Why We Need "Conscious Healthcare" (with Dr. Scott Conard)

This video provides an in-depth exploration of "Conscious Healthcare" and the blueprint for employers to revolutionize their health benefits, decrease costs, and improve employee health outcomes. Dr. Scott Conard, a family doctor and founder of Converging Health, argues that the current U.S. healthcare system is plagued by "crony capitalism" and perverse incentives, where financial success is often tied to sickness rather than health. He shares his personal journey, triggered by the loss of three patients who felt "fine" but had unmanaged health risks, which led him to shift his focus from chasing symptoms (lagging indicators) to managing health risk (leading indicators). The central thesis is that employers, particularly those utilizing self-insurance models like captives, are the most influential force capable of driving systemic change by aligning incentives toward proactive health management.

The core of the proposed blueprint involves leveraging sophisticated data analytics to create a "digital twin" for every employee, allowing for predictive modeling of potential health outcomes. This system integrates disparate data sources—including medical and pharmacy claims, eligibility, biometric data, EMR data from Advanced Primary Care (APC) providers, and participation data from various point solutions. By analyzing this comprehensive data, the system identifies the top five health risks (cardiometabolic, cancer, musculoskeletal, vascular, mental/behavioral health) and generates a prioritized list of interventions (up to 15 for high-risk individuals). This data-driven approach informs the second critical component: the personalized engagement model, exemplified by the "My Personal Health Assistant" program.

The Personal Health Assistant (PHA) serves as a dedicated, non-clinical navigator who helps members understand their health risk, overcome system barriers, and engage with appropriate resources. The PHA focuses on discovering the member's "why" (their personal motivation for health change) before guiding them down the "Yellow Brick Road" of right care, right time, right place, right person, and right price. This model emphasizes removing financial barriers for proactive, high-quality care while increasing barriers for inappropriate or low-value care. Dr. Conard cites substantial ROI figures, noting that for every high-risk person who engages, the company saves approximately $1,500 annually, with overall ROI reaching 4:1 initially and up to 10:1 after three years. The final component of the blueprint is the foundational reliance on Advanced Primary Care (APC), which is defined as primary care incentivized for total cost of care and willing to share data, demonstrating a proven ability to reduce population health costs by 20-30%.

Key Takeaways: • Shift from Symptoms to Risk: Healthcare strategy must move away from reacting to symptoms (lagging indicators) to proactively managing health risk (leading indicators). This requires identifying and intervening on underlying conditions like high cholesterol, obesity, and metabolic syndrome before they lead to catastrophic events. • The Blueprint for Better Benefits: The comprehensive strategy involves four pillars: 1) Intuitive, actionable data analytics; 2) Redesigned plan benefits and communication focused on the member's health journey; 3) Personalized advocacy and navigation; and 4) Foundational use of Advanced Primary Care (APC). • Data Integration is Essential: Effective population health management requires integrating all available data sources, including medical claims, pharmacy claims, eligibility, biometric screenings, EMR data (from APCs), and participation metrics from all point solutions to create a holistic "digital twin" of the employee. • The Personal Health Assistant (PHA) Model: A dedicated, non-clinical navigator is crucial for driving engagement. The PHA acts as a Matchmaker, connecting individuals to the right point solutions and care providers, focusing on understanding the member's "why" (motivation) before initiating any change management. • High ROI from Engagement: Engaging high-risk individuals saves approximately $1,500 per person annually, while engaging low-risk individuals saves $600 per person. Sustained engagement through personalized advocacy can yield an ROI of 4:1 initially, growing up to 10:1 over three years. • Incentives vs. Penalties: While positive incentives ($600+) attract early adopters, structuring the plan with a penalty (charging $600 if they don't engage) results in a 15-20% increase in participation, demonstrating the power of loss aversion in driving health engagement. • Advanced Primary Care (APC) as the Keystone: APC doctors are incentivized for total cost of care, not fee-for-service, leading to 20-30% cost reduction in a population. Unlike traditional Direct Primary Care (DPC), APC must partner with the employer/plan to share data (often via EMR integration) to ensure measurable outcomes and population health tracking. • Combating Fraud and Abuse: Significant savings can be achieved by auditing large hospital bills (30-40% often found to be fraudulent or unnecessary) and auditing the spread between what insurance companies report paying doctors versus what they actually pay the company. • High-Quality Care is Cost-Effective: The highest quality care is often the least expensive. Examples include guiding patients to centers of excellence (e.g., Cleveland Clinic for valvular surgery, where mortality rates are 6% vs. 26% at community hospitals) and implementing proper care pathways for conditions like musculoskeletal issues, which can eliminate up to 70% of unnecessary surgeries. • Addressing Mental Health First: Mental and behavioral health challenges often prevent individuals from engaging in physical health interventions. PHAs must build trust to uncover these issues, as addressing mental health is prerequisite to successful physical health management. • The CEO/CFO Mandate: Corporate leadership must stop tolerating mediocrity in healthcare benefits and actively invest in proactive risk management. The Consolidated Appropriations Act (CAA) now places fiduciary responsibility on CFOs to ensure fair and transparent pricing, making inaction untenable.

Tools/Resources Mentioned:

• Converging Health: Dr. Conard's company providing clinical informatics, data analytics, and the Personal Health Assistant program.
• Paro Health: A large benefits captive mentioned as an ideal vehicle for small-to-midsize employers to adopt these risk management strategies.
• Wonder (formerly Naturally Slim): A point solution for cardiometabolic health mentioned as an example of a program integrated by the PHA.
• Mayo Clinic: Mentioned as a center of excellence for complex, high-quality care.
• Which Door: A book written by Dr. Conard detailing the possibilities of transforming healthcare benefits.

Key Concepts:

• Conscious Healthcare/Conscious Capitalism: A philosophy advocating for a healthcare system where all stakeholders (patients, providers, and funders/employers) win, moving away from "crony capitalism" where incentives are misaligned and prioritize profit over health outcomes.
• Digital Twin: A comprehensive digital representation of an individual's health status, created by integrating all available claims, clinical, and engagement data, used for predictive risk modeling.
• Yellow Brick Road: A framework for guiding patients to "Right Care, Right Time, Right Place, Right Person, Right Price," minimizing financial barriers for appropriate care and increasing them for inappropriate care.
• Clinical Care Engineering: The process of using data and clinical expertise to design and implement efficient, effective, and high-quality care pathways.
• Seven Numbers that'll Save Your Life: A reference to key health metrics (detailed in Dr. Conard's book) that individuals need to know and manage to reduce their cardiovascular and metabolic risk.