Why Advanced Primary Care
[00:00:00] Stacey Richter: Episode 504. A Back to Basics Roadmap Through the Perverse Incentives to Advanced Primary Care. Today I am speaking with Ryan Jacobs.
[00:00:29] Stacey Richter: It's been a while since we started from the beginning, so let's just take stock of the basics in this show. Refresh ourselves if you're a longtime listener or welcome if you're new around here. Today we are digging on and about what I would call the poster child for proven healthcare strategies: advanced primary care, otherwise known as APC.
If you look at the data, APC, well done and with the right segmentation, neither of which should be underestimated, but done well. APC should be a slam dunk. It improves patient outcomes. It reduces costs. Listen to the episode with Dr. Kenny Cole for more on what good advanced primary care looks like, and the show with Dr. Beau Raymond on pulling it off in a community.
Defining Real APC
[00:01:15] Stacey Richter: Now I wanna make one thing really clear. When I say advanced primary care, APC, please note, I do not mean some kind of seven minute patient visit during which the clinician tells the patient he or she is limited to, but one concern only. And if they wanna talk about anything else, they gotta make another appointment and pay another copay.
I'm also not talking about any kind of model where a doctor takes a capitated payment and then doesn't even see the patient. They just process a referral, which I saw a post about by Stacy Mays the other day. So nothing of that ilk. We're talking about real advanced primary care, which is managing risk, not symptoms.
Why APC Isn't Everywhere
[00:02:32] Stacey Richter: So anyway, here is the probably multibillion-dollar question. If the evidence for APC is so robust, why isn't APC everywhere? Why aren't we tripping over high value primary care clinics on every street corner? And if you're a clinician trying to do APC, why isn't it super easy to stand up a practice and get paid?
The answer? As usual lies in the Pachinko machine. That is the US healthcare industry. You throw a great idea, even when with lots of evidence into our industry, into our sector, and the results that bounce out the other side are rarely what anybody may have expected, intended or wanted.
So on the show today, first we are exploring the pit traps--I'll call them—the blockades that keep APC from really scaling, starting with two root causes.
Fiduciary Duty Conflicts
[00:03:20] Stacey Richter: The first one being conflicting fiduciary duties. Because look, when we talk about your average--let's just say hospital board, let's just start there--health system boards fiduciary responsibility, we aren't just talking about mission.
There's a reason for the epidemic of burnout and moral injury amongst clinicians in this country. There's a reason why fewer than half, 45% of frontline clinicians trust their organization's leadership to do what's right by patients. At the board or C-suite level it's all about heads in beds, as they say.
A health system drives revenue by driving volume, profitable surgeries, infusions that are tens of thousands of dollars more than you can find at an indie practice. And again, filling those beds.
Meanwhile, the entire goal of advanced primary care is to keep patients out of the hospital and out of the ER. As my guest, Ryan Jacobs today points out, there is a very steep uphill battle when your innovation actually threatens the revenue of some of the largest players in the non-market that we have here.
Listen to the episode with Dr. Scott Conard talking about his, he calls it his Pelican Brief moment when he was dealing with a local health system. It is a really stunning, just stop you in your tracks perfect example of this whole conflicting fiduciary duties thing playing out in real life.
Black Box Complacency
[00:04:39] Stacey Richter: So then after that we get to a second reason why APC is not available on every corner. Ryan Jacobs, again, my guest today, he calls this second reason the black box of complacency.
In our healthcare nonmarket innovators and those looking to improve quality or lower costs, often don't lose to better competitors. They lose to the status quo. I mean, you think about this--it is often a rational move for "lazy networks" and consolidated health systems to do nothing because they get the volume anyway, especially when self-insured employers buy on discounts and not much else.
Listen to the episode with Jonathan Baran on the healthcare flywheel for a really, really deep dive into this point.
Three Step Roadmap
[00:05:24] Stacey Richter: All right, now let's make all this actionable. Ryan lays out a three step roadmap for founders, clinicians, plan sponsors, anybody who is tired of waiting for the invisible hand to fix things because yeah, exactly.
There's no functioning market in most of the healthcare industry, so there is no invisible hand that's gonna level up quality or keep prices down. It does not work that way.
Here's the roadmap that Ryan Jacobs lays out today.
Step 1: Perform a reality based assessment. Think about all the things that we just talked about. No magical thinking allowed. You have to follow the dollar. You gotta understand who has a negative financial incentive when patients stay healthy.
These fiduciary conflicts and these complacencies, they are material and they must be considered because that pachinko ball will bounce in response. And if you know what you're looking for because you follow the dollar, you can kind of predict what's gonna happen.
Step 2 of our roadmap: Anticipate the stakeholders math. If you wanna get buy-in from a CFO or a Benefits Pro or anybody else, you have to do the math the same way that they do. That's step 2.
Step 3: Build your own strategic conclusions. So take all this on board and maybe you arrive at direct contracting for advanced primary care, which is essentially finding a pathway that is outside of the traditional belly of the beast--or whatever you wanna call it--because when you are contracting for advanced primary care, you're going around conflicting fiduciary responsibilities.
What you are doing is bringing—Ryan Wells said this on the pod a couple of weeks ago—you're bringing together the beginning of the road (ie, the ultimate purchaser of the plan sponsor) and the end of the road, which is the doctors, the entities that are actually providing care--and getting rid of everything that is going on in the middle, where a lot of those conflicting fiduciary responsibilities, where a lot of that complacency lies.
So, yeah, if you wanna understand why on average self-insured employer ER spend is now topping out at about 6% of total plan costs and how to actually start thinking about fixing the “pipes” of primary care, you're in the right place. Continue to listen.
Show Setup Sponsors
[00:07:30] Stacey Richter: My name is Stacey Richter. My guest today, as I have mentioned several times at least, is Ryan Jacobs, who is SVP Strategy and Partnerships over at Marathon Health.
This episode is sponsored by Aventria Health Group. And we had an assist from Payerset. Payerset has price transparency data in a very elegant interface. You can use it to turn negotiations into partnerships. Certainly check them out. And I thank Payerset so much for offering financial support to keep this podcast on the air. Thank you very much, Payerset.
Oh, one last thing here. This show is part of, I don't know, a little bit of a tangent, a series on direct contracting that started off a couple of weeks ago with the show with Ryan Wells, Adam Stavisky, and Dr. Leo Spector. and which will continue through next week when I interview Dr. Ahilan Sivaganesan about what is value, which you kind of gotta know if you're trying to buy value-based care or trying to pay for value. This is a rate critical to know what value means.
Okay, so let's get to it.
Ryan Jacobs, welcome to Relentless Health Value.
[00:08:35] Ryan Jacobs: Thank you, Stacey. Nice to be here. Thank you for having me.
Pit Trap One Deep Dive
[00:08:37] Stacey Richter: So I'm just gonna kick us off here. Whenever you talk about leveling up primary care, advanced primary care, you know, you'd think if it had such a great evidence basis, it would be widespread in every American across the country, would therefore have access to a great advanced primary care setting, except that is not what's happening here.
So today I'm looking forward to speaking with you Ryan about what are the pit traps? Not limited to, but some of the big ones as we discuss advanced primary care that anyone thinking of either trying to get into this business, the business of advanced primary care, or buying advanced primary or like any, anything on or about advanced primary care might be, might really wanna be aware of.
I'm gonna identify the first one as conflicting fiduciary responsibilities. If we kind of ticked down the list. Let's just think about this. If I'm a health system, let's just say on the board, in a leadership role at a health system, how do I conceive of my fiduciary responsibility?
[00:09:37] Ryan Jacobs: At the end of the day, it's driving the right value from a profitability standpoint, from an overall revenue standpoint, and I think that's true whether you're not-for-profit or your for-profit.
There's different circumstances that they both have to operate within, but at the end of the day, they are trying to drive volume to their system.
[00:09:52] Stacey Richter: If you've got a hospital, a health system, their primary fiduciary responsibility is keep the hospital open. And what does that mean? It means heads in beds, it means profitable surgeries of some kinds.
[00:10:03] Ryan Jacobs: It does, and they have to do that in the most responsible and ultimately profitable way they can. So for both, I think both sides of that view, not-for-profit or for-profits, they're trying to drive the same outcome. They're also still competing against each other in some ways.
So you might see a not-for-profit system do things that maybe would surprise some of us. Maybe it wouldn't surprise others because they are trying to compete in this really complicated market that doesn't even always behave like a logical market.
You could probably look at the other side of that and look at a for-profit system saying, I don't get tax exempt status. I don't get all these other privileges.
And so they're doing things as well and they're doing things to try to compete against a different side of the view.
[00:10:41] Stacey Richter: Yeah, And the one thing that I would just add that in our nonmarket that we have here, how you get the highest rates, how you get the most market power or just power is growth.
[00:10:54] Ryan Jacobs: It is. It's growth and it's overall control of that market from a volume standpoint.
And you can look at that on the payer side as well. And the way that they behave.
[00:11:02] Stacey Richter: Yeah. So let's, let's look at it on the payer side. May the biggest get bigger.
[00:11:07] Ryan Jacobs: Correct. So take, take the payer side of it and you have a similar dynamic in that you have certain blues plans that are not-for-profit, that operate under the Department of Insurance in a respective state.
And what they're able to do and how they can navigate is a little bit different than what maybe we would see with a large national payer or maybe a smaller regional player that is for profit.
But at the end of the day, they share that similarity where they're trying to drive volume. They wanna have the most attractive offering, and they wanna make sure that that is giving them the right path to profitability in that state and will allow them to grow and will allow that them to have that much more purchasing power.
They're still sharing that, whether it's for profit or not for profit.
[00:11:45] Stacey Richter: Yeah. And on the payer side, there was a show with Dr. Jacob Asher, which kind of underlines we talk about the state of the carrier “market” in California. But this is this similar to what's true nationally and what you find is that the bigger the plan with the more members, the more negotiating power that they have negotiating with ever larger, ever consolidating hospitals. So scale really matters.
The more patients that you can say that you're gonna bring, the more volume like you were talking about. Then what winds up happening is that again, you have to have this scale. So the big stay big because they can get, as long as employers shop on discounts, then they can, you know, allegedly get the biggest discounts. By the way, don't necessarily result in lower prices. Let's just keep this in mind.
But it just becomes a game of scale. And I think the point that we're kind of making here is that at that juncture, those are the incentives. It is to get bigger, which might be a little bit counter to advanced primary care, which could remove heads from beds. It could reduce the number of profitable surgeries. It could do many things that could impact, in fact, having the capital to add a new wing.
I'm starting to get a vibe here of the misalignment.
[00:12:30] Ryan Jacobs: It is. It's just the reality of the healthcare system broadly in the country that we play within. We are a for-profit healthcare system, and so I think whether it's a health system, And the care they're providing, for-profit or non-for-profit, or a payer, they're operating within the bounds of the system that they live in.
While there's a healthy tension there, I think you can still look at all sides of this. If you're a hospital system, you want to stay open. You have to play within certain the rules of that game and be able to succeed and do that.
And you can do the same thing and look at that through the lens that a health carrier might be doing or a health plan might be doing. They're trying to make sure that they can stay in business and that they can provide access to a network of providers throughout the region that they play in.
[00:13:34] Stacey Richter: I'm not sure if healthy would be the adjective that I necessarily would choose, and...
[00:13:39 Ryan Jacobs: Fair point.
[00:13:40] Stacey Richter: And furthermore, if we're talking about tension, there's a flywheel that's created by that tension. So I'm not necessarily sure if the tension is at a counterpoint or the tension is kind of springing them both down this flywheel, which ultimately winds up making care more unaffordable for the patients because the bigger, getting bigger. And the profit motives are there.
And listen to the show with Jonathan Baran about how, just the way that the dynamics are set up, that actually a carrier has this weird incentive for hospital prices, for prices to go up. You know, if you're taking a percentage of premiums and costs, this is cost plus, right? Like, so there's some weird stuff going on there and I'm not necessarily sure what dimension that that tension accrues.
But at the ends of the day, if you're a carrier or you are a health system that is concerned primarily about a fiduciary responsibility, that boils down to what is the amount of money gross, whatever that we can absorb. Advanced primary care, which is gonna take people out of the healthcare system, isn't necessarily an easy part of that math.
[00:15:02] Ryan Jacobs: No, and I think we as a group of providers, right, collectively, the entire industry of APC, advanced primary care, as well as I'll call it nontraditional payment model primary care.
Our goal is to provide access. Our goal is to make sure that patients have a robust amount of time, the appropriate amount of time with the physicians and the clinicians that they need to spend time with.
It's making sure that they don't spend six months waiting to get an appointment. Because there's so much volume flowing through those doors of a traditional model that you can't get an appointment. And so that person goes without care or they end up at the emergency room.
Our goal is to try to make sure the patient, you're putting the patient at the center of what's important, but the existing structure of the fiduciary responsibilities that exist within health systems and payers are these complicating factors, and they create a very steep uphill battle for this entire industry to continue to transform and to create greater access with the patient at the center of that.
[00:15:42] Stacey Richter: Yeah, I'd probably say that the tension that's created is the tension between the fiduciary responsibility and therefore the motivations of some of these large consolidated corporatized health systems as well as these large corporatized carrier organizations versus what is actually going to make care affordable and accessible for patients.
And also in that mix too, are the clinicians who's try, who are trying to figure out how to serve those patients again within that same ecosystem.
So I think we've probably, I'm just gonna put a capstone on the, there's conflicting fiduciary responsibilities here. This is probably, this is very 101, I think for people who are longtime listeners of this show. But for anybody who might be new around here, we can put some links in the show notes to plenty of shows that really go deep on some of these topics.
But this is huge. This is really huge, and it's a result of the fact that everyone is kind of like there's a healthcare market in the United States and then they sort of wait around for the market to do its invisible hand thing and it won't like, that is not how the power dynamic works in the healthcare industry in the United States.
Pit Trap Two Complacency
[00:16:51] Stacey Richter: The second pit trap, root cause that I wanna bring up here that must be overcome if one is going to succeed with any sort of advanced primary care initiative, any sort of preventative initiative, frankly, is this I'm gonna call it a black box of complacency. You wanna talk about that?
[00:17:11] Ryan Jacobs: I'd love to, and I can give you numerous personal experiences of living through this and the challenges of it. Whether you're trying to do something that's so logical in value-based care and trying to get a deal done and you don't lose to a competitor. You don't lose to somebody else that's got a better offering or a more impactful outcome, you lose to complacency. You lose to the status quo of, it's easier to do nothing.
This is, I think something that just plagues the industry overall. And some of this ties back to what we were mentioning earlier about somebody having substantial or dominant market share. And one of the factors that plays into this is at that point, does an organization continue to push forward and continue to innovate and continue to drive change and raise the bar and make themselves that much more competitive and attractive in an offering to both patients and then to the community?
Or do they sit back and let the power and the control that they have from that market share be the most important thing and do nothing. And then they become complacent because of that complacency that creates a really complicated challenge for those that are purchasing healthcare. Whether it's down to the individual, patient, consumer, or through to the employers and others that are out there in the market buying services.
Employers are frustrated by it because they don't choose where their employees are based and they have to navigate these circumstances.
[00:18:25] Stacey Richter: We had Elizabeth Mitchell on the show a while ago, and one of the things that she mentioned was forget about, you know, everyone says the sleeping giant as per, you know, they're talking about employers and how there's so much inertia in the employer, the self-insured employer, and she's just like, Forget about employers.
Let's talk about inertia amongst TPAs and health systems and etc, because an employer who's trying to do the best they can, but then is faced with a stone wall of an industry who's not willing to help, that's where you wind up with just this concrete sludge of inertia.
[00:19:05] Ryan Jacobs: This is actually, this is what's driven most of the change in the advanced primary care space has been employers coming direct to APC organizations.
We exist because, if we started and tried to go direct to a payer or be a complement to an ACO, whatever it might have been, we would've failed. We were successful because you had such frustration by self-insured employers. They took it upon themselves, and they've gone out and they've purchased their own services and access to care.
And I think you're gonna continue to see that as a market shift and a market dynamic to make sure and that hopefully that creates a pressure point against this complacency. But I think we'll continue to see some of that.
[00:19:42] Stacey Richter: For sure. And I am going to assume when we get to the roadmap portion of this conversation, that direct contracting is certainly going to come up.
The one thing that I do just wanna underline though, if, and again, go back and listen to that show with Dr. Jacob Asher, it's quite revealing relative to the ASO/carrier market.
The one thing that I would say is that, you know. If, let's just say you had a functioning market, what would happen would be that those who had the best service offering at the best price, you'd have the supply and demand curve, move, share, move volume, like everyone would fire the one right, and then go over to the better one.
But in an environment where that is not happening, if you're big, what incentive do you have? You could spend a lot of money trying to level up this or do better over there, and if you did not get commensurate share for that investment, then your investors are not gonna be super happy. There's no reason to do it.
Dr. John Rodis was on the pod. He was a CEO of a health system. He spent so much time and energy, they threw their backs into leveling up safety and quality. They got no more patients at their hospital. If this is the environment that we live in, then frankly it is a rational move if you think about it, to be very complacent because you're not spending money then doing things that you don't have to do in order to get more volume, because you're not gonna get more volume anyway. Why spend the money?
[00:20:05] Ryan Jacobs: I agree and to our earlier points, I think the intent is there, but people are operating, and the executives and the boards of these organizations, They have to have an appropriate return on their overall financial picture.
They cannot deploy capital to get a terrible return. And so this is most organizations, whether it's on the payer side or the system side. And it is, it's an illogical market in a lot of ways because you might do great things and it's not gonna drive greater revenue and volume, but sometimes you have to step back and say, are those things the right thing to do, just because.
And that's harder to do depending on the circumstance of your particular organization and the constraints that you have to operate within.
[00:21:30] Stacey Richter: We did the show with Dr. John Lee called something like operating as best you can within the belly of the beast.
Because on the ground the individuals that are actually working with members are actually working with patients can see what the implications are of some of these moves that are being made based on the incentives of the overarching organization. And they could potentially be very suboptimal. And I'm using my professional words, right? On the, if you're thinking about this at the level of the patient. But this is the ecosystem exactly like you just said. This is the ecosystem that has been set up. This is how it frankly operates. So yeah, here we are.
Roadmap Step 1: Follow Money
[00:22:11] Stacey Richter: I wanna talk about a roadmap, therefore, to succeed. And you alluded to the idea of direct contracting and that will certainly factor into this roadmap, but just starting from the very beginning.
If we're thinking about what step one needs to be, I'm gonna suggest it's this. Perform a reality based assessment. Because you probably are never gonna get too far down the path that you wanna get to if you don't, the things that we just talked about that is the reality of things. And so, you know, assuming it's gonna be any different is a little bit of magical thinking here.
But if we're thinking about what a reality based assessment looks like, again, if you're trying to find a roadmap to get patients, members better access to affordable high value care, what kind of assessment needs to happen?
[00:23:00] Ryan Jacobs: To a founder, to an innovator or somebody that's creating a product or solution? It has to come back to, and this is I think, the sad reality, we've covered this well today. Follow the money. You can create something that has the most magical, impactful patient experience, if it does not drive a financial impact in the world of healthcare, that's gonna be a really difficult path ahead.
You're going to have to have, and this I think, fits into a reality based assessment. Go back to the financial mechanisms. Who's going to pay for this? Is it gonna be an employer? Is it gonna be a health plan? Is it gonna be a system? Is it gonna be somebody else inside the, the overall healthcare world that we live in?
And how is it gonna drive an impact through their eyes, through their lens?
Roadmap Step 2: Anticipate the Stakeholder’s Math
[00:23:39] Stacey Richter: Step 2, anticipate the stakeholder's math. Someone's gonna do math.
[00:23:42] Ryan Jacobs: You have to understand how it's gonna translate to value because we don't live in a world where you have consumers purchasing healthcare on a regular basis. That is a newer, as the ACA rolls out and other functions within a consumer-based care. That's not the reality of most of our the world.
So go back to how are you gonna have this solution translate value to an individual that is actually gonna be controlling the fiduciary responsibility and deploying funds for that person.
[00:24:07] Stacey Richter: So if I'm a plan sponsor, how do I take on board what the reality is of the situation? What math somebody else is gonna do. What does strategic thinking look like if I'm an employer?
[00:24:16] Ryan Jacobs: If I'm an employer and, and you're gonna step back and you're gonna look at your data first and hopefully you have access to that. And you can see a full view of the overall utilization, driving your medical costs, driving your pharmacy costs. You wanna look at that and you wanna look at the things that are impactable.
If I know that as a significant portion of my population is not able to get access to appointments, whether it's primary care, whether it's specialty visits, whatever it might be, that's a problem. Now I wanna step back and think about different ways that I might be able to solve that I might not be able to go out and work with APC, an advanced primary care provider and go find my own cardiology groups because they're all tied to the health systems.
But I would imagine as you look at different options, you're going to have pathways that give you, as an employer a way around the limitations that you have to operate within today that are driving those costs up. You want to create better access to care. You wanna make sure that people within your population have the right things at their fingertips.
I think that's why you see ASO employers being so strategic and really at the forefront of what we've seen throughout digital health, throughout all kinds of other healthcare changes in the system, because they are frustrated and they are looking for different options to give themselves pathways to get outside of the constraints in the system today.
[00:25:27] Stacey Richter: If people don't have access to primary care, then they're getting less primary care, and someone stated this so eloquently the other day. If we're thinking about leveling up healthcare and reducing the overall cost of healthcare, then doing so by inadvertently limiting access to primary care A, you're never gonna save that much.
And B, the potential consequences are high. Like, if you wanna save money, go move infusions around. Don't try to figure out how to gut primary care or limit access to primary care, intentionally or not, right? Like if, if you don't actually have access to primary care, then you're limiting primary care.
That's effectively what's going on.
[00:26:09] Ryan Jacobs: This is the overall premise of how primary care can support allowing patients on the front end to have more care and more access to care, will offset the impact that you see downstream.
[00:26:20] Stacey Richter: Okay, so if we're thinking about our roadmap here, the first thing that we talked about was perform reality-based assessment.
We talked about some of the realities here. We've got conflicting fiduciary responsibilities versus patients trying to get affordable care or health plans, self-insured employers, ultimate purchasers, getting a good price. Like let's not be naive here. You said follow the dollar, Ryan, that's a pretty good way to do it.
Just figure out who's making money and how. If you're on the founder side, keep that in mind. I hear plenty of really sad stories about really great clinicians who are trying to do the right thing and they do not understand. There's a lot of people that have a negative financial impact from preventative care. For example, if like, we gotta just get real about that.
So that's step one. Step 2, anticipate the stakeholder's math. And Ryan, you were talking about this, you gave a great example about how someone's gonna do math. So be aware of how that math is gonna happen.
Because if you're doing math differently and then you show up with a different spreadsheet, right? Like they're not gonna be like, oh, let's do it your way. Right?
Roadmap Step 3: Direct Contract
[00:27:19] Stacey Richter: And then thirdly. This is where I'm very interested in what you have to say about it. Step 3, proceed based on your strategic conclusions. You had earlier mentioned direct contracting, for example.
[00:27:31] Ryan Jacobs: Employers at the end of the day, want to make sure that their populations, their members, their family members have access to care and have timely access to great care.
And then that person is thinking about the overall longitudinal journey of that patient and making sure that everything is happening in the right way. And we have strategic alignment in how we do that, to create something that gives them the path that they cannot necessarily get in the market that exists today.
And maybe this has not been seen everywhere, but we have seen an increase in overall primary care utilization drive a downstream impact on how people are accessing care throughout the rest of the system. And that creates an overall financial return for those that are very concerned about that.
[00:28:09] Stacey Richter: What I'm reminded of, and I'm thinking back to the comments that you made earlier about direct contracting, which is basically this quote by Buckminster Fuller, which I just pulled up. "You can't change things by fighting the existing reality. To change something, build a new model that makes the existing ones obsolete."
Because if you're thinking about, okay, you've got these carrier networks who do not have a market incentive to change what they're doing, then to a certain extent, that is a very strategic move to do something outside of the existing system.
A, for the reason that Buckminster Fuller said, but also because what you're actually doing, whether the self-insured employer, who's going down this path, realizes it or not, is creating a market. Is creating like, “Hey, if there's a better alternative, let's move share over there. Let's move volume over there.”
So the incentives become more aligns with better patient experience, better patient health, more affordability, which the existing system, the not market, doesn't revolve around that North Star.
[00:29:08] Ryan Jacobs: I would agree. I think self-insured employers for a number of years has have effectively created their own market due to the constraints that have been placed against them. And they've gone outside of the normal channels and they've deployed their dollars to put in place partners, models, access to care that they were not getting within the traditional world that they had to play within.
And it's a sad reality, but at the end of the day, I think that change can be a motivating factor within the overall market for health plans and what they offer to those employers. And it's an overall mark, not in a positive way against the overall system and what's available.
Advice For Clinicians
[00:29:42] Stacey Richter: So if I am a founder or if I am a, let me tell you, I probably get 15 emails a week from physicians who are looking to find a better path forward. What advice do you have for someone who's trying to figure out how to create or work in a role that is more aligned with maybe their own values or what they thought they were going to be doing as a physician?
What's the roadmap for them if they go through the reality, you know, figure out the math. What's the third step of this roadmap for them? Their strategic consideration?
[00:30:20] Ryan Jacobs: It's, I would say step back and look at different alternatives. There might be more value-based models within your particular region that you could potentially go partner with and be a part of.
There could be, groups in the overall primary care space that are creating alternative models that put the patient and the relationship between the patient and the clinician, front and center. And allows for them to have the capacity to operate within the top of their license and spend more time with patients, which is effectively why I think most people got into medicine to begin with.
I think there are different options. There might not always be everything that everybody wants, but there are different ways to look at that and there's different ways that those individuals can find a better balance. The care and the experience they wanna provide on a day-to-day basis.
Wrap Up Payment Models
[00:31:02] Stacey Richter: Ryan Jacobs, is there anything that we didn't talk about today that I did not ask you that you think it's important to mention?
[00:32:10] Ryan Jacobs: I think we covered quite a bit, and I think we hit a number of really important points. The things that I would reiterate, we operate within a really complicated, not always logical market, that we call it a market within healthcare.
And while there's always gonna seem like there's roadblocks and there's different ways to prevent any type of innovation and or any type of strategic advancement that is at the center of providing better care to patients and greater access, there are different ways around that.
And the best thing you can do is to step back and try to get a full view of the landscape. Understanding the decision makers, understanding why they behave the way they behave, understanding what their overall motivations are. And the better you can have that landscape view, the better you're gonna be able to navigate those hurdles because they will exist and they're gonna try to knock you down.
But there are ways around that. We've seen great success with a lot of different clinical impacts that are being made, as well as different solutions that are out there and different payment models that have created the right incentive structures.
But continue to look at that full view and try to navigate that in the most effective way because there are ways around that and look to others. This podcast is a great example of hearing about a different view from different people that have navigated the systems. And the constraints that they operate within, and there's a lot of different pathways and there's a lot of people willing to help and offer different support to help you navigate that.
[00:32:24] Stacey Richter: Yeah, you said not always logical, but it is always rational at a certain level if you understand that full ecosystem. That was very well said. You mentioned there's different payment structures that are better. Is that something you could talk about?
[00:32:38] Ryan Jacobs: Payment structure can vary. It's a combination of capitation in some circumstances through to just an enhanced payment model based upon the overall outcomes.
But it's putting a level of accountability on the organization and the care that we provide to make sure that we are being paid for the value that's being provided. And the access to care that we're providing, and not having it purely be based upon the codes that we might be submitting.
[00:33:00] Stacey Richter: Where can someone learn more about Marathon Health? Should they be interested?
[00:33:05] Ryan Jacobs: I think the easiest way is to head out to our website if you have a chance, and that is simply marathon.health. No .com at the end, just marathon.health. And then if anybody wanted to reach out for any kind of conversations, you could reach out to us at hello@marathon.health.
Final Thanks
[00:33:19] Stacey Richter: Ryan Jacobs, thank you so much for being on Relentless Health Value today.
[00:33:22] Ryan Jacobs: Thank you, Stacey.