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How our client spends $1000 less than U.S. Average PMPY

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Rethinking ER Utilization: How Clinical Consulting Can Boost Profitability and Patient Outcomes Emergency room (ER) visits are climbing at an unsustainable pace—outstripping population growth and burdening healthcare systems across the country. For providers and clinics navigating shrinking margins, this trend isn’t just a symptom of patient behavior—it’s a call to action. As noted on the Relentless Health Value podcast, Al Lewis points out that “commercially insured individuals are visiting the ER at rates now exceeding 200 visits per thousand lives.” That’s roughly one ER trip for every person under 65 every four to five years—and that’s not including the elderly or Medicaid populations, where rates are often even higher. What’s driving this surge? A key culprit is limited access to timely, coordinated primary care. Dr. John Lee, an ER physician featured on Relentless Health Value, described the downstream effect vividly:“Patients arrive with symptoms they’ve had for months, unable to get in to see their PCP. We run CTs, labs, ultrasounds—all in one visit. We skip the prior auth headaches, but we also cram weeks of diagnostics into an afternoon. Multiply that by thousands—it’s no wonder ER volume has exploded.” This pattern of delayed care, over-reliance on emergency departments, and unnecessary diagnostics doesn’t just harm patients—it hits your clinic’s profitability and efficiency, too. A Smarter Way Forward: Clinical Consulting with Converging Health At Converging Health, we partner with healthcare organizations to break this cycle. Our clinical consulting services help practices and systems shift from reactive, fragmented care to proactive, coordinated strategies that reduce unnecessary utilization and drive down the total cost of care (TCOC). One of our community hospital clients is a case in point. Over the past five years, their cost containment trajectory has significantly outpaced national averages: Year Converging Health Client Expected Spend (based on US average Increase) March 2023 $5,102 PMPY 2023 Baseline March 2024 $4,749 PMPY $5,520 PMPY* March 2025 $4,986 PMPY $6,033 PMPY * *WTW’s Global Medical Trends Survey, the cost of medical care benefits in the U.S. increased about 9.3 percent in 2024, compared with 8.2 percent in 2023. Converging Health started working with this group in March of 2023. While national healthcare costs and Total Cost of Care (TCOC) are expected to jump by nearly $1,000 PMPY between 2023 and 2025, our client is projected to remain more than $1,000 below what they otherwise would be spending based on average U.S. increases in TCOC—a compelling return on investment. This isn’t just about suppressing numbers on a spreadsheet. It’s about reengineering care delivery to prevent unnecessary ER visits, improve patient engagement, and enable earlier intervention. This client achieved an 18.4% reduction in ER utilization and 21% reduction in Inpatient Days by implementing: This systematic, data-driven approach allows PHAs to steer individuals toward the most appropriate, cost-effective care—reducing risk, avoiding high-cost interventions, and improving quality of life. Or, as Relentless Health Value puts it:“Fix the front end of care, and you’ll save money on the back end. It’s that simple—and that hard.” The Bottom Line for Providers When your clinic loses patients to the ER, it doesn’t just lose revenue—it loses a chance to deliver higher-value care. Converging Health’s clinical consulting equips your team with the tools to reduce costs, improve outcomes, and protect profitability. Because healthcare doesn’t need to cost more to deliver more value. It just needs to be smarter. 👉 Learn more about how Converging Health’s Clinical Care Transformation services can support your practice at ConvergingHealth.com.

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ICYMI: Blog series with Mike Adams and Scott Conard MD

Employer Healthcare Solutions /

In case you missed it, 7-11’s Mike Adams and Converging Health’s Scott Conard MD published a series of blogs as it relates to corporate healthcare and navigating the complex realm of employee benefits. See below for any of the posts you may have missed: Mike Adams and Scott Conard: Nursery School is Over Mike Adams and Dr. Scott Conard emphasize that individuals must take personal responsibility for their health, utilizing available resources. Employers should implement data-driven wellness programs with effective incentives. Payers are urged to act as responsible fiduciaries, and health solution providers must deliver measurable returns on investment. Collective accountability is essential for improved health outcomes. Read More Here Mike Adams on The Vital Role of a Physician Advisor Physician advisors are crucial in healthcare organizations, ensuring compliance, optimizing clinical documentation, and enhancing patient care quality. They bridge the gap between clinical staff and administrative processes, leading to improved efficiency and financial performance. Their expertise supports medical necessity reviews, appeals, and staff education, fostering better healthcare delivery.​ Read More Here The Real Enemy in Healthcare Benefits: Fighting Disease, Not Just Managing Costs Mike Adams and Dr. Scott Conard argue that the true challenge in healthcare benefits is combating disease, not merely controlling costs. They advocate for a shift from transactional to relational healthcare, emphasizing preventive care and active employee engagement. By focusing on long-term wellness, companies can reduce expenses and enhance workforce health Read More Here Mike Adams and Scott Conard Discuss: Why Chronic Diseases Matter in Designing Effective Plan Benefits  Mike Adams and Dr. Scott Conard emphasize the importance of integrating chronic disease management into employee benefit plans. They advocate for early intervention and targeted strategies focusing on prevalent conditions like musculoskeletal disorders, cancer, heart disease, diabetes, and mental health to reduce long-term healthcare costs and enhance workforce well-being. Read More Here Mike Adams & Scott Conard on The Vital Importance and Role of Your Broker Mike Adams and Dr. Scott Conard emphasize the critical role of brokers in healthcare benefits planning. They advocate for treating brokers as consulting partners, ensuring transparency in compensation to avoid conflicts of interest. By fostering proactive partnerships and prioritizing quality over cost-cutting, organizations can enhance employee care and achieve strategic goals. Read More Here

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Mike Adams & Scott Conard on The Vital Importance and Role of Your Broker

Employer Healthcare Solutions /

Summary: Mike Adams and Dr. Scott Conard emphasize the critical role of brokers in healthcare benefits planning. They advocate for treating brokers as consulting partners, ensuring transparency in compensation to avoid conflicts of interest. By fostering proactive partnerships and prioritizing quality over cost-cutting, organizations can enhance employee care and achieve strategic goals. Broker Relationships in Healthcare Benefits Planning: Transparency, Innovation, and the Real Value of Partnership  In planning healthcare benefits having the right broker may be the most essential yet often overlooked relationship. Brokers are the gatekeepers, guiding organizations through the complex landscape of legal, compliance, and marketplace options. But not all broker relationships are created equal, and there’s a lot to consider when determining the true value of a broker.  Reclaiming Strategic Control: Brokers as Partners, Not Planners  For any business leader, it’s crucial to treat brokers as consulting partners rather than as strategic decision-makers. Your company’s vision, values, and goals should shape your benefits strategy—not your broker’s latest product lineup. While brokers bring industry insights and can be invaluable for vetting and implementation, they shouldn’t be your main source of innovation.  The best approach is to take ownership of the strategic direction. Tap into other resources—conferences, peer networks, and industry research—to identify trends and innovations. Then, involve your broker as an implementation partner. Share your ideas and ask them to stress-test these solutions: How would this integrate into our current benefits ecosystem? What data would we need to make this work? Where are the potential pitfalls?  This approach ensures that brokers act as allies in achieving your strategic goals rather than dictating them. When you lead the innovation, your broker’s role becomes one of enabling and refining rather than steering.  The Problem with Kickbacks and Hidden Agendas  One of the most troubling issues in broker relationships is the lack of transparency around compensation structures. In many cases, brokers earn commissions or “back-end” deals through point solutions, which can create conflicts of interest. These financial incentives often go unreported, leaving employers in the dark about whether a recommendation truly serves their needs or merely boosts the broker’s earnings.  The reality is, when 80% of corporations say they rely on their broker’s advice for benefits planning, there’s an inherent risk that these hidden incentives will skew decision-making. Employers need to understand that without full disclosure, they may be getting a recommendation driven by profit rather than by what’s best for their organization and employees.  Demanding Transparency in Broker Compensation  Transparency in broker compensation is non-negotiable. A company has the right to know exactly how a broker is compensated, whether through commissions, retainers, or equity stakes in recommended products. Clear, upfront agreements—such as a flat fee for specific services—builds trust and is the best way to avoid any perception of bias.  Some employers limit broker commissions to only a handful of services—like medical, dental, and disability insurance—while establishing strict controls around fees for point solutions. This approach minimizes conflicts of interest and helps ensure that every recommendation aligns with your organization’s needs.  Why Transparent, Value-Driven Broker Relationships Matter  At the end of the day, a transparent and well-aligned broker relationship directly impacts the quality of benefits you provide to your employees. Quality benefits aren’t just about saving money; they’re about enhancing the quality of care for employees. By reducing unnecessary costs and improving care, both the employer and employees win.  When companies hold brokers accountable, they not only save costs but also create a benefits ecosystem that genuinely supports their workforce. In healthcare benefits planning, transparency, proactive partnership, and a commitment to quality over quick fixes make all the difference. ICYMI: In Case You Missed It Check out the entire series of blog posts between Mike Adams and Scott Conard HERE

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Mike Adams and Scott Conard: Nursery School is Over

Clinical Consulting /

Taking Real Responsibility for Health in the Workplace  When it comes to health and well-being, it’s time to step up. No one else can take ownership of your health for you—not your employer, not a wellness app, not the healthcare system. Real progress starts with you taking responsibility. But let’s not forget, there’s a shared responsibility here. Employees, employers, payers, and point solutions all have a role to play, and it’s time everyone gets real about what that means. Nursery school is over, folks.  Employees: Ownership Starts With You  As an employee, you have access to resources, tools, and sometimes even incentives to help you live a healthier life. But here’s the deal: nobody can take that step for you. Your employer can provide fitness programs, nutrition coaching, and mental health support, but it’s on you to use these resources. Take the time to understand what’s available and how it can benefit you. This isn’t about hitting a wellness quota—it’s about investing in your own health and future. Engage, ask questions, and take advantage of every resource that fits your needs.  Employers: Stop Baiting and Start Engaging  Employers, let’s talk about your role in this. It’s tempting to throw the latest wellness trend at employees and hope it sticks. But true responsibility means more than just offering shiny new programs. It means looking at the data, understanding where your workforce’s health needs really are, and then using targeted, data-driven solutions to make a difference. Don’t fall for the “shiny object” syndrome; find the programs that address specific health concerns relevant to your team.  Incentives and engagement strategies matter too. Behavioral economics shows that people respond to well-structured rewards and consequences. By thoughtfully designing incentives and disincentives around health behaviors, you can help employees stay engaged in their health journey. But remember, this is about shared responsibility. You’re not forcing change; you’re creating an environment where employees have every reason to take action.  Payers: Act Like Good Claims Fiduciaries  Payers, the responsibility is on you to act like true claims fiduciaries. As employers work hard to allocate their budgets toward effective healthcare programs, it’s critical that payers handle those funds responsibly. That means spending with accountability, transparency, and integrity. Too often, there’s a lack of fiduciary responsibility that costs employers money without delivering meaningful outcomes. Payers need to step up and make sure they’re truly adding value, not just processing claims without any strategic foresight.  Point Solutions: Deliver Real Value, Not Just Promises  Point solutions—if you’re offering a health solution, you’ve got to back it up. It’s not enough to promise “great results” without proof. Employers need solutions that deliver measurable, reliable ROI. That’s return on investment, not a return of investment. Employers aren’t here to spend money on programs that don’t work just to get a refund later. They’re here to get results that benefit both their workforce and their bottom line. If a company spends $200,000 on a solution, they want to see savings of $300,000 or more. Everybody’s got to win, and that means delivering on the value you promise.  It’s Time for Real Responsibility  In the end, this message of responsibility applies to all players in the healthcare ecosystem. For employees, it’s about taking advantage of resources. For employers, it’s about choosing solutions that make sense. For payers, it’s about responsible financial stewardship, and for point solutions, it’s about delivering measurable ROI.  If each of these groups steps up and takes responsibility, everyone benefits. It’s time to get serious about health, because nursery school is officially over.  By Mike Adams with Scott Conard, MD Written by Rob Thwaites in consultation with the Converging Health Consulting Team Join the Conversation HERE on LinkedIn

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Building a Health-Literate Culture: A Strategic Imperative for Corporate and Medical Leaders

Clinical Consulting, Employer Healthcare Solutions /

Health literacy is a critical factor in achieving better healthcare outcomes, yet it remains a significant challenge for both individuals and organizations. For corporate executives and medical practice owners, fostering a health-literate culture is not only an ethical responsibility but also a strategic imperative that impacts patient outcomes, workforce productivity, and overall healthcare costs. Defining Health Literacy Health literacy is the ability of individuals to understand and act on healthcare information to manage their health effectively. It encompasses numeracy skills, the ability to navigate the healthcare system, and the competence to make well-informed health decisions. In a broader sense, health literacy includes motivation, access to reliable health information, and the capacity to make sound judgments regarding one’s well-being. Challenges of Low Health Literacy A large segment of the population lacks the necessary health literacy skills, contributing to poor health outcomes and increased healthcare costs. Traditional approaches—such as using plain language and the teach-back method—help to some extent but do not always lead to meaningful behavior change. Chronic disease management, for example, requires patients to understand terms like cholesterol levels and insulin resistance. However, healthcare professionals often have limited training in educational methods and insufficient time to provide the necessary guidance, exacerbating the problem. The Health Literacy Instructional Model To address these challenges, a structured approach is necessary. The “Health Literacy Instructional Model” presents a three-step strategy: A key takeaway is that social and emotional support systems play a crucial role in health literacy. Patients with strong support networks are more likely to acquire and retain health knowledge, ultimately leading to improved self-management. Modern Educational Approaches to Health Literacy Traditional educational theories can enhance health literacy programs: The Role of Healthcare Professionals and Digital Tools Healthcare providers must become more effective educators. Integrating health literacy into clinical workflows, decision-support tools, and patient engagement strategies can bridge the knowledge gap. Digital health solutions—such as mobile apps, wearable devices, and AI-driven platforms—can further enhance personalized learning and engagement. However, disparities in digital access, often termed the “digital divide,” must be addressed to ensure equitable access to these resources. Patient Engagement and Shared Decision-Making Engaging patients in their healthcare journey is a critical predictor of outcomes. The FLAIR score (which evaluates patient engagement levels) is an innovative approach to measuring and improving patient participation. Shared decision-making, where patients and providers collaborate on treatment choices, further strengthens health literacy. Creating a Health-Literate Culture For healthcare organizations and corporations, cultivating a health-literate culture requires a system-wide effort. This includes: Assessing and Enhancing Health Literacy Measuring health literacy can be challenging, but tailored assessments—especially for chronic conditions like cardiovascular disease and diabetes—can help personalize patient education strategies. Understanding a patient’s literacy level allows for more effective interventions that drive better long-term outcomes. Converging Health’s Approach At Converging Health, we prioritize actionable intelligence for clinicians by answering three key questions: By leveraging data analytics and physician-driven insights, Converging Health takes the burden off clinicians, providing them with real-time, meaningful information. Our approach facilitates Advanced Primary Care, integrating population health strategies with proactive patient engagement and trust-building to drive better outcomes at lower costs. Conclusion Enhancing health literacy is a shared responsibility that requires leadership from both corporate executives and medical professionals. By implementing structured educational strategies, leveraging digital tools, and fostering patient engagement, organizations can contribute to a health-literate culture that improves lives, enhances productivity, and reduces healthcare costs. At Converging Health, we are committed to advancing this mission through innovation, data-driven insights, and physician-led strategies that empower patients and providers alike. For more information on how Converging Health can help your organization build a more health-literate workforce and patient population, visit our website or contact us today.

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Corporate Determinants of Health: The Untapped Driver of Workforce Well-Being

Employer Healthcare Solutions /

Introduction For years, companies have recognized the importance of offering competitive health benefits to attract and retain talent. However, health benefits alone don’t determine employee well-being. A growing body of evidence shows that corporate determinants of health (CDoH)—factors embedded in workplace policies, culture, and environment—play a pivotal role in shaping employee health outcomes. As HR professionals and corporate leaders, you have the power to influence these determinants, improving both employee well-being and company performance. But how? Let’s break it down. What Are Corporate Determinants of Health? CDoH are the factors within a company’s control that impact employee health and well-being. These include: When companies prioritize these factors, they shift from a reactive to a proactive healthcare mindset—one that fosters healthier, more engaged employees while reducing long-term healthcare costs. Why Should Companies Care? Neglecting corporate determinants of health comes with a price. The cost of chronic diseases driven by stress, poor nutrition, and sedentary lifestyles is skyrocketing. Delayed care due to financial barriers leads to higher claims and lower productivity. A disengaged workforce is more likely to experience absenteeism, presenteeism, and burnout—all of which impact a company’s bottom line. On the flip side, organizations that optimize their CDoH create an engaged, healthier workforce that drives innovation and operational success. Companies that integrate health-focused workplace policies see: ✅ Lower healthcare costs✅ Higher employee satisfaction and retention✅ Increased productivity and engagement✅ A stronger employer brand How Companies Can Take Action HR professionals and corporate executives don’t need to overhaul their benefits strategy overnight. Small, strategic interventions can make a profound difference. ✅ 1. Rethink Health Benefits Unsupported Approach: High-deductible health plans (HDHP) with high out-of-pocket costs discourage employees from seeking preventive care.Supportive Approach: Companies can offer high-value primary care at no cost, cover preventive screenings (e.g., colonoscopies), and eliminate barriers to chronic disease management (e.g., covering essential medications). ✅ 2. Build a Culture of Well-Being Unsupported Approach: Stressful, transactional work environments with little support for mental and emotional well-being.Supportive Approach: Companies can create psychologically safe workplaces, offer mental health resources, and cultivate leadership styles that emphasize empathy and support. ✅ 3. Improve Work Environments Unsupported Approach: Offices with poor air quality, lack of natural light, sedentary work routines, and limited access to nutritious food.Supportive Approach: Organizations can redesign workspaces to promote movement, healthy eating, and ergonomic safety, all of which contribute to physical health. ✅ 4. Invest in Employee Development Unsupported Approach: Employees feel stagnant, disengaged, and unchallenged in their roles.Supportive Approach: Providing ongoing training, career growth opportunities, and leadership coaching fosters a sense of purpose and resilience. Final Thoughts The shift toward a corporate determinants of health strategy isn’t just about ethics—it’s about business performance. Companies that take proactive steps to improve workplace health reduce costs, enhance productivity, and retain top talent. The question is no longer whether companies should invest in employee well-being, but how quickly they can adapt to this new model. Are you ready to lead the charge? For organizations looking to optimize their corporate determinants of health strategy, reach out to Converging Health for tailored solutions that drive measurable results. Written by Rob Thwaites in consultation with the Converging Health Consulting Team

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The Power of Asking the Right Questions in Healthcare and Organizational Improvement

Employer Healthcare Solutions /

Originally posted on Choose Which Door By Scott Conard MD and Brian Uhlig Asking the right questions is a fundamental skill that drives success in healthcare and organizational improvement. Thought leaders across various fields emphasize that well-formed questions help in understanding value, identifying issues, fostering collaboration, driving change, and measuring success. Here’s why asking good questions matters and how it impacts different aspects of healthcare and organizational progress. Understanding Value and Needs A core function of asking questions is to determine what constitutes value from different perspectives, particularly the patient’s. Stacey Richter highlights that value is in the eye of the beholder, and true value emerges when we deeply understand others’ challenges, pains, and needs. Dr. Komal Bajaj underscores the necessity of questioning and listening to discern employees’ purpose and align them with organizational goals. Similarly, Dr. Beau Raymond advises that the first step in improving care is defining the destination—asking where are we trying to go? provides direction. Gathering Critical Information and Identifying Problems Asking the right questions is essential for collecting crucial data and pinpointing underlying problems. Dr. Beau Raymond notes that even if certain questions feel uncomfortable, they must be asked to gain meaningful insights—for instance, inquiring about gender identity to better tailor healthcare solutions. Karen Root also stresses that analyzing the root cause of customer-initiated calls can expose systemic issues and lead to more effective solutions. Driving Change and Innovation Innovation often starts with curiosity. Asking questions challenges the status quo and fuels progress. Dr. Komal Bajaj shares an example where healthcare workers’ enthusiasm for “planet-friendly care” was uncovered simply by asking and listening. Marty Makary argues that when patients become health literate and ask informed questions, it shifts the market towards more ethical and evidence-based care. Stacey Richter reinforces the importance of asking “why” questions to build a compelling case for transformation. Fostering Collaboration and Alignment Good questions enable communication and collaboration among diverse stakeholders. Stacey Richter points out that ensuring the right voices are included in discussions about value is crucial for making informed decisions. Jodilyn Owen highlights the importance of asking questions in the presence of peers, as it promotes shared learning, strengthens trust, and ultimately enhances patient care. Meanwhile, Brian Uhlig suggests that targeted questions during the discovery phase help assess a client’s readiness for optimization and improvement. Improving Communication and Understanding Effective communication depends on asking clarifying questions to ensure alignment. Scott Conard emphasizes the importance of identifying what others don’t understand and framing messages accordingly. This is particularly vital when communicating across different expertise levels or organizational hierarchies. Asking simple but strategic questions bridges knowledge gaps and enhances comprehension. Measuring Progress and Success Well-crafted questions help define objectives and track progress. Ashleigh Gunter advocates for soliciting feedback by asking what worked well and what could be improved. Regularly measuring and sharing successes reinforces positive change. Kate Wolin further asserts that you can’t optimize a process if you haven’t first defined the goal—a process that begins with asking the right questions. Conclusion Ultimately, asking good questions is not just about finding answers; it is a powerful tool for understanding value, diagnosing problems, driving innovation, enhancing collaboration, improving communication, and measuring success. Whether in healthcare or broader organizational contexts, mastering the art of inquiry leads to better decision-making and improved outcomes. By fostering a culture that encourages thoughtful questioning, we pave the way for meaningful progress and lasting impact. Written by Rob Thwaites in consultation with the Converging Health Consulting Team

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July 24, 2024: It’s the Delivery System, Stupid!

Clinical Consulting /

Moving from Fee for Service to Prospective Payment in Primary Care: Advanced Primary Care: The Future of Primary Care – Part 15 Sponsored by              WWW.THEMDCEO.COM  “It’s the delivery system, stupid!” James Carvel, an advisor to President Clinton during his run for the White House, famously wrote on the wall of their office. “It is the economy, stupid! It was his way of staying on message. We’ll follow in his footsteps with our saying that is intended to keep people’s attention focused on the real issue underlying healthcare reform. It’s the delivery system. stupid! Many people believe that doctors are greedy money-oriented bastards. If you change the financial incentives, they’ll change their behavior is the thought. There is a whole pay-for-performance industry dedicated to this. What people don’t realize is that this is not the case for most doctors. And doctors work within a system of care delivery that, as an individual, they have very little control over. They are trapped, especially in primary care, by a hamster wheel that keeps them struggling to get through the day. It is far easier to change the payment system than it is to change the delivery system. A payer can negotiate for a new payment system with the healthcare providers and with the signing of a pen the new financial payment system is in effect. While it’s true that this involves a lot of work, it’s still pales in comparison to changing the delivery system. Think about it. All of the practitioners and administrators in the current healthcare system grew up in the fee-for-service hamster wheel world. They adapted to it over decades, it’s all they’ve ever known for the most part. The medical students and residents in our current workforce training system are all learning how to practice in that model. Only those who spent time in the Veterans Affairs system have experienced something different. So along comes a new model, which we call prepaid advanced primary care and the docs and administrators at all level don’t know how to behave. The systems they’ve created that direct and constrain their practice behaviors, the teams they’ve created to support their current delivery of medical care, and the entire administrative system has all been formed in the fee-for-service, reactive care delivery world Changing the delivery system requires near radical learning at all levels. It’s not just the Docs, it’s not just the team that supports them. It’s all of the administrative infrastructure that surrounds them as well. We say this with no disrespect intended. In the fee-for-service model, administering a primary care service line is a relatively straightforward enterprise. We realize that the people in these administrative positions work hard day in and day out to manage things All the metrics and the management tools are relatively straightforward. The more you do, the more you make. Get them in – get them out; get the docs motivated to do whatever it takes to generate revenue. This is far different from prepaid advanced primary care, the payment model we are presenting in this new model, It’s all about keeping people healthy. It’s about them not using services that are unnecessary Within the delivery system, it is only the docs who can discern what is necessary care? The administrators are totally out of their league when it comes to this. This transformation is going to require learning at all levels and learning makes many people uncomfortable. They want the rules and the clear protocols and those are not easily laid out. It’s the delivery system stupid! And it’s going to take physician leadership within the practices and within the systems to make this work Currently only about 5 to 10% of all contracts involve risk and even less involves full risk. It is very hard to change the current delivery system when the revenue that the systems require are split between prospective payment and fee-for-service payment. Until the prospective payment gets to 50% or so of the business on which the providers/systems rely, it is very inefficient to run two types of payment systems So the change is slow and for many they cannot see evidence of transformation. They become disillusioned with the promise of value based/prospective payment. It takes the innovators and early adopters among both the physicians and the administrators to see the change and to seize the moment Carpe diem primary care. Your time is at hand. The revolution has begun. Scott Conard, MD              Michael Tuggy, MD                   Susan Lindstrom                 Laurence Bauer, MSW, MEd [email protected]   [email protected]   [email protected]   [email protected]

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Mike Adams and Scott Conard Discuss: Why Chronic Diseases Matter in Designing Effective Plan Benefits 

Employer Healthcare Solutions /

In today’s workplace, the impact of chronic diseases cannot be overstated. With an estimated six in ten adults living with at least one chronic condition, and four in ten affected by two or more, the implications for employers are significant. Nationally, it is projected that 90% of the $4.1 trillion spent on healthcare annually is directed towards individuals with chronic and mental health conditions. This staggering figure emphasizes the urgent need for HR departments and corporate executives to integrate chronic disease management into their benefit design.  The Cost of Chronic Conditions  Chronic diseases, defined as health conditions lasting one year or more that require ongoing medical attention or limit daily activities, often develop over many years. This progression typically moves from pre-disease to disease without complications, then to complications, and finally to end-stage disease— a journey that can take anywhere from 5 to 20 years. The costs associated with each stage escalate dramatically, making early identification and intervention crucial. By understanding this continuum, employers can implement strategies that address issues early, thereby significantly reducing long-term healthcare costs.  Understanding the Landscape  To design effective benefit plans, HR professionals must first comprehend where employees stand on the continuum of chronic disease. Gathering data on employee health status allows organizations to tailor resources and programs to meet their specific needs. Given the sheer volume of chronic conditions and the limited resources available, focusing on the top five conditions that affect either the highest number of employees or incur the greatest costs provides a pragmatic approach.   Key Conditions to Address  1. **Musculoskeletal Disorders**: Consistently one of the most prevalent and costly chronic conditions, musculoskeletal disorders affect a significant portion of the workforce. Addressing these conditions through ergonomic programs and physical therapy can lead to improved employee health and productivity.  2. **Cancer**: With rising incidence rates, cancer poses a considerable challenge. Offering comprehensive support, including screenings and mental health resources, can improve outcomes and reduce associated costs.  3. **Heart Disease**: As a leading cause of death, heart disease requires robust management strategies. Providing access to preventive care, nutrition counseling, and fitness programs can help mitigate risks.  4. **Diabetes**: With its growing prevalence, diabetes management programs that focus on education, nutrition, and regular monitoring can lead to significant cost savings and better health outcomes.  5. **Mental Health**: The COVID-19 pandemic has amplified mental health issues in the workplace. Addressing mental health proactively—through employee assistance programs (EAPs) and mental wellness initiatives—can create a supportive environment that fosters overall well-being.  A Holistic Approach  It is important to note that chronic conditions often co-occur, meaning that addressing one condition can positively impact others. For instance, a comprehensive program designed for diabetes management can also benefit employees with heart disease and mental health issues. By implementing an integrated benefits strategy, employers can create a more cohesive system that supports overall employee health.  Conclusion  Chronic diseases significantly impact healthcare costs and employee productivity. By understanding the prevalence and progression of these conditions, HR departments and corporate executives can design benefits that not only address immediate health needs but also foster long-term well-being. Focusing on key chronic conditions—musculoskeletal disorders, cancer, heart disease, diabetes, and mental health—will allow employers to create targeted programs that ultimately lead to healthier employees and reduced healthcare expenditures. In this era of rising costs and increasing health challenges, a proactive approach to chronic disease management is not just beneficial; it’s essential for sustaining a healthy workforce. 

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Mike Adams on The Vital Role of a Physician Advisor

Employer Healthcare Solutions /

By Mike Adams and Scott Conard M.D. When we think about a physician, the classic image is someone in a white coat, caring for patients. But in today’s healthcare landscape, there’s a new kind of physician stepping into a very different role—one that’s shaping the way companies approach employee health benefits, healthcare costs, and workplace well-being. This is the physician executive, and they’re here to break traditional molds, offering insights that align medical expertise with business strategy. And the impact? It’s profound.  A physician executive isn’t just a consultant ticking off metrics; they’re catalysts driving companies to ask the tough questions about healthcare. They’re the ones who help employers understand not only what health benefits to offer but why these decisions matter to both their people and their bottom line.  Breaking the Benchmark Trap and Leading the Pack  Let’s talk benchmarks—a favorite topic in the world of employee benefits. Many companies measure themselves against industry standards, but is being “average” really good enough? Physician executives challenge this mindset. They encourage companies to stop aiming to be in the middle of the pack and instead set new standards that prioritize quality care and employee well-being.  One popular saying captures their philosophy perfectly: “Lead, follow, or get out of the way.” That’s the attitude physician executives bring to the table. They aren’t there to rubber-stamp the same-old solutions. Instead, they push companies to take an innovative approach, whether it’s in healthcare plan design, employee engagement strategies, or even how they measure success. The goal is to create a benefits package that’s not just comparable, but truly better—one that resonates with employees and delivers real results in terms of health outcomes and cost savings.  Aligning Employee Experience with Quality Care  Here’s a crucial insight from the physician advisor’s perspective: employee experience doesn’t just mean giving employees everything they ask for. Rather, it’s about designing healthcare benefits that balance experience with top-notch clinical care. The focus should be on creating an environment where employees are engaged, healthy, and supported, not just momentarily satisfied.  This is where a physician advisor’s clinical insight comes in. They’ve spent time in the trenches, navigating the patient care process, so they understand firsthand what high-quality care looks like and how to deliver it efficiently. They know how to blend the “wants” with the “needs” to create benefits that improve employees’ overall health and productivity.  The Converging Health Solution: Data-Driven Savings and Better Outcomes  If you’re a company leader looking to improve your healthcare strategy without breaking the bank, consider partnering with Converging Health. Physician advisors from Converging Health specialize in using data to guide smarter healthcare choices, helping businesses focus on what really matters. With a deep understanding of behavioral economics and healthcare systems, they know where to trim costs without sacrificing quality.  Converging Health’s services, grounded in analytics and a comprehensive understanding of the healthcare ecosystem, help companies manage complex healthcare dynamics, from insurance to point solutions. They offer a blend of clinical expertise and financial insight that lets you see tangible savings—reducing unnecessary spending while boosting employee health and engagement.  In short, with a physician advisor from Converging Health, you’re not just navigating the system; you’re setting a new standard for healthcare benefits. Ready to save money and elevate care? Reach out to Converging Health and see how an innovative approach to healthcare can benefit your company’s bottom line and keep your employees healthier, happier, and more productive. https://converginghealth.com/contact-us    In collaboration with Mike Adams and also posted on Scott Conard’s Blog

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