In this episode of Quality Talks With Peggy O’Kane, NCQA President Peggy O’Kane speaks with Susan Dentzer, President and CEO of America's Physician Groups. Susan brings her extensive experience in health policy to a rich discussion on the evolution, strengths and future of value-based care, particularly within Medicare Advantage.

Susan explains models of care that emphasize accountability for both cost and quality. She and Peggy explore how two-sided risk, smarter reimbursement and more coordinated primary care can lead to better outcomes and lower costs. Susan shares new evidence on Medicare Advantage’s impact and highlights what it will take to scale accountable care models across the health system.

Peggy and Susan explore:

• Introducing the Value-Based Vanguard: Some physician groups have figured out how to deliver superior outcomes at lower cost.
• How Two-Sided Risk Works and Why It’s Hard to Scale: Two-sided risk arrangements are succeeding but can’t spread fast enough.
• Barriers to Expanding Value-Based Care: A discussion of the domains where organizations need skills and sophistication in order to succeed in value-based care.
• Medicare Advantage’s Promise and Perception Gap:  What the 56 percent of Medicare enrollees who are in MA get and what MA’s critics miss.
• What’s Next for Accountability and Reform: Navigating provider shortages, risk adjustment and the next iteration of ACOs.

This conversation offers a timely and practical roadmap for advancing value-based care.

Key Quote:

Health economists will tell you there's no entirely benign set of financial incentives. All financial incentives have consequences.

But then there's a question of what's better and what's worse. So the old saw is what happens if you have a system that pays surgeons for amputations? You get a lot of chopped-off legs because the financial incentive is on the surgeon to amputate.

This remains true today in the United States. A surgeon who performs an amputation of a limb of a diabetes patient is paid much, much more than the person who is basically working hard to help the patient with prediabetes avoid a moving to full-blown diabetes — let alone down the road to serious complications such as amputation.

-- Susan Dentzer

Time Stamps:

• (02:08): Setting the Stage for Change
• (05:29): Comparing Incentives in Different Payment Systems
• (08:21): Why Expanding Value-Based Care is Hard
• (11:01)  Misunderstanding a Model That Works
• (16:31)  Expanding the Value-Based Vision
• (20:13) Peggy’s Reflections

Links:

Potential Spillover Effects on Traditional Medicare When Physicians Bear Medicare Advantage Risk

Medicare Risk Arrangement and Use and Outcomes Among Physician Groups

Connect with Susan Dentzer