Encore! EP391: A Case Study for Anyone Trying to Level Up Primary Care That I'm Gonna Call "How Margin Shoves Mission Off the Bus," With Scott Conard, MD

Scott Conard, MD, grew a solo practice into a 510-clinician, value-based integrated delivery network that reduced the cost of care through prevention and proactive engagement — and then watched it get acquired by a hospital system whose incentives ran the opposite direction. In this encore episode, he tells Stacey Richter the story in detail, including how one North Texas health system managed to raise local healthcare spend by $100 million in a single year, partly by pulling back the population-health infrastructure that had been keeping patients out of hospital beds. It's a case study in what happens when margin quietly shoves mission off the bus — and Dr. Conard is careful to note that the people making these calls upstairs are rarely the doctors themselves.

WHAT YOU'LL LEARN

✅ Why a PCP can produce genuinely high-value care inside a fee-for-service model — if they're willing to change practice patterns and think of themselves as a risk-management expert, not just someone who treats symptoms

✅ What a "Whole-Person Risk Score" is, and how it helped move Dr. Conard's practice from a transactional model to a relationship model

✅ Why total cost of care — not just primary care cost — is the number that actually matters when evaluating a risk-based contract

✅ How a local health system raised North Texas healthcare spend by $100 million year over year, partly by scaling back the very population-health efforts that kept patients out of hospital beds

✅ Why "fiduciary responsibility" so often functions as a euphemism for decisions with questionable community benefit — and why that's a systemic incentive problem, not evidence of bad people

WHY THIS MATTERS

Dr. Conard's story is a case study anyone trying to level up primary care should sit with: doing the right thing clinically doesn't protect a practice from getting acquired, financialized, and repurposed toward incentives that undo the very outcomes it was built to produce. As he puts it, this isn't about villainizing the people inside not-for-profit hospital systems — it's about recognizing that even well-intentioned organizations operate under incentives that can quietly increase spend, reduce prevention, and produce moral injury in the clinicians caught in the middle. Fixing that requires looking at the system's incentive structure, not just the intentions of the people working inside it.

MENTIONED IN THIS EPISODE

Encore! EP335 with Brian Klepper, PhD: Apple Podcasts | Spotify | Other Apps

Encore! EP381 with Karen Root: Apple Podcasts | Spotify | Other Apps

EP364 with David Muhlestein, PhD, JD: Apple Podcasts | Spotify | Other Apps

EP384 with Wendell Potter: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction

06:54 What triggered Scott's career journey?

07:31 What caused Scott to rethink what is good primary care?

08:11 Why did Scott realize that he is actually a risk-management expert as a primary care doctor rather than someone who treats symptoms?

09:25 Encore! EP335 with Brian Klepper, PhD.

09:53 How did Scott's practice change after this realization?

10:04 What is a "Whole-Person Risk Score"?

13:05 "You start to move from a transactional model to a relationship model."

15:31 Did Scott have any risk-based contracts?

16:08 Why is it so important to look at total cost of care and not just primary care cost?

22:13 Encore! EP381 with Karen Root.

30:43 Why did Scott move over to help corporations?

33:10 EP364 with David Muhlestein, PhD, JD.

33:51 "Everybody thought they were honoring their fiduciary responsibility, and the incentives are completely misaligned."

34:31 EP384 with Wendell Potter.

34:43 "It's the system that's broken; it's not bad people."