EP322: Cherry Picking, Lemon Dropping, and Other Learnings for Value-Based Care Models, With Monica Lypson, MD, MHPE
Relentless Health Value™May 13, 2021
322
30:3041.88 MB

EP322: Cherry Picking, Lemon Dropping, and Other Learnings for Value-Based Care Models, With Monica Lypson, MD, MHPE

Imagine if innovators in other businesses operated in the way that some health care status quo doomsayers finger wag. So much for failing fast, iterating, and folding learnings into something that might work better. I don’t like to see screeds that seem to advocate an approach of “try it a few times at a minimum half-heartedly, fail, and then just quit, because obviously anything worth doing should be that easy.”

Pieces fell into place with me as I was speaking to Monica Lypson, MD, MHPE. Dr. Lypson is an expert in a bunch of things, but one of them is thinking about next-generation primary care and health equity and what that might look like in value-based care (VBC) metrics. I asked her if because of some of the negative potential perverse incentives to these patient populations whether we should throw out the VBC baby with the bathwater. Her response was succinct and amounted to, “And go back to what? FFS? Because that’s worked out so well?”

All this being said, there are big issues with value-based care right now that we really need to take a hard look at and think critically about. But that critical thinking, to be considered innovative and productive, really should inform creative thinking: What do we learn and do better next time?

Cherry picking and lemon dropping is a very real potential problem with value-based care. To find out what that means, you’ll have to listen to the interview. Another issue is who gets to decide what the measures and standards are. Who determined what is high-value and low-value care? And is that determination relevant to all communities and all care settings? Then ferreting out from there the potential loopholes for people to game the system because, despite all the virtue signaling that goes on around here, it is amazing sometimes the raw ingenuity exhibited when it comes to gaming the system.

Dr. Lypson brought up some points that I have not heard so succinctly before. One of them is that a national framework is pretty necessary here to enable local initiatives. You can’t have a local program, for example, help the homeless get homes when, on a national level, dollars are siloed into firewalled buckets. So, trying to take health care dollars and apply them to housing takes two years and an act of Congress—because it literally takes two years and an act of Congress, or at least someone with more time and authority than a local care team.

For more insight into this topic, listen to also the upcoming interview with Mai Pham as well as Nicole Bradberry and Kelly Conroy. Also, the recent interview with Dr. Rich Klasco (EP321), Jeff Hogan (EP309), and Dr. Mark Fendrick (EP308).

This is a huge, complicated topic that will take everyone sitting at the table thinking creatively to solve, incrementally, one step forward at a time. Monica Lypson, MD, MHPE, is currently vice dean for education at Columbia University Vagelos College of Physicians and Surgeons. She has practiced in a number of primary care settings, including the Department of Veterans Affairs. MHPE stands for Master of Health Professions Education, by the way.

You can connect with Dr. Lypson on LinkedIn.  

Monica L. Lypson, MD, MHPE, FACP, serves as a professor, vice-chair of medicine, division director of general internal medicine at The George Washington University School of Medical and Health Sciences. She will join Columbia University’s Vagelos College of Physicians and Surgeons as vice dean for medical education on June 1, 2021. Her work focuses on innovations and improvements in health professions education and assessment, health equity, workforce diversity, faculty development, medical care delivery, and provider communication skills. Dr. Lypson most recently served as director for medical and dental education for the Veterans Health Administration, where she oversaw undergraduate and graduate medical education across the nation within the Department of Veterans Affairs.


04:08 Is value-based care good for underserved communities?
05:09 “If you create perverse incentives, you actually might make known health care disparities worse … to meet the demands’ value.”
06:29 “There actually might be systematic and structural ways that the health care system might say … we’re not interested in taking care of you.”
07:12 “The incentive to have a good outcome is not there; the incentive to have another visit is there.”
08:33 “If you don’t have any connection in that system, even the provider trying to … provide a good outcome might be disconnected because the system is not in place to … connect the dots.”
08:55 “The only indictment I have on the fee-for-service system is that it’s gotten us to where we are right now.”
09:30 What are the must-haves for a value-based system that creates the patient outcomes we need?
09:58 What is a whole health model?
10:43 EP319 with Grace Terrell, MD.
11:08 EP312 with Douglas Eby, MD, MPH, CPE.
16:25 “We want to move money around with the accountability of the patient outcome. We want to be responsible stewards of that dollar.”
17:14 What does it mean to keep an equity framework?
20:48 Do we know the impact of independent physicians closing their offices?
25:20 What do we need to be mindful of when constructing a value-based system of care?
27:52 “The large health care system needs their community partners at the table.”

You can connect with Dr. Lypson on LinkedIn.


@mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

Is value-based care good for underserved communities? @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

“If you create perverse incentives, you actually might make known health care disparities worse … to meet the demands’ value.” @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

“There actually might be systematic and structural ways that the health care system might say … we’re not interested in taking care of you.” @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

“The incentive to have a good outcome is not there; the incentive to have another visit is there.” @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

“The only indictment I have on the fee-for-service system is that it’s gotten us to where we are right now.” @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

What are the must-haves for a value-based system that creates the patient outcomes we need? @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

What is a whole health model? @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

“We want to move money around with the accountability of the patient outcome. We want to be responsible stewards of that dollar.” @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

What does it mean to keep an equity framework? @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

What do we need to be mindful of when constructing a value-based system of care? @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

“The large health care system needs their community partners at the table.” @mlypson discusses #valuebasedcare models on our #healthcarepodcast. #healthcare #podcast #digitalhealth #valuebasedcaremodels #vbc

ValueBasedCare,digitalhealth,healthcare,vbc,

Recent Episodes

EP432: The Knifepoint Intersection of Margin and Mission and the Peril of Cutting Clinical “Waste,” With Kate Wolin, ScD
March 28, 2024
432
38:1835.05 MB

EP432: The Knifepoint Intersection of Margin and Mission and the Peril of Cutting Clinical “Waste,” With Kate Wolin, ScD

For a full transcript of this episode, click here . First of all, I just want to start out this pod and really thank everyone listening and for showing up for a show like this one. You do it and you are here because you care about patients/members. It’s just so easy to feel like we’...

EP431: How Accountability for Outcomes Works in the Real World With Kenny Cole, MD
March 21, 2024
431
39:2436.06 MB

EP431: How Accountability for Outcomes Works in the Real World With Kenny Cole, MD

For a full transcript of this episode, click here . There’s this meme that’s going around on the interwebs with the caption, “Sometimes the shortest distance in between two places isn’t a straight line.” What? Yeah, because actually there’s three dimensions in ...

EP430: Advice for Digital Health Vendors Selling to Employers, With Barbara Wachsman
March 14, 2024
430
38:4535.47 MB

EP430: Advice for Digital Health Vendors Selling to Employers, With Barbara Wachsman

For a full transcript of this episode, click here . We have been spending a bunch of time here on Relentless Health Value talking about PBMs (pharmacy benefit managers) lately and pharmacy benefits, but we are moving into a new topic area. It sort of kicked off three weeks ago with the pod with Rik...

EP429: Following the Dollar Through Pharmacy Acronyms Like WAC, AWP, and NADAC, With Luke Slindee, PharmD
March 07, 2024
429
38:2052.64 MB

EP429: Following the Dollar Through Pharmacy Acronyms Like WAC, AWP, and NADAC, With Luke Slindee, PharmD

For a full transcript of this episode, click here . In this healthcare podcast we’re talking about pharmacy acronyms or terms like AWP and WAC, and, not really an acronym, but we’ll also talk pharmacy list prices, rebates, discounts. We also have NADAC, but that’s slightly off to the side for reaso...

EP428: Do-It-Now Advice From the J&J and the DOL v BCBS Lawsuits, With Julie Selesnick
February 29, 2024
428
41:5257.49 MB

EP428: Do-It-Now Advice From the J&J and the DOL v BCBS Lawsuits, With Julie Selesnick

For a full transcript of this episode, click here . This show is different, so if you’ve already listened to or read all about the gory details of the J&J and/or the DOL v BCBS lawsuits, this is not gonna be a repeat of that information. Julie Selesnick, my guest today, does cover the v...

EP427: How Do Digital Health Vendors Deliver Patient Outcomes and Experiences? With Rik Renard
February 22, 2024
427
36:2349.97 MB

EP427: How Do Digital Health Vendors Deliver Patient Outcomes and Experiences? With Rik Renard

For a full transcript of this episode, click here . Hey, Relentless Health Value Tribe, thanks so much for being here this week. I gotta say, I really appreciate all of you who write and tell me that you kick off your Thursdays by listening to this show every week. You just pop open your app an...

Encore! EP379: How Much Money, Really, Are Employee Benefit Consultants and/or Brokers Making From Plan Sponsors? With AJ Loiacono
February 15, 202435:1348.35 MB

Encore! EP379: How Much Money, Really, Are Employee Benefit Consultants and/or Brokers Making From Plan Sponsors? With AJ Loiacono

For a full transcript of this episode, click here . Here on Relentless Health Value, we have done a bunch of shows lately on how some weird PBM (pharmacy benefit manager) and pharmacy goings-on impact plan members, patients, and also independent pharmacies. During the conversation with Benjamin J...

Listen and Follow

Sponsored by Aventria Health Group
©2024 BD Bridges LLC.