Employee Wellbeing

Stories of Hope, activation, and outcomes: The MyPHA Impact

Leave a Comment / MyPHA /

The MyPHA Difference: 25+ Stories of Real People, Real Impact At Converging Health, we believe every healthcare journey should be guided, not navigated alone. The MyPHA program—short for My Personal Health Assistant—exists to ensure that no member feels lost in the system. From billing frustrations to chronic care coordination, these 25+ real-life stories highlight the transformational role MyPHA plays in people’s lives every day. 1. A $218 Medical Bill Turned into $0What started as a routine colonoscopy turned into a $218 surprise for one member. The procedure should have been covered as preventive care, but a lab bill from an out-of-network facility arrived unexpectedly. Confused and anxious, the member contacted MyPHA. Rather than offering a generic solution or deferring to customer service, our Personal Health Assistant took ownership. First, we contacted the lab to clarify the billing error, then stayed on the phone with the insurance provider, advocating for the member and reiterating the preventive nature of the service. It wasn’t enough to get a partial reduction—we knew what the member deserved. Our persistence paid off. The bill was reduced to $71, but we weren’t satisfied. Another call, another push—and the balance dropped to zero. The member was both relieved and amazed. What felt like an unfair, confusing setback became a story of advocacy and resolution. Now, they proudly tell coworkers how MyPHA stood by them, fighting not just for dollars, but for peace of mind. 2. From “I Don’t Need Help” to Full EngagementWhen our Care Coordinator first reached out, the member was polite but firm: “I don’t need help.” Instead of pushing, we paused and listened. The Personal Health Assistant explained the value of MyPHA, outlining how the program could make life easier—from saving money to gaining access to better care. They described how members often don’t realize the benefits available until they talk to someone who connects the dots. The conversation didn’t end in a breakthrough. But within 24 hours, the member had booked their first appointment and was fully engaged in their wellness plan. What changed? It wasn’t pressure. It was presence. It wasn’t about convincing. It was about showing up with empathy, offering real value, and building trust. That’s what changes minds—and health outcomes. That member now checks in regularly, refers colleagues, and takes pride in the control they’ve gained over their health. 3. Better Blood Pressure, Better LifeDuring a check-in call, a Care Coordinator noticed something concerning: the member’s blood pressure medication wasn’t working. Their readings were still high, and they felt tired and foggy. Often, this is the point where people give up or assume there are no better options. We encouraged the member to contact their physician and ask for a medication review. The provider adjusted the dosage, and within weeks, the member’s blood pressure stabilized at 120/70. The member shared how different they felt—more energy, clearer thinking, and a return to feeling like themselves. They hadn’t realized just how much their quality of life had slipped until things started improving. We kept in touch to ensure they stayed on track and had the support they needed to maintain this new normal. Sometimes, it’s not about a major diagnosis. It’s about paying attention, asking the right questions, and supporting small changes that lead to big improvements. 4. From Frustration to Trust in Just One CallA client employee came to us after feeling passed around by the system—long holds, vague answers, and no resolution. They were skeptical, frustrated, and just wanted help finding a primary care doctor. After so many dead ends, they didn’t expect much. Our team listened. We responded quickly, scheduling an appointment with a Care Coordinator that same day. Behind the scenes, the Personal Health Assistant briefed the Coordinator so the handoff would be seamless, building continuity and reducing emotional fatigue. By the end of the day, the member had not only found a provider, but also felt genuinely heard and supported. They told us they were “blown away” by how quickly things turned around. That single touchpoint transformed a skeptic into a MyPHA advocate, restoring their faith in the system and showing them they were more than just a number. 6. When High Risk Meets High TrustA member flagged as high risk initially wanted nothing to do with MyPHA. He was polite but dismissive, saying he was too busy and didn’t need help. But our Personal Health Assistant didn’t walk away. Instead, they followed up respectfully, expressing genuine care without pressure. Gradually, his guard lowered. He agreed to a conversation and shared his situation: he hadn’t seen a primary care doctor in years, missed critical wellness visits, and relied on emergency care for routine issues. He hadn’t realized how avoidable his last ER visit had been. That one conversation changed the course of his care. He reconnected with a primary provider, scheduled preventive services, and started seeing his health differently. Later, he texted, “Thanks again. I wouldn’t have followed through if you didn’t stay on me.” Sometimes, the breakthrough isn’t a treatment—it’s a mindset shift. And that’s where trust makes all the difference. 7. Empowering a Member with COPD—One Breath at a TimeA new COPD diagnosis left one member feeling overwhelmed and resistant. He was still smoking, didn’t trust the healthcare system, and didn’t see much point in changing. But when a Care Coordinator called, they didn’t lecture—they listened. Instead of diving into medical advice, they talked about the diagnosis, what it meant, and offered reading materials. They scheduled a follow-up to revisit questions once the member had a chance to reflect. By the second conversation, he had read the materials and had real questions. He began tracking his breathing, explored options to cut back on smoking, and slowly began engaging with care. He wasn’t looking for perfection—he just needed to believe improvement was possible. MyPHA met him there, one breath at a time. 8. Saving a Member $800 on a Dental BillAn $800 dental bill landed in a member’s inbox, with no warning. She was told the

Stories of Hope, activation, and outcomes: The MyPHA Impact Read More »

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

Uncategorized /

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.

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

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

Mike Adams and Scott Conard: Nursery School is Over Read More »

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.

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

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

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

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

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

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. 

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

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

Mike Adams on The Vital Role of a Physician Advisor Read More »

Relentless Health Value: Episode 462 with Converging Health’s…

Clinical Consulting, Employer Healthcare Solutions /

Today, Dr. Scott Conard discusses the evolution of his life’s work, focusing on his current collaboration with Mike Adams from 7-Eleven to support their plan members. Their efforts revolve around a few striking yet common insights that many plan sponsors will recognize in their own data. One key finding: roughly 70% of individuals who exceed a plan’s high-cost threshold in any given year were previously high-risk but low-cost. These individuals don’t appear out of nowhere—they were identifiable in prior years. The challenge is to identify them early and provide the right interventions to prevent them from transitioning into the high-risk, high-cost category. Effectively managing a population requires proactive identification of high-risk, low-cost members before they escalate into high-cost care. To achieve this, Dr. Conard follows a best-practice, stepwise approach, which we’ll outline below. While we cover each step in the discussion, some are explored in greater depth than others. Best-Practice Approach to Managing Population Health 1. Get the Data – The Whole-Person Risk Score Rather than categorizing members into isolated disease groups, the goal is to assess risk at a whole-person level. Patients aren’t just a collection of separate conditions—they’re complex human beings whose health factors interact. Dr. Conard often uses a car analogy: If a car’s tires wear out, you simply replace them. But humans don’t work that way. A patient may need surgery but be unable to proceed because their cardiovascular markers are too high. Yet, they can’t take the necessary medication due to contraindications with existing kidney or liver conditions. This fragmentation in care often leads to patients being bounced between specialists who don’t communicate effectively. A real-world example comes from Miriam Paramore, who shares a harrowing story about her father’s end-of-life care—an illustration of why whole-person risk scoring is critical. 2. Provide Access to Advanced Primary Care Teams Members need access to high-functioning primary care teams that are empowered to make informed referrals to top-tier specialists. These teams should ensure care is high-quality, appropriate, and optimized for each patient. 3. Align Benefit Design with Optimal Care Pathways Plan sponsors must structure benefits to support the care members need. If benefit design creates barriers—like high co-pays for essential services—members may forgo necessary care, leading to worse outcomes and higher costs in the long run. Dr. Mark Fendrick once compared benefit design and optimized medical care to peanut butter and jelly—they must go together. For example, if a doctor tells a diabetic patient to get regular foot exams to prevent amputations, but the patient can’t afford the co-pay, the system fails. The patient suffers, the doctor’s quality scores take a hit, and the plan sponsor ultimately pays for costly, avoidable complications. Step 3 ensures benefit design supports, rather than hinders, effective care. 4. Engage Members with Navigation Tools Members need guidance to navigate the healthcare system effectively. Tools like My Personal Health Assistant play a crucial role in engaging unengaged patients and ensuring they follow optimal care pathways. These tools complement advanced primary care efforts, helping members stay on track and receive the right care at the right time. By following this structured approach, plan sponsors can proactively manage population health, reduce costs, and improve outcomes—transforming their approach from reactive to strategic.

Relentless Health Value: Episode 462 with Converging Health’s… Read More »

HR Director’s Dilemma: How Corporate Financial Incentives Impact Employee Healthcare Costs and Access

Employer Healthcare Solutions /

As an HR director, managing employee benefits is one of the most impactful ways to support your workforce. Yet, navigating the complexities of healthcare costs and access has never been more challenging. Corporate financial incentives—the unseen forces behind many decisions in the healthcare system—play a critical role in shaping the quality and affordability of care for your employees. These incentives, while often intended to improve efficiency, can unintentionally lead to higher costs, reduced access, and a focus on profit over patient outcomes. Understanding how these financial incentives affect your employees’ healthcare experience is essential. Here’s a breakdown of key factors and potential solutions: Employer-Sponsored Health Plans: Navigating the Balancing Act Provider Incentives: A Double-Edged Sword Pharmacy Benefit Managers (PBMs): Misaligned Incentives Insurance Companies: Limited Competition, Rising Costs Lack of Transparency: A Barrier to Better Decisions The Ripple Effect on Employees and the Economy Charting a Path Forward: Solutions for HR Leaders A Call to Action As HR leaders, we have a unique opportunity to influence not just the lives of our employees but the broader healthcare system. By understanding the unintended consequences of corporate financial incentives and advocating for innovative, patient-centered solutions, we can create a system that prioritizes care over costs. It’s time to step up, ask the tough questions, and champion changes that benefit our employees, organizations, and communities. Together, we can transform healthcare from a source of stress into a cornerstone of employee well-being and organizational success.

HR Director’s Dilemma: How Corporate Financial Incentives Impact Employee Healthcare Costs and Access Read More »

Scroll to Top