Feb 4, 2021
In Episode 308, Stacey Richter talks with Mark Fendrick, MD, director of the University of Michigan Center for Value-Based Insurance Design, about two surprising insights into why value-based care so often fails to align incentives in the real world.
WHAT YOU’LL LEARN
✅ Why doctors get dinged on quality scores when their patients can’t afford the follow-up care they’re told to get
✅ Why cost sharing in most benefit designs is based on how expensive a service is, not how valuable it is
✅ Why that mismatch pushes patients toward cheap care instead of high-value care
✅ What V-BID’s core pillars are for redesigning benefits around value
✅ Why aligning patient and provider incentives — not just cutting costs — is the real goal of value-based insurance design
WHY THIS MATTERS
Dr. Mark Fendrick, who coined the term Value-Based Insurance Design, argues that value-based care breaks down for a simple reason: benefit design and quality incentives often work against each other. A doctor tells a diabetic patient to get an eye exam, the patient can’t afford it because of a high deductible, and the doctor gets penalized on quality metrics for an outcome the benefit design itself caused. Meanwhile, most cost sharing is tied to how expensive a service is rather than how valuable it is — pushing patients toward cheap, low-value care and away from expensive, high-value care. Fixing that misalignment, not just cutting costs, is what V-BID is built to do.
MENTIONED IN THIS EPISODE
🔗 Encore! EP176, with Dr. Robert Pearl
=== LINKS ===
🔗 Show Notes with all mentioned links: Episode Page
🔗 Healthcare Industry Acronyms and Terms
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00:00 Introduction.
03:53 Is back surgery high-value care?
04:46 If care is patient to patient, how is high-value care decided upon?
05:36 “Flintstones delivery: We have to move from the sledgehammer to the scalpel.”
10:19 “Almost all of the services that we recommend to reduce cost sharing … do not save money.”
11:36 “I didn’t go to medical school to learn how to save people money.”
16:14 “When a patient and their clinician agree … the patient should be able to get that [service] easily, and the clinician should be paid generously.”
17:14 “When patients and providers are aligned, they do much better.”
19:07 What services are deemed high value, and what services should be pre-deductible?
21:04 “Are primary care visits high value? … The answer is, it depends.”
25:13 What are V-BID’s core pillars to address value-based care?
27:24 How does Dr. Fendrick’s method of value-based care and reimbursement actually enable better consumerism?
29:11 What do providers think about changing reimbursement on low-value and high-value care?
30:21 “We have incentives that are run amok.”
31:34 Encore! EP176 with Dr. Robert Pearl.
32:12 “It’s all about incentives.”
33:05 “You do have the funding; you just have to have the courage.”