So, this one's gonna be a little bit different. Back last year, I sat down with Dr. Cristin Dickerson. She is the founding partner of Green Imaging, which is a physician-led radiology network doing direct contracting for imaging. And we talked about how imaging can run 6% to 11% of total plan sponsor spend and how direct contracting can bring that down while actually improving access.
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So, that is episode 485 if you want to go back and listen to that whole thing—and you should, because it's a great show.
But here's the thing about a good conversation: It wanders, and somewhere in the middle of that conversation, Dr. Dickerson and I went on a tangent that never made it to the final cut of that episode. But we got into this back-and-forth about PMPM (per member per month) subscriptions, which are a way to conceive of and pay for value-based care. It's a capitated per member per month up-front payment.
So, we talked about this payment methodology versus FFS (fee for service), specifically whether a PMPM—where, again, you're paying per member per month, regardless of whether they use the service or whatever that is being paid for—whether this creates the potential for perverse incentives. Maybe a new and excitingly strange perverse incentives that could be just as perverse as the old-fashioned fee-for-service perverse incentives, depending on who's holding the risk and why.
It's a really good few minutes that is actually a great follow-on from the show from last week with John Quinn (EP524), where he talked about employers, self-insured employers, or other plan sponsors considering buying healthcare like they consider procuring almost every other thing that they probably procure. It's a supply chain, not a "one network to rule them all" construct.
So, John Quinn, he talked about last week this whole supply chain analog, kinda like thinking about for each subassembly or pod of care, which he defines as services that have defined boundaries. So, you can easily see where they begin and end, and it's possible to kind of look around and see who's doing these defined things, these subassemblies, and then buy the subassembly from whomever the plan decides is doing it best.
And look, a lot of plan sponsors, especially ones who listen to this show, are doing or already trying to do this; but I thought this kind of way to think about it as a supply chain with pods of care was refreshing and interesting and maybe feels a little more comfy for plan sponsors.
But these subassemblies, they do not have to come with some kind of crazy new payment model. John Quinn last week made this point, and today—this is why it occurred to me that right now might be a great time to air this earlier conversation with Dr. Cristin Dickerson—she makes the same point.
You can procure with value-based care and PMPMs and bundles with warranties and total cost of care stuff, or you can pay fee for service.
Now I would suggest after listening to this conversation and also listening to the shows with Andrew Tsang (EP521) and several others that there are also different flavors of fee for service.
And maybe we shouldn't be just with a broad stroke saying fee for service, actually, because there's fee for service where you know the price up front and you can see how much you were charged because you're getting the data so you can compare the price that you contracted for with the price that you actually paid. There's that kind of fee for service.
And then there's the kind of fee for service where you don't have the data and all you've got is a discount. So, you sort of don't know what the price is up front. And if you do it that way, then you're gonna add at least 20% to your bill or your clinician's expense line for revenue cycle management, "hot potato" games as, again, discussed with Andrew Tsang a few weeks ago.
And I'll tell you another thing you're gonna have to deal with: probably network pricing games like Ryan Kline talked about in his recent LinkedIn post.
But look, you know, it can be fee for service; but when the prices are figured out up front and they're good prices, and you can see if the billed amount matches the contracted rate, again, real prices now, not some wild discount calculus that takes 20 pages of a contract to explain—I'm talking about when the prices are determined up front—then, you know, if you do it this way, it could be a new day for fee for service. It's certainly the "Keep It Simple, Stupid" payment model here.
This podcast is sponsored by Aventria Health Group, and our 2026 series underwriter is Payerset. Check them out. They are doing some interesting things in price transparency.
I also would like to thank Patient Rights Advocate for their really nice donation this year. Both of these sponsors I thank so much for helping us keep this podcast on the air.
And with that, let's pick back up mid-conversation with Dr. Cristin Dickerson.
Also mentioned in this episode are Green Imaging; John Quinn; Alex Sommers, MD, ABEM, DipABLM; Astia Health; Andrew Tsang; Ryan Kline; Aventria Health Group; Payerset; Patient Rights Advocate; Preston Alexander; Tom X. Lee, MD; and Tom Nash.
For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here.
You can learn more at Green Imaging and follow Dr. Dickerson on LinkedIn.
Cristin A. Dickerson, MD, is the founding partner of Green Imaging. She is a graduate of the University of Texas (UT) Medical School at Houston, where she was elected to Alpha Omega Alpha Honor Medical Society. Dr. Dickerson completed her radiology residency at UT Houston, where she was a chief resident, with extensive training in cancer imaging at MD Anderson Cancer Center.
Dr. Dickerson practiced for 13 years at the Diagnostic Clinic of Houston, where she served as a two-term president of the 50-physician clinic and oversaw a self-funded health plan.
She founded Green Imaging in 2011 to provide affordable, high-quality medical imaging for uninsured and high-deductible patients in Houston and rapidly expanded the company to provide services throughout most of the United States and to employer-sponsored health plans. She loves being able to provide quality services to patients who otherwise couldn't afford them and delivering significant imaging cost savings to patients with healthcare coverage and their employers without compromising quality.
00:00 Introduction to this episode.
01:02 EP485 with Cristin Dickerson, MD.
01:15 What today's conversation entails.
04:40 EP521 with Andrew Tsang.
05:35 LinkedIn post by Ryan Kline.
06:36 The conversation with Dr. Cristin Dickerson.
07:13 In a PMPM scenario, who is taking the risk?
08:54 EP482 with Preston Alexander.
10:44 What mitigates the perverse incentive to drive up volume.
11:32 EP445 with Tom X. Lee, MD.
12:18 The other difference between PMPM and fee for service.
Recent past interviews:
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John Quinn, Dr Suhas Gondi, Ge Bai, Andrew Tsang, Stacey Richter (EP520), Dr Lisa Rosenbaum, Claire Brockbank, Stacey Richter (EP517)