How Trusted Primary Care Relationships Keep Patients Out of the ER — and Lower Plan Costs

ER spend is now about 6% of average plan spend, and it doesn't have to be. In this Take Two episode, Stacey Richter revisits her conversation with Kenny Cole, MD, primary care internist and system vice president at Ochsner Health System, through a focused lens: what does it actually take for primary care to function as an investment in health rather than a cost center — and what happens when it doesn't? Dr. Cole designs new care models at Ochsner. His results are instructive: 98–99% of his patients tolerate metformin, and he holds a target of 95% hypertension control as the standard — compared to the 60–75% rates many practices consider excellent. WHAT YOU'LL LEARN ✅ Why trust is the operative word in primary care delivery — if a care team hasn't earned a patient's trust, that patient will wind up in the ER in a moment that matters, at great cost to the patient, the plan, and the community ✅ How Dr. Cole achieved 98–99% metformin tolerance by treating GI side effects as a solvable clinical problem, using iterative patient conversations and a standardized smart phrase in his EHR to coach every patient on food pairing ✅ Why care flows and standardization are the difference between 40% and 80% hypertension control within the same physician group — and how making best practice visible and measurable unlocks competitive improvement across a whole clinical team ✅ How digitizing care pathways lifts cognitive burden off physicians so they can use limited appointment time to build the patient relationship rather than process clinical complexity, and why this is necessary for panels of 2,500 to 3,000 patients ✅ The perverse incentive buried in the traditional fee-for-service model: health systems often subsidize primary care losses with downstream revenue from hospitalizations, stents, and bypass surgeries — meaning great primary care can look like a financial liability to health system leadership even when it's clearly the right thing for patients WHY THIS MATTERS As Stacey frames it, if you aren't getting your members a trusted advisor who will be there for them when it matters, someone else will steer that member — and they're steering based on their own financial incentives. The Upton Sinclair line Dr. Cole quotes says it plainly: it's hard to understand something when your income depends on understanding the opposite. Primary care is already fixed. The clinical knowledge, the care flows, and the measurement tools all exist. The obstacle is a business model that rewards volume over outcomes — and plan sponsors who understand this dynamic are better positioned to demand something different. === LINKS === 🔗  Show Notes with all mentioned links:   https://cc-lnk.com/EP473 ✉️  Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙  Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤  Listen on Apple Podcasts  https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤  Listen on Spotify  https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺  Subscribe to our YouTube channel   https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn   https://www.linkedin.com/company/relentless-health-value/ ✭ Threads  https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky   https://bsky.app/profile/relentleshealth.bsky.social ✭ X   https://twitter.com/relentleshealth/ 00:00 Introduction 07:35 Is there an optimal care pathway where there might be a lot of treatment variability? 10:52 EP412 with Robert Pearl, MD. 12:32 Why is it important to start with the end in mind? 15:44 How do you scale clinical excellence? 18:18 EP315 with Bob Matthews. 19:12 EP242 with Marty Makary, MD. 21:29 Why is it important simply to demonstrate what's possible for better health outcomes? 22:33 EP427 with Rik Renard. 23:18 How do we reinvent the business model of healthcare? 24:51 EP466 with Vivian Ho, PhD. 25:06 EP415 with Rob Andrews. 26:51 EP391 with Scott Conard, MD. 30:14 EP455 with Beau Raymond, MD. 34:22 Dr. Cole is published in various healthcare journals; check out his most recent article.