and everybody inyour company's tires looks like this.
And it's like, you need to treatthe car, not just change a tire.

Stacey Richter (09:44):
Okay.
So let me restate our, our stepone here, which is get your data,
but what should be done with it?
Isn't the typical divideeverybody into diseases.
What should be done is have somekind of equation algorithmically
where you're, we're assessing whole,you call it the whole risk score.

Scott Conard (10:03):
The whole person risk.

Stacey Richter (10:04):
The whole person risk score.
So, so effectively what we're doingis we're scoring, you know, based on
all of their whole person, what thecategories are in that population of who's
really at high risk, who's not, right?
Like, and we're staggering the individualsin our population relative to that,
because that is going to determinewhat the risk is overall, as opposed

(10:28):
to like what is the musculoskeletalrisk or something like that.
That's actually very interestingand a big paradigm shift.
So that's number one relativeto the get your data.

Scott Conard (10:36):
It's such an opaque system.
It's not a system.
It's such an opaque marketplace.
And so you get a person who doesn'tunderstand what they really need to do,
trying to figure out what to do, and theytalk to somebody at a water cooler, and
they say, oh, I went to, you know, Dr.Hatchett, and Dr. Hatchett, you know,
cut this off me, and now I feel better.
You should go, and it'scompletely inappropriate care.
So, the flaw or the fly in thatointment was that people didn't

(11:00):
understand what's going on.
The other fly is that I feel fine is Iam healthy about 60 percent of the time
and I feel fine is I just haven't gottensymptoms about 30 percent of the time
and the rest is I don't feel fine andI've got symptoms out of the people.
So what happens is people willdelay engaging in care while there's

(11:22):
something you could do to reverse it.
In fact, in the data, what we find is 70percent of the time when you have somebody
that becomes a high cost claimant or has ahigher cost associated with them, we call
them high risk, high cost individuals.
70 percent of the time, if they had gottenappropriate Intervention, preventive
care, medications, and change theirlifestyle, they would not be there.

Stacey Richter (11:44):
Okay, so that's why it's so important to get the data, but
it's not just about getting the data.
It's like, it's really what are youdoing with it and making data driven
decisions based on someone's risk scoreso that we're optimizing the usage
of the system, not kind of chuckingpeople into various point solutions
with the issues that you've described.

Scott Conard (12:04):
So let me say, systematically driving people into the
most dangerous healthcare marketplace evercreated in the world is not a good idea.
CFOs should get very upset withthat and say, let's not do that.
Driving people into a optimized systemof outstanding care, the greatest system
in the world, when they have a need andit's appropriate, will save that same CFO

(12:28):
a ton of money and the HR suite honestlyneeds that CFO, COO, CEO to get on board
with getting people to the clinicallyoptimized high quality care so that
they don't have to fund the 70 percentof things that happened that didn't
need to happen that are now high cost.

Stacey Richter (12:46):
We've got step one, get the data, but use it to
optimize high quality care, right?
Like it's not just a get the data.

Scott Conard (12:55):
Oh, look at the cancer.

Stacey Richter (12:56):
It is very much, um, there's roadmap.
For what should be done with thatdata, what is the whole person
risk score of any given individualthat are in that population?
So that's number one.
We've got our second step here, whichis to get our advanced primary care game
strong so that the team there is empoweredand equipped to refer to specialists

(13:20):
with proven outcomes on appropriate care.
Maybe there are, I've heard it said,green, yellow, and red options of
specialist practices, for example.

Scott Conard (13:28):
So, Stacey, I think that you're really hitting
on incredibly important things.
And by the way, just a quick sidebar.
There's a group of us thatstarted an organization called
primarycareforallamericans.org.
And all it is, is a statement thatevery person in America needs to have
access to high quality primary care.
Period.
It's got to be done at a community level.
It's not something you'dlegislate from Washington.

(13:50):
And so this is how do people ina community figure out how their
primary care is going and how theycan improve it so that every person
in a community gets appropriate care.
And the stunning thing for me, Stacey,is that If everybody, like, let's
suppose that they said, oh, we've gotwater, we've got waste removal, we've
got police, we've got fire, and we'regoing to now put primary care in.

(14:14):
The cost of primary care foreverybody in the community to get
it is the same as fire and police.
And it would decrease the cost, forthe CFOs listening, it would decrease
the specialist and facility costs,so dramatically, it would fund it.
Now, I don't, I don't believe in, youknow, in the state running things, but
the question that we're trying to do isget people to figure out how do we make

(14:34):
sure everybody gets access to primarycare because we as taxpayers, let's be
real, we as taxpayers through Medicaid,Medicare, uninsured care, that then
they transfer the cost over to privateinsurers, we are paying for people not
getting preventive and primary care.
Preventive and primarycare are an investment.
The rest of health care is an expense.
And you can invest in that smartly, andit will pay for itself three times over.

Stacey Richter (14:59):
And we can link to a, uh, in Rhode Island, they're doing,
there's a really good example of, of acommunity that, installed, I'm not sure
what the right word is, stood out care.

Scott Conard (15:11):
That's right.
They found everybody but 200people that had got, had access
to effective primary care.
And so the community said, we're going to,they went to the primary care doctor and
said, would you care for these 200 people?
Yes.
How much would you charge?
$40 a month.
And they just wrote a check for them.
So now all of a sudden these peoplewho are showing up in the emergency
room and very, very sick, we're gettingproactive care and it saved them a lot.

Stacey Richter (15:31):
Read Hospital press releases, they say they have to
charge plan sponsors more becauseof all the uninsured or underinsured
patients that are showing up.
So, you know, like this is not likethere's some curvy line that's very
squiggly from point A to point B. Likewe have a pretty direct correlation
between let's get everybody good primarycare, not transactional primary care.

(15:53):
It is relationship basedadvanced primary care.
This primary care team has thedata to know which specialists
or specialist practices areachieving the better results.
Doctors who have demonstrated alignmentwith the general appropriateness measures,
which is a term that at least MartyMakary, Dr. Marty Makary uses, he was
on the podcast in 2024, in September2024, talking about that, if anyone

(16:18):
wants to go back and listen to it.
You, my friend, we're going to talkabout an example, like a real live
example, and maybe we can kind of likebring this home, all these sort of
theoretical concepts that we talked about.
Maybe let's talk about them in the contextof like a very exemplar patient study.

Scott Conard (16:34):
Mike Adams is the one who is designing and
implementing with his leadershipteam a new approach at 7-Eleven.
And Brian Uhlig is an example of a planof a broker consultant who gets it.
And so here's a realexample from the last year.
There's a woman, I'm goingto call her Margaret.
That's not a real name.
But when we did the wholeperson risk score, it was high.

(16:54):
And a hundred is what it was.
And this is not on ascale of one to a hundred.
This is on a scale ofone to about two hundred.
So it's high.
And she had spent $14,324in the last 12 months.
She'd missed 16 days of work.
And she'd gone to primary care officewhere she had seen the seven minute nurse
practitioner visits, and I'm not bashingnurse practitioners, they're necessary and

(17:17):
important, but she was running through thefee for service system in the usual way.
She'd had five emergency roomvisits, she had not gotten her
cervical cancer screening mammogramand colonoscopy, although she was
the age she needed all of them.
And the ER doc on the last visitsaid you need to go see a back
surgeon and sent her to a backsurgeon who said she needed surgery.
And so she reached out to what wecall the personal health assistant

(17:40):
and said, I can't afford tocontinue to live my life this way.
It's bankrupting me.
What do I do?
She felt hopeless and helpless.
So the plan benefit structure thatwas designed by the company she's in
actually is designed to minimize the costif you seek and get appropriate care.
So what happened was that she got adifferent primary care clinician, one that

(18:03):
was aligned with her in terms of the, youknow, the risk profile and by the way, I
just want to make a slight aside and sayon site, near site clinics and prepaid
advanced primary care solutions are anexample of the way a lot of companies are
addressing this and I think it's brilliantand it's going, it makes a big difference
and I've got the data to prove it.
But anyway, so this particular person,she didn't have access to that, but

(18:25):
we got her to a, let's say a greenadvanced primary care provider who got
her in, educated about what's going on.
She got her cervical cancer screening,mammography, colonoscopy, thank
goodness they actually turned outto be okay, and set her up with a
nurse practitioner in his office.
And she, the nurse practitioner,who loved to educate, taught this

(18:46):
woman about what's going on and thepersonal health assistant also got
her connected with their weight lossprogram that they have at the company.
So fast forward a year later, she'sgot primary care, she's engaged,
she's on the right medicine, she'sgotten the preventive services.
She weighed 30 pounds less.
Her risk score had droppeddown to 41 from 100.

(19:08):
The projected spend of a person witha risk score of 41 is $3,500 a year.
So, the projected spend at 104for the next 12 months would
have been $25,000 on average.
So we took her from a person who, witha prospective risk score, was going
to spend on average $25,000, down to aperson who's going to now spend $3,500.

(19:29):
So all CFOs, please take note, wespent about $3,000 on her and some
medication that cost about $800.
And we decreased the likelihood of youwriting a $25,000 check dramatically.
And now she wasn't feelinghopeless, helpless.
By the way, she had missed,she still missed five days of

(19:50):
work in the last 12 months.
And those five days were for thecolonoscopy and the mammogram.
And she had caught a cold and shewent to physical therapy for her low
back pain, but she was able to domost of that at home through a really
innovative point solution that reallyworks because in musculoskeletal point
solutions make a huge difference.
So this woman's life wascompletely transformed.

(20:13):
She had a guide, the personalhealth assistant, that, by
the way, is not a nurse.
It is not a clinician.
It is just a person that understandstheir health benefits, how to work the
health care system, how to use the pointsolutions effectively, and is connecting
her along the way and walking sideby side with her through the process.
So what we just did, we just heard, ishow do you take the chaos of the most

(20:35):
dangerous healthcare marketplace in theworld and create a healthcare system
that promotes health within your company.
I could go over a hundred examples thatare very similar to this where they stayed
engaged, they afforded it, the cost wascovered, most of the prevention was.
For this woman, her out ofpocket this year was under $500.
So, the median deductible, she spent $500.

Stacey Richter (20:59):
Recapping what you said there because I think that was very
striking and this is kind of anotherthing I guess you can do with the data is
correlate the risk scores with the spend.
So as you said, the whole personrisk score is from zero to 200.
She was around a hundred andshe was costing, you know,
those around the hundred range.

Scott Conard (21:17):
$14,000.
Yeah.
If you look at her actual spend theyear before she started to work with the
personal health system, it was $14,324.
Looking at that risk score, projectingthe average person with the risk
score spends $25,000 a year.
So, believe it or not, she came inunder the average, but still she had to
meet her deductible and was very toxic.

Stacey Richter (21:35):
Okay.
Margaret had spent $14.4, but the averagespend with her same risk score was $25k.
So chances are she's going to regressto the mean and we're going to have a,
yeah, spend is just going to increase
. Through this program, the team got her from the 100 risk score down

(21:55):
to a 41, and average at 41, wholeperson risk score is $3,500, which
obviously is considerably less.
I also could just think relative to thewhole attract and retain talent mandate
that, wow, this feels so comforting.
As you said, she's hopeless and helpless,like just to now have hope and feel helped

(22:21):
would just have such a psychologicalsafety versus kind of being chucked in
the chaos of the healthcare marketplaceand being told to fend for yourself, which
as you said, and I think this is becomingincreasingly clear is very dangerous.
It's, it's dangerous financially.
It is dangerous from anover treatment standpoint.
Like people are becoming aware of this.

(22:41):
So if we are even just thinkingabout it from the attract and
retain, having a solution like thisfeels, I'm sure it feels daunting
for every plan sponsor listening.
But there is a pathway, there is aroad to get to a place like this.
It's not like anyone is, you know,taking a machete and has to go
hacking through the jungle, right?
Like, this has been done.
There is a road to get to a solution likethis . So it's possible to work with

(23:05):
an entity like yours to get this done.
Let me ask you one last thing here.
It is often said, and I oftenhear, that 5 percent of any given
population is 50 percent of the cost.
And because of that, I have talked toplenty of pretty sophisticated plan
sponsors who are like, you know what?
We're not going to do anything reallywith the people who are in air quotes, I

(23:27):
feel fine or they're healthy or whatever,because it never works out, right?
Like you wind up spending a ton of moneyand the cost curve does not get bent.
So, we're going to focus entirelyon the 5 percent and we're really
going to make sure that thosedollars are spent very wisely.
Like, you know, make sure that oncologypatients get nausea med because turns

(23:49):
out oncology patients with nausea arethe most common cause for readmissions.
Like, like that is what we're goingto solely throw our backs into.
If you're confronted with that sort ofphilosophy and maybe a lot of historical
data to back that up, what do you say?

Scott Conard (24:06):
What we know is that the people that are high risk, high cost,
and by the way, when we define high cost,we're actually saying, you know, more
than $6,500 a year is high cost, okay?
So what we see in our data isthere's somewhere between 9 and 14
percent of the population that isspending 80 percent of the money.
And by the time you're spendingsix thousand plus dollars a year.

(24:26):
It's not routine preventiveand primary care.
You're actually in the system.
You're, you're floundering around in theocean of, Oh my gosh, what do I do next?
And that's why we chose that number isbecause when you look at that, that's
where people need a lot of support.
It is going to be specialists,facilities, and optimization of
pathways of care, which we didn'treally talk about a whole lot today.

(24:47):
So 60 percent of the people thatare in that high risk high cost will
either die, go on disability, retire,or they'll go back into the low cost
the next year, i. e. they have a heartattack, they spend $100,000, the next
year they're going to their familydoctor and cardiologist and getting
a stress test and they spend $4,000.
And so a new 60 percent isgoing to replace them, and

(25:10):
guess where it comes from?
It comes from the high risk, low cost.
And so what those companies are arguing,and I appreciate their frustration in
having wellness programs not workingin the past, I'm not being critical.
But what they don't appreciate is thatthe people who are now going to move
in and replace those high cost people,70 percent of the time, if they had
gotten basic preventive and primarycare, would not be migrating up there.

(25:33):
It's like saying we're going to letthe houses catch on fire and we're
going to discharge a fire truck and wethink that's the best way to decrease
the cost of fires in our community.
It doesn't make sense.
You put fire alarms in, do thebasic things to keep the fires
from happening, or when they get onfire, you catch it early, you put
it out before it damages the house.
Because even though you put thefire out of the house, it's not like

(25:56):
that house is livable the next daywhen it's been that far destroyed.
You've got to go rebuild thewhole thing and that's expensive.
So, it is a strategy that, that isnot going to get them where they
want to get, is what I believe.

Stacey Richter (26:09):
So, what I'm hearing you say implicit in that
it's not like this 5 percent likecame out of nowhere a lot of times.
I mean, maybe some, some ofthem do, like all of a sudden
they get some life threateningcancer that just like happened.

Scott Conard (26:19):
Brain cancer, pancreatic cancer, gallbladder cancer.
Yeah.
I mean, people, 30 percent ofthe time, they got struck by
lightning and it's not fair.
It just is.

Stacey Richter (26:27):
So that's 30 percent of the time, but you actually
do have 70 percent of the time.
It was a, it was a slow roll upto that top point, or it was like
a, kind of a building situationthat all of a sudden crescendos.
So it is in fact possible, using the data,the whole person risk scores to identify

(26:48):
these people that are on their way towhat is probably going to be within a
short enough period of time, a costly,problematic from a health standpoint,
like bad for everybody situation.
And, you know, there's a lot of waysto do this wrong, as you said, where
you're just poking and prodding anddoing all kinds of stuff to all kinds of
people and basically over medicalizingand spending a whole ton of money

(27:11):
and it's not getting you anywhere.
Certainly there's ways to do thiswrong, but if you do this right,
that's what you can accomplish.

Scott Conard (27:18):
What I would say is don't boil the ocean.
Don't take 100 percent of your populationand force them into the healthcare system
thinking somehow that's going to savemoney and make people get right care.
That has been proven beyond areasonable doubt to not work.
Get your data, find the 30%, figureout what they need, like have a care
plan for them, give them a guide togo through the system that you have
created with your point solutions andyou know, you're optimizing the network

(27:40):
and your bundled care if you have that,and have the guide walk them through.
What you'll find is badthings don't happen.
We've seen that movement from the highrisk low cost to high risk high cost.
In the company, I'm talking about 23%.
of the people in the low cost,high risk population moved to the
high risk, high cost last year.

(28:01):
We have corporations that we've workedwith for years that we've gotten that
down to as low as 11%, but on average, 15percent is very possible after two years.
And every time someone moves from thehigh risk, low cost, which is about $1,500
a year, to high risk, high cost, whichaverages 33 to $35,000 depending on your
network contracts, you just saved $28,000.

(28:23):
And it's very easy to do the mathon, okay, if we have a solution
that costs $200,000, we need to getin there and keep 10 people from
migrating up and it will fund that.
And on average, you can do 4to 18 times that if you have
effective programs in place.

Stacey Richter (28:41):
You're going to have like 30 percent that migrates
from, they were not on the radar.
In other words, they weren't high cost to

Scott Conard (28:49):
Right, they felt like they weren't engaged.

Stacey Richter (28:51):
Yeah, to all of a sudden they are.
So it feels like it came out of the bluefor the plan sponsor, but in a way we
were not using our data and calculatingthis because they didn't actually
come out of the blue most of the time.

Scott Conard (29:03):
Well, cancer has been in a woman's body.
Let's say breast canceror cervical cancer.
Three to five years before it's diagnosed.
Hypertension, diabetes, high cholesterolhas been in a person's body five to twenty
years before there's a complication.
There's plenty of time to get in thereand get in the game and help that person,
but saying, let's hope they make it toMedicare and let's just wait till they
blow up and somehow spend less on them isa really challenging way to run your life.

(29:27):
It, you know, to avoid preventionin primary care is to damn yourself
to, you have a good year, you havea good year, it's a horrible year.
And you reset the base pointand then you have a good year.

Stacey Richter (29:38):
And based on sort of the numbers that you're sharing, you
said you got to only find 10 patientsand keep them from progressing and
you pay for the whole programs.
That is a very smallpercentage of patients.

Scott Conard (29:50):
Right.
And so in the large company thatwe've been talking about today, if we
reduce the percentage of people thatgo from the high risk, low cost to
high risk, high cost, just by 3%, itwill save $12 million for the plan.
The cost is under a million dollars.

Stacey Richter (30:06):
I was just going to say, it's not 12 million.

Scott Conard (30:07):
We get an 11 to 1 ROI, and we know because of historically
being able to do that again and again,that over the next 18 to 24 months,
this is not in 12 months, but 18 to 24months, as we get people through that,
they meet their guide, they get to knowtheir guide, they like their guide.
And by the way, this is not a call center.
This is a one on one relationship.
It is not a transaction.
And that is something that somany people are missing today

(30:29):
is having that trusted guide.
As we know, we're going to beable to accomplish it and we're
going to track the numbers as wedo always in those situations.

Stacey Richter (30:35):
So talk about Converging Health.

Scott Conard (30:38):
Stacey, as this mindset that we've gone over today has evolved
over the last 18 years, we ended up havingto create a company called Converging
Health that has the clinical analyticsthat actually do the risk scores and
figure out what's going to happen topeople and gives them that care plan.
So that's the first part of our company.
The second part is companies gotfrustrated seeing that their risk

(30:59):
scores weren't going down andpeople weren't getting healthier.
It was not a healthcare system, it wasjust a financial extraction system.
And so we, we created My PersonalHealth Assistant at their insistence,
and one of them funded it, actually.
And so we have the My PersonalHealth Assistant, which creates the
guides to help people navigate theirhealth benefits, healthcare system
literacy, and their health literacy.

(31:19):
And then we have consulting because howto apply this and what the timing is,
every company is different, and they havedifferent geography, they have different
challenges, and they have different sizes.
So, we have a consulting divisionboth on one side for ACOs and medical
groups in transforming their care,That, uh, Dr. Mike Tuggy leads,
and then on the corporate side.

(31:41):
But our goal isn't to havejust ongoing consulting.
It's to teach them, give them the data,have them put effective tools in place,
and need us less and less over time.
Because their people are healthier,and we've added years to the
life, and life to the years.
By empowering the individualpeople through effective plan
benefit design to take controlof their health and well being.

Stacey Richter (32:00):
Converging Health.
We've got the clinicalanalytics side of the house.
We've got the My Personal HealthAssistant, which is navigation and
coaching and all the things that arewrapped up in the one to one relationship.
And then we've got the consulting arm.
Dr. Scott Conard where can people find youif they are interested in learning more?

Scott Conard (32:18):
Yeah, converginghealth.com is probably the easiest place.
And, uh, we'd love to, you know,help support people through
this journey as much as we can.

Stacey Richter (32:25):
Dr. Scott Conard, thank you so much for being on
Relentless Health Value today.

Scott Conard (32:28):
I think you're so wonderful, Stacey.
I just think you're fantasticand I'm so honored to have
gotten to be here with you.

Stacey Richter (32:34):
Thank you so much.

Scott Conard (32:34):
You're changing the world.
This is Dr. Scott Connor from ConvergingHealth, encouraging everyone to
listen to Relentless Health Value.
Stacey, I listen to your show every week.
I can't wait for it to come out bothbecause I love the people you have on.
They're brave, courageous peoplewho are willing to speak out,
and that is really challengingin today's political environment.
And, two, what I learn, and Ialways learn something, and what

(32:58):
comes to me as I listen to thisis, who can I share this with?
And so I will send the Relentless HealthValue link, text it to people, and
email it to people, and it's amazing tome how people listen, they get turned
on to you, and they change the waythey're designing their health benefits,
they're reviewing their contracts,they're getting their PBMs contracts.

(33:18):
And it is so exciting to be ableto have you in the world doing that
because I don't know of anybody elsethat has the wisdom and the vision
that you're putting forth and bringingthe people that you are on your show.