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

  • 2025/01/30
  • 再生時間： 34 分
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EP462: Managing Populations of Whole, Actual People Who Are Not the Sum of a Bunch of Different Body Parts, With Scott Conard, MD

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  • 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. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. 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 a particular employer client. 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 ...
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あらすじ・解説

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. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. 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 a particular employer client. 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 ...
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