Early in Dr. Rahul Rajkumar’s career, he wondered how he could help improve health outcomes at a population level. An interest in public policy led him to the realization that, at least in the U.S., the financing mechanisms of the health care industry are “the main lever” that we have to this end. The question of how these mechanisms should (or could) be reengineered has guided Dr. Rajkumar through a career that has taken him from the clinic to the health insurance industry to government, where as deputy director at the Center for Medicare and Medicaid Innovation, he experimented with different approaches to organizing and paying for health care systems. The problem is “really, really hard,” he tells host Dr. Rishi Desai. Every single case “is a puzzle with a human being at the center of it.” Rajkumar believes more attention should be paid to what he calls ‘the black hole of American Medicine’ – the period after a patient is discharged from the hospital when coordinating care becomes more difficult. “Is there an accountable provider, or a quarterback outside of the hospital? Someone who, beyond their professional ethic, actually cares about what happens to this patient? That's the nut of the issue.” Tune in to hear about novel payment systems emerging in the wake of the Affordable Care Act, the true social meaning of health insurance, and what other nations try to emulate about the famously dysfunctional U.S. health care system. If you like this podcast, please share it on your social channels. You

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