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Back at the beginning of this year, I was so sad when I had to edit out the clip that follows from the original and extremely popular episode 391 with Scott Conard, MD.

In the literally probably three minutes that follows in this clip with Dr. Conard after I finish my ramblings here, Dr. Conard introduces the impact that changing the practice model in a PCP practice in Queens, New York, had on the staff and patients alike. Spoiler alert: No way no how were they going back to the old way of doing things.

The \u201cBefore\u201d here was a clinic where the waiting room was filled to overflowing out into the hall with patients waiting to be seen, and this included a mix of really sick people who really needed to be seen and also \u2026 others.

And thus they had, among a whole host of other bad things going on, the whole issue of suboptimal ER (emergency room) visits and urgent care usage. Anyone who couldn\u2019t wait just headed elsewhere.

Also, as it is so many places, care was pretty transactional. A patient who wasn\u2019t in clinic had an \u201cout of sight, out of mind\u201d relationship with their PCPs. There was no systemic way for the clinical teams to really think about the \u201cin between spaces,\u201d as Amy Scanlan, MD, put it (EP402)\u2014the spaces in between office visits. But then as a result, of course, we wind up dealing with uncontrolled chronic conditions and the failure to prevent preventable disease. We wind up with urgent needs for care and acute situations that had, frankly, no business getting to that stage in the first place.

So, Dr. Scott Conard and his team worked on practice transformation, including focusing on operational excellence. I say all that to say, here\u2019s Dr. Scott Conard:

DR. CONARD: We went and did one pilot clinic, which is, I think, the right way to do it. And then the practice manager was recruited by a competing group. They put another person in the clinic, another practice manager. And she immediately came in and thought that her job was to go back and put the old way of doing things in place, and within literally four or five days, they got together and sat down and said, \u201cLook, we understand where you\u2019re coming from, but we will never go back. We are not going back to that old system. We are going to do things in this new way because it makes our lives\u2014and we work together\u2014so much better. And we enjoy being together, and we\u2019re seeing \u2026 we like not having 30 people waiting to get here at work. We like people getting \u2026 having a waiting room be close to empty as we just have one or two of the next people coming in. And we will never go back to that old system.\u201d And, to her credit, she\u2019s like, \u201cOkay \u2026 cool. Let me understand this.\u201d And she\u2019s now one of the strongest leaders in that organization for this transformation.

STACEY: So, the PCPs \u2026 it was like mutiny on the bounty. They were like, \u201cNo way no how are we going back.\u201d

DR. CONARD: Oh, it was the entire team: their receptionist, the telephone operator, the MAs. They have a patient navigator, which is another part of the equation we haven\u2019t talked about that\u2019s really important. And so, the whole team said no.

Listen to the full episode 391 to learn more about Dr. Scott Conard and his team\u2019s approach to practice transformation. But in the meantime, Peter Watson, MD, captured a few learnings from the original episode really nicely on LinkedIn.

Dr. Watson has some other really great posts on the topics of value-based care and primary care. I would highly recommend following him on\xa0LinkedIn.

Should you continue to be interested in this topic of transformational primary care, additional shows on transforming primary care\u2014including bright spots and challenges\u2014are the shows with Eric Gallagher (EP405) and, as aforementioned, the show with Dr. Amy Scanlan (EP402). Also check out the upcoming show with Larry Bauer, which will be approximately episode 409, should I get my act together. And Vivek Garg, MD, MBA (EP407), who, by the way, is coming up in next week\u2019s summer short talking about the common rebuke of comprehensive primary care, which is that it diminishes patient access because PCP patient panel sizes tend to be smaller in comprehensive primary care models.

Since the original show with Dr. Scott Conard aired, his new book Which Door? came out. I\u2019m gonna say that this book is relevant. It\u2019s written for employers but still relevant here because employers have a terrible track record for helping (ie, paying for healthcare) in a way that enables PCPs who want to do comprehensive primary care to actually do comprehensive primary care. When an employer lets the status quo prevail, employees get fragmented care provided by PCPs struggling under the weight of brutal administrative burden and often nasty and counterproductive incentives.

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You can learn more by emailing Dr. Conard at scott@scottconard.com.

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\xa0Scott Conard, MD, DABFP, FAAFM, is board certified in family and integrative medicine and has been seeing patients for more than 35 years. He was an associate clinical professor at the University of Texas Health Science Center at Dallas for 21 years. He has been the principal investigator in more than 60 clinical trials, written many articles, and published five books on health, well-being, leadership, and empowerment.

Starting as a solo practitioner, he grew his medical practice to more than 510 clinicians over the next 20 years. In its final form, the practice was a value-based integrated delivery network that reduced the cost of care dramatically through prevention and proactive engagement. When this was acquired by a hospital system, he became the chief medical officer for a brokerage/consulting firm and an innovation lab for effective health risk\u2013reducing interventions.

Today, he is co-founder of Converging Health, LLC, a technology-empowered consulting and services company working with at-risk entities like self-insured corporations, medical groups and accountable care organizations taking financial risk, and insurance captives to improve well-being, reduce costs, and improve the members\u2019 experience.

Through Dr. Conard\u2019s work with a variety of organizations and companies, he understands that every organization has a unique culture and needs. It is his ability to find opportunities and customize solutions that delivers success through improved health and lower costs for his clients.

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02:15 Why a transformed PCP practice didn\u2019t want to go back to the old way of doing things.

03:39 Dr. Peter Watson\u2019s takeaways from Dr. Conrad\u2019s EP391.

04:02 Can fee for service in the short term still benefit primary practice?

04:43 EP405 with Eric Gallagher; EP402 with Amy Scanlan, MD; upcoming episode with Larry Bauer; and EP407 with Vivek Garg, MD, MBA.

05:24 Scott Conard\u2019s new book, Which Door?

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You can learn more by emailing Dr. Conard at scott@scottconard.com.

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@ScottConardMD discusses #PCP transformation on our #healthcarepodcast. #healthcare #podcast

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Recent past interviews:

Click a guest\u2019s name for their latest RHV episode!

Brennan Bilberry, Stacey Richter (INBW38), Scott Haas, Chris Deacon, Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid