How Whole Person Care and Data Can Transform Healthcare Outcomes

Welcome to another episode of Patients Win. Today, we explore what it truly means to move healthcare upstream, shifting the focus from reactive disease treatment to proactive, whole-person care. We’re joined by Dr. Scott Conard, a family physician and leader in value-based care, who shares his transformative journey from traditional allopathic medicine to embracing integrative and preventative health. Dr. Conard recounts how personal loss early in his career compelled him to question the conventions of medicine and motivated his mission to become not just a doctor, but a healer focused on the entire individual - body, mind, and spirit.

In this conversation, you’ll hear candid stories about the shortcomings and perversions of value-based care, how data and risk management can be harnessed to save lives before crises strike, and how innovative care models are both saving lives and challenging the financial incentives of traditional healthcare systems. Together with hosts Dr. Jonathan Bushman and Troy Reichert, we’ll discuss empowering patients to take control of their own health, building systems that identify risk before it becomes reality, and the ongoing battle to align healthcare incentives with true wellness. Get ready for a deep dive into the future of medicine, the power of data, and the courage it takes to lead change that puts patients first.

Timestamps:

00:00 Transitioning from Doctor to Healer

04:11 Rethinking allopathic medicine basics

08:58 Building health literacy and relationships

11:27 Discussing patient post-surgery recovery

15:11 Mindset and Physical Transformation

17:50 Using data to prevent health issues

22:42 Using a whole person risk score

24:08 Expanding and diversifying clinic services

29:51 NDA and deciding to leave

32:34 Discussing healthcare financial conflicts

33:34 Frustrations with insurance and patient care

37:59 Improving Patient Care and Services

40:44 Innovations in healthcare cost reduction

45:01 Commitment to healthcare reform

48:36 Hospital reimbursement rates increase

50:54 Discussing US healthcare costs

Show Website - https://thepatientswin.com/

Primed Healthcare - https://primedhealthcare.com/

Troy Reichert - Show Host - LinkedIn - https://www.linkedin.com/in/troy-reichert-67606b5/

Dr. Jonathan Bushman - Show Host - LinkedIn - https://www.linkedin.com/in/jonathan-bushman-do-106821191

Media Partner - TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Transcript

SPEAKER_01 0:00

She works in a clinic with the number one employer of physicians in the United States. But she's quitting her job there because they're having her do diabetes retinal screening on blind people. And she's like, why am I doing retinal eye exam on someone who's already blind? And they're like, oh, don't worry, we need to get our star ratings up. And she's like, I don't want to be a part of this. So value-based care has been perverted and bastardized so badly.

SPEAKER_00 0:45

I'm Dr. Jonathan Bushman, along with my co-host Troy Reichert. And today we're going to be exploring one of my favorite concepts in healthcare, which is how do we move upstream? And uh very privileged to have one of my great friends, someone I look up to, and a mentor of mine and Scott Conard, who's a family physician out of Dallas. And I'm so excited to have him with us today. Scott, welcome to the show.

SPEAKER_01 1:10

Very excited. Thanks, Jonathan. I can't wait. We're gonna have fun, that's for sure.

SPEAKER_00 1:14

Absolutely. Scott, you and I uh met a few years ago. Um, and looking back on how many different pieces of a puzzle have to be connected for certain people to meet, um I I start looking and connecting the dots and connecting the dots, and it's somewhat incredible to me. This happens in healthcare a lot, where um you end up meeting, and once you've met someone that you click with so well, um you forget the time of your life when you didn't know them. So um I feel that way about you, and um the synergies that we've had in working together have been phenomenal. And um, for those of you who don't know Dr. Connard, um, I'll let him introduce himself a little bit further. But he's a family physician out of Dallas who um really found his way in healthcare in multiple different ways as both a leader and and entrepreneur into just this passion for figuring out how to improve the lives of his patients. And um can't wait for you to share your personal journey, your personal story about how you got there. So without further ado, Dr. Connard, please uh tell us a little bit more about your background and how you got into medicine and and and we're gonna get into this conversation about getting upstream.

SPEAKER_01 2:33

Well, for the sake of your audience, let's uh I'm gonna um I'll tell my the the the lessons I've learned and the story behind it. It's much more interesting that way. And and so the first thing I'd say is that um what I'm really, really clear about as a is I went from an allopathic doctor, which you know, I was like in the uh, you know, top of my medical school class and top of my residency chief resident, and I just thought I was all that in a bag of chips, you know, when I came out, like, you know, modest doctor, yeah, cough, cough, cough. And I got really clear that allopathic medicine in the United States of America, and I know you're an osteopath, which is more enlightened in my opinion than the MD allopath, but it needs to continue to evolve. So I kind of moved from a doctor to a healer, and being a healer takes care of the whole person. They don't take care of a disease, they don't take care of an organ, they take care of a person. And so who I am today is a person who has evolved from allopathic doctor to a I went and got a board certification in holistic and integrative medicine to try to figure out what what's missing. And the reason that that happened was um seven years into practice, uh, my best friend who was in his early 40s at the time, who I had just seen as his doctor in the last 90 days, died. And by the end of the summer, two more of my patients in their 40s had died. And you know, when you're the greatest doctor ever, Marcus Wellby reincarnate, that's not supposed to happen, right? And so at that point, it was like, wait, time out, stop. I've been sold a bill of goods, or I'm not doing what I was taught, and I was doing what I was taught. So I went back and said, What are we missing in allopathic medicine? And how do we start to do it differently? And so those the death of those three had me go from a reactive allopath who was looking for disease to uh uh you you know, you said swimming upstream to, okay, wait a minute, those people died of heart disease. Where does heart disease come from? Well, this was 1996, so we didn't really understand uh everything about it, but now we do, right? It's a plaque, a plaque rupture. So somebody can go from feeling fine to dying in in a second. Well, uh, what causes a plaque? Well, diabetes, hypertension, and high cholesterol. What causes those? Well, obesity and excess calories cause those. So, well, what causes that? Well, lifestyle. So it all kind of rolled back uphill, and I started going from treating congestive heart failure, AFib, and and uh and heart disease to uh diabetes, hypertension, high cholesterol to obesity. And um, and then finally I got really clear that um these are not these are not bodies that we're treating, these are human beings that we're treating. And so the obesity, why do people why are they obese? And then I had to take a big step back and say, you know what? I can't have a transactional practice. I have to have a relational practice where I get to know the human being, and then I can help them actually all the way upstream start to enjoy, experience joy, peace, love, patience, kindness, self-control in their life. And so this whole person perspective that I've evolved through started from a karma, you know, kind of a body mechanic and worked all the way back up to someone who just loves people and loves to help them add years to their life. But I come from Florida. There are a lot of people sitting in nursing homes, stooling and drooling, baby. That's not being alive. So the second the second clause is life to your years, and that's about health span. But I got really clear that I didn't eat, drink, sleep, exercise, take medicine, go to the doctor, get cancer prevention screening. I can't do that for my patients. There's only one person that can determine how long and how well they live, and that's them. So the third phrase is by empowering you to take control of your health. And that's what I've dedicated my life to.

SPEAKER_02 6:49

So, Scott, where were you when that happened? I mean, you have three close friends that die. Were you at a hospital? Were you uh in independent practice? Where were you?

SPEAKER_01 6:59

No, I was just like Dr. Bushman going into the office every day. Um, so I was just seeing these patients. You know, the first one, uh, he was he had what we today would call metabolic syndrome and uh and hypertension, and he died of a massive heart attack. Um the second one was a woman with type 1 diabetes, and she was afraid to titrate her insulin up because she was afraid of hypoglycemia or low blood sugar, and so um she was walking around with a hemoglobin A1C that was in the low teens, and I could not get her to get it down. Um and the third one was a woman who smoked cigarettes, had a family history of heart disease, and she went hiking with her kids out west somewhere and uh and had a massive heart attack walking up a mountain. Um, you know, but again, all three of them I had just seen, and I said, How do you feel? I had the notes. I went back to the notes and I said, uh patient feels fine here for whatever medicine refill or annual exam, whatever it was they happen to be in for. And then I'd say my assessment plan was here, you know, I recognize the problems, and I'd say to them, I need you to take a medication, I need you to take a statin for your cholesterol, or I need you to increase your insulin, or I need you to um you know take a higher dose of antihypertensive medicines, those kind of things. And they'd all say, But Dr. Connard, I feel fine.

SPEAKER_03 8:19

Wow.

SPEAKER_01 8:20

And they did feel fine until they didn't, and then we were trying to react, but all three of them died before we could even get them into care. And so that's where I got really clear. I'm a risk management expert. I am not a symptom treating expert. I do a lot of that and I can do it well, but I don't wait for symptoms. I work with people and uh to to make sure that um they understand their risk. My job is not to tell them what to do. My job is not to get up in their grill and and you know, and insult them or or or push them or coerce them. And if you convince or coerce a person, you destroy your relationship with them. So my job is to raise their literacy, to have them understand what's going on, health their health literacy, their healthcare system literacy, and their health benefit literacy. And so that they understand what their options are and the risk that they're in, and then to love up on them and to encourage them and support them and make sure they know how valuable they are to their kids, to their families, to the people they work with, and and and then I just kind of ask them, what's your commitment to them and to yourself and um to not have something terrible happen? And then start from understanding their why would I change my behavior? And from the why, they eventually ask, Well, how would I do that? And then we walk through that, and then eventually what I see is these miraculous things happen. But it starts with the relationship in love. It doesn't start from being a blowhard doctor who thinks he knows everything, telling you what to do.

SPEAKER_00 10:02

This is interesting. So so taking back, like, what was the era of time? Did you already mention that? Or or how how far into practice were you when this happened? Seven years. So this was 1996.

SPEAKER_01 10:14

I was seven years in. And um so from from 2000 from 1996 to 2006, I went through the the process of swimming upstream, right? Okay, heart disease, how do you treat that? And I got real involved with American Heart Association and American Diabetes Association, was like the president of North Texas and got all that straight, and then you know, realized sleep apnea was a huge problem um with people with atrial fibrillation stuff. So then I got board certified in sleep medicine, and then I became a certified diabetic educator, and then you know, I realized there was obesity, so I got board certified in uh whole uh in um bariatrics, and then I did holistic and integrative medicine. Um and so you know I kind of collected these, you know, additional certifications as I realized that I had I was in the wrong place and I needed to go upstream and go upstream and go upstream. And at the end of the day, um it came back to actually um it's if I said psychology, that that that might not be the right answer. It's more getting people in touch with their purpose and then um touch moving and inspiring them to live their life differently.

SPEAKER_00 11:27

I love that. And and I'll tell you, Scott, just literally this morning, my last patient um came in a couple weeks post-op and uh just kind of a little bit depressed, is not recovering from a surgery as quickly as he he thought he would. And uh, but he's got now controlled blood pressure, uh uncontrolled cholesterol with insulin resistance and obesity. And and I I actually said to him, I was like, I know that I spoke with you about this last time you were in, but remember my role here is your risk manager. And you have a lot of risk that I don't I don't want to go unmanaged, and it's kind of unmanaged right now. But let's get to something that's really important to me. If um what what's going on the rest of this summer and how much yard work do you have to do right now? And he goes, Oh I I the yard needs a lot of attention. But do you think I should be doing that? And I said, A hundred percent. Within your restrictions, one hundred percent you should be doing that. And he said, Why? And I said, Because your mental health needs it. Your mental health needs it, you're recovering from a surgery, you've got to do this. And it's interesting because I to I went, you know, along the same sort of philosophy there, where it's like, okay, I could I could throw three medicines at him right now. Um, I could explain or educate on metabolic syndrome, I could any but what I saw in his face and what I heard in his voice was dejection, right? And I met his dejection and said, what are we gonna do about this? And what I want you to do is go touch grass. Did you know him well? Go touch grass. You kind of knew that he that that uh he's new to me within the last six months. Yeah, he's new to me within the last six months, but our our initial visit was uh 45 minutes or an hour long. I got a chance to really know how this guy ticks. And um, you know, he's about he's about your age, and I I knew like, you know, he he he doesn't sit well. Uh he's active, and I'm watching a guy who looks mildly situationally depressed post-operatively, and I'm like, get out, touch grass, pull some weeds. Um, and that will be the start of him open-minded to let me control those plaques in your vessels as well. Yeah.

SPEAKER_01 13:46

You know, Wayne Jonas wrote a book, How Healing Works. And everybody listening to this, I would really encourage them to get in on audio and while you're exercising, listening to it. And uh but he talks about how we as doctors need to move from the soap note, which is symptoms, right? S O A P objective assessment plan, to hope notes, where you're looking and getting to know that person and what's important to them, and you're starting by understanding what motivates them and what they are hopeful about in their life, and then working through creating a plan to help them engage in that. And, you know, it's just like you and I know. You look at some people, it's like, man, you shouldn't be alive right now, and they are, but it's because they have those relationships and that purpose and that meaning, and they're not gonna check out right now, they're still very excited about it.

SPEAKER_02 14:41

Scott, you really agree with an important point. You know, what do you well, how would you describe the relationship between psychology and the physical person? Because so much of what we think controls what we do.

SPEAKER_01 14:56

Well, I'm gonna tell I'm gonna go way out on the limb here with you, Troy, just because I know I know that you're very open-minded. And that is um with quantum physics, what we know is that it's all energy. And the vast majority of what we perceive as physical is actually um the vast majority of it's energy. It's just energy in space. And so I actually have gone to the point now where I believe that the physical manifestation sitting in front of me is a physical manifestation of that person's beliefs, their values. And so when I look at them physically, I'm looking at what they believe in and how they believe to live their lives and how they think about themselves and what's important to them, or you know, what were the kind of the trauma and the wounds they've had in their life all manifesting physically. And so as I work through with them the mindset and the why and how they think about themselves and other things, I watch their bodies morph into healthier and stronger and happier, you know, individuals. And so I actually think that the way we think about ourselves, our mindset, the way we choose to engage with others and uh with our and care for ourselves, that's all psychological or spiritual, depending on you know kind of where you're at at a given moment, and it's manifests physically. And so you can use the physical to actually get a clue to what's going on and then work up again, upstream to use Jonathan's term, to actually heal the person instead of fixing their body. And that's where we've got a shift in America from an illness paradigm to a well-being paradigm. Not wellness, because people think about wellness as the body being well, well-being is physical, emotional, spiritual, social, and financial. All those things have to come together for a person to experience well-being in their lives. And for me, as you know, as the one that's on the teeth here on this call, um, you know, that's that to me, that's the art of medicine. How quickly can I get in sync with that person at that level? Because then the physical part will get better, but just focusing on the physical is just like, oh, please shoot me. It's not gonna work.

SPEAKER_02 17:06

Yeah. You know, my uh son has uh been accepted to a grad program. Are you familiar with Loma Linda University?

SPEAKER_01 17:12

Oh yeah, very well.

SPEAKER_02 17:14

Great, great. You go into their campus and on their cornerstone it says to heal the whole man.

SPEAKER_03 17:22

Yeah.

SPEAKER_02 17:23

And that's really what you're talking about. You know, yeah, we can see the physical, we can describe or prescribe medication, but that may only be part of it. We've got to look at the whole person. I'd love that about your story because you came to that and fortunately early for you, seven years into practice, you see, okay, I've got a I'm dealing with a human being who's a mind, body, and spirit. I'm not just dealing with a body. That that just that is so insightful. That's awesome.

SPEAKER_01 17:50

Yeah, it's been a great life. And you know, now the company that we have called Converging Health, we actually take data, and Jonathan and I, you know, have done a lot of work in this together uh at with his clinic, where we actually take the claims data and the EMR data, put it all together, and we figure out who is at the greatest risk of having an event before they have the event. So, you know, it's not waiting for it to cat try to put the cat back in the bag, it's it's soothing the cat and keeping it asleep, uh or maybe even healing it inside the bag. And so um, and we have a service called My Personal Health Assistant, which again, Jonathan has uh operationalized in his practice, where we have people doing proactive outreach, engaging people before bad things happen, figuring out their why, figuring out what would motivate them to heal their bodies and not have that stroke, heart attack, be diagnosed with stage three, four cancer, needing that surgery, having an emotional or mental breakdown, or becoming an addict to something because they're trying to soothe themselves with alcohol or drugs or something else. 70% of the terrible things that happen to people when you know Jonathan and I and you, Troy, get that information and we look at it, 70% of the terrible things that happen, we could stop if we could get them engaged in their own health earlier in the process, which again, Jonathan called the introduction swimming upstream. If we could help that person swim upstream, we could add years to their life and life to their years by empowering them.

SPEAKER_00 19:22

Absolutely. Yeah, and so so I want you to go into a little bit more of what that means for a whole person risk, but let me kind of introduce that a little bit. Uh about a decade ago, I was still working within uh, you know, fee for service in a in a hospital-based system, and we had a um we had a medical group meeting where they introduced quality metrics. And uh I won't go too far into this, but just suffice it to say that these were all uh retrospective and static data, um, meaning that I was getting graded or incentivized in things that uh on one hand I don't have control of. Uh and number two, there wasn't anything beyond just that single data point that mattered in terms of quality, right? It was definitely not a comprehensive view of the patient and or their overall risk. It was just here's a few data points that if you can reach a certain threshold, you'll get quote unquote bonus, which I won't go into the details of that either because there wasn't really a bonus, but uh, you know what I'm saying. Uh take me into that whole person risk and why it's so important that we don't look at one or two individual factors as as too weighty.

SPEAKER_01 20:38

Yeah. So um what value-based care has been reduced to is uh gaps in care. And uh, you know, what you're talking about. So I was just here interviewing a medical assistant. I'm I'm in my clinic right now, uh uh interviewing a medical assistant and uh for a job uh here, and she works with uh in a clinic with the number one uh employer of physicians in the United States. I won't say who they are, but she's quitting her job there because they're having her do diabetes retinal screening on people who A aren't people with diabetes or B blind people. And she's like, why am I doing an eye retinal eye exam on someone who's already blind? And they're like, oh, don't worry, it's uh it's it's it's we need to get our um star ratings up, and they do it by how many people with this condition get that. And then if we say that people who are really prediabetic or diabetic, um, you know, that they're really diabetic, then they look really good because they're not as sick, and so it increases our denominator. So there's more people with diabetes in our clinic and they have fewer kidney failure and heart attacks and strokes. So so we call people with metabolic syndrome and pre-diabetes diabetes diabetes people with diabetes. Like we code it that way because that's creating a bigger denominator. And she's like, I don't want to be a She's like, and this is the number one employer of physicians in the United States. And um the other thing is that she they had people come in that are literally having myocardial ischemia and they're they're across the street from the hospital. And they said um she said, you know, she did an EKG and they have ischemia, and they're like, Do you want me to send them to the emergency room? They're like, Oh no, don't do that. Don't do that. We'd have to pay for that admission. What we're gonna do is we're gonna give them nitroglycerin and we're gonna give them beta blockers and we're gonna give them drugs to try to decrease the the demand of their heart for oxygen, but we don't want to send them to the hospital. I mean, it's just it so value-based care has been perverted and bastardized so badly. And Jonathan, so the answer to your question for me is with the whole person risk score, what we did is we take 320 variables, there's three categories. One is absolute risk, and that is what conditions do they have, how many, what uh medicines are they on, how many doctors are they trying to coordinate, um, what is their demographics, which is you know, their height, their weight, and then other things. What are their biometrics, which is their blood work? Um, what are their social determinants? You know, do they live in a food desert or a security desert or a Medicare healthcare desert? You know, what's going on around those variables? And so when you and I walk in a room and as a person sitting in a chair, we call that the absolute risk that that person has. Then the second thing is we ask the question, how well is that person being taken care of? And we don't use gaps in care, like you know, that's kind of grade school stuff. What we actually do is we say, or the conditions that person has, where are they on the continuum? And if we want to we want to catch things as early as we can and make sure they get all the things they need early so they don't progress into having more advanced disease or complications. Um, and so we have five major areas: uh the cancer, uh, emotional and mental health, uh hypertension and heart disease, diabetes and endocrinologic problems, and musculoskeletal problems. So every person gets staged on all five of those, and we ask, are they getting what they need? Whether it's disease, we're not waiting to treat disease, we're addressing their health literacy, their health care system literacy, their health benefit literacy, and making sure they know what to do and what to watch for. So early in the process, they're going to reach out for help. So that's the second, the second big score. And then the third one, and this is based upon um what we haven't gotten to in my story yet, is um the clinic that I grew, uh, we had 13 clinicians, five sleep labs, a research um division, a DME division around sleep primarily, and then a um a well-being course that we took out to corporations and a bariatrics weight loss and diabetes kind of clinic specialty. So we had you know 35,000 square feet, and we were doing this integrated advanced care. We also had Troy, we had a psychologist, a chiropractor, and I had taken um a part of my clinic and turned it into a gym with the chiropractors, and so they had you know exercise equipment and machines, and the chiropractor was seeing people full time. He wasn't just doing manipulation, he was actually doing physical medicine um with them. So that was our clinic, and people would be able to see all of those resources, and it was called Tiena Health. Tiena um is an Eritrean, it was based upon an Eritrean word meaning whole and complete, physically, emotionally, spiritually, socially, and financially. We named the clinic Tienna initially, and everybody thought it was a hair salon. So it's like, okay, Tienna Health. And then everybody who was Hispanic that came to our clinic, which we had a lot of them were nerving, um, they all thought I was an idiot who couldn't spell TNA, which is to have, and they all thought I meant to say TNA hell, to have hell, and like this gringo is can't spell properly, but you know, finally they they they figured out TNA is meant to say whole and complete physically, emotionally, and spiritually, and financially and socially. So anyway, so we built that, 13 clinicians, it was a lot of fun. Um, and we were rocking and rolling, but a one of my patients was the wife of somebody who ran 182 clinics. And one day I walk in a room and he's like, Hey, you're Scott Connery. Yep, doom, you know my wife, and I said, Yeah, I know her well. And he said, uh, she, I've been watching your clinic and for the last you know seven or eight years. Would you come run our 182 clinics? I was like, I don't know how to run 182 clinics, I could barely run one clinic. And they're like, Don't worry, we'll we'll give you resources. So I jumped over, we went from 182 clinics, 343 clinicians, to 510 clinicians and 240 clinics. And my job was to manage the value that we were providing. And uh and so it was a wonderful experience. And we ended up with uh we ended up uh with Eduardo Sanchez, who's a fantastic doctor, he's now at the American Heart Association, he's the chief medical officer there, um, calling me up. He was at Blue Cross BShield at the time saying, Oh my gosh, if if our patients on Blue Cross Ray Shield in North Texas choose your clinic, it's it's $17, which is about 5% less expensive than any other clinic in North Texas. And by the way, we have 400,000 people coming to your clinic. So that's $5.4 million a month that we save if they choose your practices over anybody else's practices in North Texas. And I said, Well, that's because we're a risk management platform. We are not a symptom free platform. We're doing proactive out, we're we're rating everybody's risk, we're doing proactive outreach, we're getting the right people in front of the clinicians. The clinicians are great clinicians and they do they do the right thing, which I believe most all primary care clinicians are or you know, at least 90% of us are really outstanding in care a lot. And um, and as a result, you know, by getting the right people in front of the the clinician, we're having that effect. And he's like, man, we're gonna send you all of our fertile, fully insured people because we're at risk for them. So um the uh so we did well, but then the next thing that happened was that a hospital system came in. Obama was being elected, so I went to a hospital and said, Hey, we've got 510 docs, you've got 17 hospitals. Let's get together and form an ACO, this new thing you know, President Obama is talking about, and then we can get first mover advantage and we can save millions of lives in North Texas and uh have people live happier, happier, and healthier. We'll get a fur first mover advantage again. And they're like, great idea. And so they got a list of all of our doctors, we signed NDAs and everything, and then they bought our practice because they said being one tax ID number would be better. Okay, all right, I get it. So um as soon as they bought the practice, within 90 days they had shut down everything that we had created. And I went to the chief strategy officer who was a great guy, and said, Dude, what just happened? And he said, You don't get it, do you? And I said, Obviously not. Um he said, You were keeping people well and they didn't need the hospital, and so our revenue dropped down like a hundred million dollars over two years from your doctors, and it it was going faster. I mean, the the the drop was going faster, not slower. So we bought you to shut you down because we're in a fee-for-service environment. And we need Oh my word, we bought you to shut you down.

SPEAKER_02 29:34

Yeah, they bought you're hurting our r you're saving people's lives, but you're hurting our revenue, so we're gonna shut you down.

SPEAKER_03 29:41

And it is our fiduciary responsibility to protect the health of our hospitals.

SPEAKER_01 29:50

Wow. That was my pelican brief moment, right? It's like, oh my god, this stuff actually does happen. And so it was like, I could barely breathe. And he and and he said, you know, I told you this to be honest with you, because he and I were the two that came up with a plan to build the ACO. And he and I were been working together really closely for over a year at that point. He said, I told it to you out of respect, but now you can't tell anybody for two years because you signed an od uh, you know, an uh uh non-disclosure agreement. And um and so I will, you know, I said, I can't work here, and he's like, I understand. So they gave me a severance package um that took care of me for two years, and uh and and I just couldn't tell anybody that they had done that. But that was a long time ago. That was sixteen years ago. So that's where I got worried. So that did two things for me. First of all, I got to work at scale. Like I had to work at scale, right? And we had a a $2.4 million IT budget to build all the analytics that I needed to figure out the right person to come in. And two, it validated that it worked. It works, it works. Right. Like, ooh. So uh so exciting, right? That's what value-based care is supposed to be, and it works. So it was like, let's go save lives, let's go. And um and then it's taken me till here we are, you know, 16 years later, um to it's taken me this long to rebuild all that, because I obviously I don't have a budget of 2.6 million or 2.4 million a year, um, to build all the analytics and then to deploy the analytics inside corporations and medical groups like Jonathan's, and then get people to actually be able to know how it works and to buy it, because this is pretty sophisticated stuff that Jonathan and Troy, you two do using the analytics tools. Um, and uh and so it's taken me a long time to get there, but you know, last year we had a 25,000 life group that um they had had 1,115 catastrophic, you know, high-cost claimants the year before. And last year they had 400 and I don't know the exact number. I'm gonna I'm gonna make it up, but I think it was 489 or something. But the point is that the number of people who had events went down dramatically because they were engaged before the event and given the yellow brick road to keep from having the event occur. And so that was a that was a $17.6 million savings for that company. And it's $17.6 million because bad things didn't happen to good people.

SPEAKER_02 32:29

Wow.

SPEAKER_00 32:30

And that's why I get up and that story just makes me sick, honestly, Scott. Like I like in a lot of ways. Uh and I've heard you tell me this story before about what happened, but like I I can't imagine that two years worth of just sitting on the hardest truth you've ever experienced in your life and realizing that what what what it what is going on. And but but here's the other thing, like as you mentioned, you you know the the payer in the in in the earlier part of that story, Blue Cross, was like, hey, we want all our fully insured people there because ultimately they were the ones at risk. And then you look at the hospital who says it's their quote unquote fiduciary duty financially to protect the hospital, and so therefore, you know, this is hurting the hospital, so they do what they need to to protect their money. And then the work you do today is is exclusively with with either value-based or um you know self-funded, risk-bearing employers in their health plan. And just as an everyday clinician, the thing that that kind of bothers me is that you know, if you're out in the marketplace on an insurance plan or you're in a small group, lots of small businesses, lots of small group plans, basically any insurance plan that someone might hold or coverage that they might hold, if it doesn't have risk bearance to the clinician um or a third party who's engaged in this kind of data work, your risk doesn't matter to them. I had that conversation. Well, but you know what I mean. Like we we we went to medical school to help everybody. We didn't say, well, you know, if you're in this demographic or if you work for this employer or use this certain card to pay for your services, then then we can take care of you. We never that was never in our mind. And as you go through residency training, you get out into practice, and some of those layers start to get peeled back, it's it's kind of sickening as is. But what's really bothered me, and and this isn't a discredit to what you've done, but what bothers me is like, okay, I have this little segment of risk-bearing um individuals, health plan members, that I have the data for, and I'm engaged with it, and I'm able to make these differences, and I'm I'm effectually improving their lives. And um, but there's so many people who don't fit that, right? I mean um and that's really my goal. You know, I think you did that as a whole clinic system there with those 510, you know, um clinicians, but but yeah, here we are um looking at it today. But tell us a little bit about what uh you see coming in terms of um the not just the clinical risk, but you know, you and I got brought up in the healthcare system as clinical risk managers, and then we've found our ways, uh whether it's through a CMO role or in my case advising, brokering, where we're on the financial risk management side. Um how does converging health and what you do fit in the middle? How do you how do you work through both directions sitting there in the middle of uh the stream of healthcare?

SPEAKER_01 35:43

Yeah. So um let me uh let me answer that by addressing what you just said. Um so you know the prayer, God forgive me for what I have done and for what I've left undone. And when we had the 510 docs and I had all that analytics, I literally would go to the doctor and say, This is the state of your practice. This is the this is how well your people are doing. And and it was usually mediocre. It was usually not great. And their first response from all the doctors was, that's bull crap. I am a great doctor. I go home every night knowing I made a huge difference to all the people I saw that day. And the problem was what you said, Jonathan. It wasn't the people they saw that day, it was the people they didn't see that day that were out there having strokes and heart attacks and ending up in the emergency room, and then they go to specialists and blah, blah, blah. They have no primary care guide, they don't know what to do, they're being told all this stuff in a system where people get paid to do things to them. So they were getting inappropriate things done, multiple things done, costing a fortune to the system, uh, hurting the person. And um, and so then when I gave them the actual roster, like here are the people, here is what's happening to them, and you know, and they're on your watch, dude. Those are the sheep. You are the shepherd. And they'd be like, well, well, but wait a minute. But but Susan Williams couldn't come in because her husband's a truck driver, and you know, she has she has uh a child with cerebral pals cerebral palsy, so she couldn't get here. And I'm like, dude, she's dead. Like, that did not serve her, right? You know, we need to think about this differently, right? Don't don't be a humanitarian who lets people not come in and get taken care of, find a way to take care of them. Even that means we've got to go do a house call. Let's go. And so um, once the doctors got their mind around the fact there's a lot of crap going on that I don't know anything about, and this system that you just created is now reaching out, calling those people, bringing them in, and all I have to do is come to work every day, and I am literally taking care of all those things. And then what happens is that um the cost of care for your population starts to go down dramatically because remember the 70% that didn't have to happen, now they stop, it stops happening. And so you're literally changing the financial futures, the social future, the personal emotional future of the individuals. And the doctors loved it because it actually meant they just got to do what they want, what they love, which is being with patients, and they made a huge difference, a much bigger difference because their receptionist is calling them in, and their MA is making sure they get their preventive services done. And the um in our group, we were big enough. We had social work and pharmacists, and we had mental health techniques, um, you know, professionals that they got to see also. And so it created the crucible that they went into clinical health care to do. And I saw that and I felt like so excited. And and then when it worked so well, and Eduardo called me up, it was happy dance, happy dance, happy dance. Um, let's spend the rest of our lives doing this. And then when it got shut down, it was like, oh my god. And so my where I my default was I lasted two weeks at home, Jonathan. I went home two weeks later, my wife surprised face doors over there, like go, please. Because I was going crazy. So I went and worked for um uh homesmurphy and um ACAP Health, which is a uh broker consultant and a um and a and really it's a lab. ACAP Health was accountable care, accountable patient, ACAP. And um and we we found innovative, great programs like Naturally Slim and Compass and Rosty, and we made sure that corporations were inculcating them into their plant benefits. So I I went straight to work for corporations because I figured I'll take $200 million out of that hospital system by helping people be healthier. But now I was working for the corporations because the corporations were all complaining about their health care costs going up. Right. And they wanted to keep their costs down. So I assumed I'd walk in and say, here's how you do it, and they'd say, Thank you, let's go, and they do it. Well, back then, Medicare was paying what private insurance is paying today for health care. And um, you know, so we've just watched this cost go up, but it's very frustrating because most corporations don't engage. The HR staff doesn't feel like they've got support. The uh CEO and COO feel like if you're paying less for healthcare, that means that you're depriving people from health care. They don't get it. And a lot of them are on the board of directors of the regional hospitals or other big things, and they get a lot of self-esteem from that uh because they think they're doing the right thing and helping people, but they don't want to piss off the regional healthcare system. And um, and it's been just very, very disappointing and very upsetting. And I know you too, this is your space. I mean, I'm in your space right now, so you guys want to comment on who you see picking up the mantle and running downfield? Because I think what I've done is I built the infrastructure that we could take any company and get their health care costs down by 30% just by getting the right people to the right clinicians at the right time for the right price. And and and Troy, I know you built a big infrastructure to make sure that whether it's bundled surgeries or uh episodes of care or imaging, whatever, people know where to go and they have excellent direct prices. And Jonathan, I know you've flipped the model to do prepaid advanced care. So you're doing prepaid instead of fee for service, so you're getting rewarded for keeping people healthy and alive instead of needing them to be sick so you can run them to your office. And by the way, the latest research, five minutes and eight seconds is how long a primary care doctor's offices in the United States. Five minutes and eight seconds. And that's what I said earlier, and it doesn't matter what we do. What I was trying to communicate was you're gonna make the same amount of money if you spend five minutes and eight seconds with somebody as if you spend 58 minutes with them. And so our system is completely upside down and backwards. Um but uh you know you still get paid, even if you have no value. And so that gets flipped with direct primary care, which is Jonathan Bushman, and that gets flipped with bundles of care and high quality, high-value care, which is Troy, your your work. Um, and then I have the electronics or the analytics to be able to say this is who needs, you know, Jonathan Bushman and direct primary care, advanced primary care, and this is who needs Troy Solution A, B, C, D, E. And then we've got this group of warriors that are called uh personal health assistants that a corporation will put in place, and they're the ones that are connecting the right person at the right time to the right place so that they get the right price and that costs are down, their care is up, they're connecting them with mental health, with addiction uh programs, community programs, whatever it takes to have that person be empowered to add years to their life and life to their years by empowering them to take control of their health. Yeah. That's meature is Jonathan. I think a healthy future is we're building the infrastructure and we're paying people for um keeping people healthy. We're not paying people for making sure that they do something to a person. And that's right. We've got a five trillion dollar industry. That's a lot of people who really don't want anything to change. So I think we're gonna have to be gorilla. We're gonna have to put people first, we're gonna have to build um strong advocates that are influential people that see the benefit of what we're doing, whether that's because they they're doing it in their corporation and saving a fortune, or whether that's because they had somebody's life that they love their husband, you know, husband, wife, whomever, um, see what happens when you do that, and they just become an evangelist. And you know, primary care for all Americans is a non-for-profit. We've we've we've we've started to try to get community members across the United States to embrace this concept. I know you've spoken on those webinars to embrace this concept so that um the concept. Community says, stop enough. We're going to make sure our people get the right primary care, which keeps those other bad things from happening. That's 70% from happening.

SPEAKER_00 44:09

Absolutely. Yeah, Troy and I recently had a conversation about even just this inherent um responsibility that I feel, sometimes uh overcommitted, but uh, hey, let's commit to one more thing. But the idea behind it is, hey, there's nobody else around me who's more equipped and ready to help drive that change. I'm not going to do it on my own, but we need each community to have that person who helps to educate, promote, get the people together, um, organize the effort around it so that our education, and and and really this goes back to the schools as well, is um any anybody like you and me should be involved at the the clinical training level uh at the medical schools, hosting students and and involving them in these conversations uh so they can be the catalyst for the change as well. Exactly.

SPEAKER_01 45:01

Exactly. And everybody listening to this podcast, if not you, then whom? I mean, at some point you just have to say, you know, I'm gonna walk down that beach and pick up those damn starfish and start throwing them back one at a time, and I'm not gonna get stuck on the fact that there's a lot of them left on the beach when I walk off the beach tonight, right? And so I know you and I and Troy, I know you um we get up every day and start throwing starfish, and you know, I get to look my granddaughters in uh Violet and Piper in the eye and say, you know, I'm doing everything I can every day to make sure that there is a strong economy and a country for you to to have your children in. And if we don't fix this, the middle class who's getting shellacked right now is gonna eventually just run out of gas. I mean, and they're exhausted, and I think we'll have bad things happen. So I'm very, very committed to to seeing health care become uh literally uh something that keeps people healthy and encourages well-being, doesn't just pay people to do crap to other people.

SPEAKER_02 46:02

Right.

SPEAKER_01 46:03

Absolutely.

SPEAKER_02 46:04

Scott, I got two questions for you. Uh in terms of you had 200 plus clinics, you had 510 doctors who were all pointing in the same direction, doing the same thing, having phenomenal results, and they get shut down. How did how did those doctors feel? You created this ecosystem of impact, and then it gets cut off at the knees and said, You are not doing that anymore by a big health system. How did those doctors feel? Do you keep in touch with any of them?

SPEAKER_01 46:33

Well, yeah, I love them. Oh my God, they're great people. But you got to realize, Troy, so the fit is so funny, you'll get a kick out of this. So when I went there, I went to the doctor and said, I'm gonna help you become the greatest population health managers in the entire world. And they turned around and said, You give me one more thing to do, I'll kill you. I have no interest in being a whatever the hell you just said. And so I got was like, that strategy's not gonna work. So what I did is I built the system, I say I, it's never I, it's always a team of really committed people. We built um the system to identify who's at risk. We'd call them up and say, hey, Dr. Bushman would like to see you today. Can you make an appointment? We'd have the person go see Dr. Bushman. Dr. Bushman is a great doctor, he's going to do a great job. So all they knew is they walked in and their schedule was full. And when they went in and saw the people, they were they were people who really needed their help. So when the hospital bought it, they still had a full schedule. They just were seeing whoever happened to call on the phone and make an appointment. What we see is that 70%, up to 70% of the visits in a doctor's office, primary care doctor's office, are are filled by low-risk people and 30% high risk. And then what happens is that high-risk person who's starting to have a heart attack calls in and says, Hey, I'm really not feeling good. I'm sweaty and uh short of breath, and they say, Okay, we'll get you in next week. Yeah. And then the person either goes home and dies or goes home and has a heart attack and ends up in the hospital, or they go to the hospital, and then the they the doctor, primary care doctor, lost the lost the communication with them. So by having the system get the right people in front of the doctor, it gets the doctor and that person to have the right conversations at the right time, and it keeps bad things from happening. So they never knew what was happening.

SPEAKER_02 48:34

Interesting. Interesting.

SPEAKER_01 48:36

Yeah. And then, you know, the other thing I'll tell you is um, like, let's suppose that um uh the average visit, let's say it's a 99214, and we were getting paid as an independent group $120 for that visit. Okay. Well, the hospital, because it was so big and had so much power, was able to negotiate $170 for the same visit, same work. And so what happened was for them is they all went to work and did the same coding, and their income went up by $100,000 the next year. In fact, in North Texas, the employers of North Texas paid $100 million more for health care the year after our group was acquired for the same care. Same care. A hundred million dollars more. And they never knew it happened to them because they didn't know that the hospital had these great reimbursement rates and the independent doctors, which we were an independent doctor group, um, had much worse uh rates. All they knew is they kept going to the same doctor and you know, and uh they're paying their copay, and so they didn't really know about it, but their employers sure the heck did.

SPEAKER_02 49:49

Yeah, because it came out of the premiums, right? Yeah.

SPEAKER_03 49:56

Yeah, it came from the corporations.

SPEAKER_00 50:00

Wow, incredible. Well, Scott, you know this you know this, but patience win when data helps us see people sooner, reach them earlier, and and use limited resources where they matter most. And we know that we're operating under um limited time, people, and money. And what I love about what you've done, created, and have deployed in so many different areas of our country and with our people and in clinics like my own is that um it's it's so satisfying to know that those resources were used wisely to the people who needed our help the most. And uh appreciate the work that you've done, appreciate you uh coming on the show today, um, the insights that you've provided. And and again, uh last but not least, but your your friendship and uh appreciate everything you do. Thanks again for being with us.

SPEAKER_01 50:54

I just have to say it's you know, it's courageous people like you know, you two and what you're doing with this podcast that's gonna eventually change the system. And uh right now in the United States, we're paying enough money that we could give free health care to everybody if the care that people received was the appropriate care. There's no reason. We could we what would happen is the cost of health care in total would go down 30%. And what we know right now, the average person in America, like Troy, I'm in your world here, um, but the average person is paying, or the company's paying 70%, the person's paying 30%, you know, kind of the ratio of how much the person pays versus the company. And if you took away all that um, you know, 30% of $5 trillion is $1.5 trillion. And so that'd get us down to $3 trillion, and if everybody just paid their their premiums during the year, um, that would cover the cost of care um in all likelihood. So the thing is at some point American people are gonna wake up and they're not gonna be willing to continue this nonsense, and as a result, um there'll be change, there'll be real change. We just have to be the you know, kind of the lights, the light lanterns up that are up high, they're not under a bush, and make sure that we continue to shine what's possible into the ecosystem and have corporate leaders who want to be a little innovative and that'll do something really good for their people join us.

SPEAKER_00 52:21

Yep. Absolutely. Well, thanks again, Dr. Connard. Uh appreciate your time, appreciate the the expertise.