Better Care Depends on Aligning Incentives
Susan Dentzer presents a compelling vision of accountability, highlighting how savvy health systems are leveraging new payment models and building on strengths of Medicare Advantage to achieve better patient outcomes at lower costs.
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Our Guest
Susan Dentzer President and Chief Executive Officer, America's Physician Groups
Susan Dentzer is President and CEO of America’s Physician Groups, representing over 360 physician organizations committed to patient-centered, cost-effective and high-quality care. A prominent health policy expert, she frequently writes and speaks on health care issues and is the lead author of Health Care Without Walls. Dentzer is a member of the National Academy of Medicine and the Council on Foreign Relations, and a fellow of the National Academy of Social Insurance and the Hastings Center.
A Dartmouth alumna with a master’s in health care delivery science, she is a trustee emerita and former chair of Dartmouth’s Board of Trustees. She has also served on the boards of Dartmouth Health and the Geisel School of Medicine. Dentzer currently advises Duke’s Margolis Center for Health Policy, Dartmouth’s Center for Global Health Equity and UCSF’s Philip R. Lee Institute. She previously chaired the boards of Research!America and the Global Health Council and served on the board of the International Rescue Committee, where she now sits on the advisory board.
Episode Description
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 throughout American health care.
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.
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.
Timestamps
(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
