Podcast
PCP Lens Podcast
Hosted by Medicine + Metrics + Money + Madness = Healthcare · EN
I discuss the boring, confusing, and maddening details about the business of healthcare, which has a big impact on your wallet—and your health.
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23episodes
Episodes
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Podcast -Why VBC Makes Healthcare More Expensive
May 700:16:11Tap to summarizeDescriptionValue-based care was designed to make healthcare cheaper and better. But in the last 15 years, it has done the exact opposite. This podcast explains how VBC is implemented in real life as risk-based contracts, leading to consolidation and, in turn, higher costs across the entire economy.Chapter Markers* 00:00 - Intro* 00:25 - The Misdiagnosis* 01:45 - Value-Based Care: Background & Assumptions* 02:20 - The Game of VBC* 02:53 - What is a Budget/Benchmark under VBC?* 03:22 - Gaming the Benchmark* 04:13 - Impact on Small Practices* 05:29 - Quick Recap* 06:09 - Why Small Practices Matter* 06:33 - Consolidation* 07:39 - Types of Consolidation* 09:06 - 1 Contract vs TCOC* 10:29 - Effects of Consolidation* 13:00 - Medicare Advantage & Value-Based Care* 13:26 - VBC, Consolidation & Medicaid* 14:40 - Conclusion* 15:50 - The Question to Ponder?Link to Written Article Link to VideoSubscribe to my YouTube Channel Please see the Disclaimer on the PCPLens "About" Page. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.pcplens.com
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Podcast - VBC & PE: A Match Made in DC
Mar 2600:15:14Tap to summarizeDescriptionIn this episode, I discuss why Private Equity (PE) is so interested in funding Accountable Care Organizations (ACOs) participating in Value-Based Care (VBC) contracts. I break down the math to show why PE always wins at the expense of independent physicians.Chapter Markers* 00:00 - Intro* 00:33 - Step 1 to 3: Setup, Pot of Gold & Infrastructure* 03:11 - Step 4: Private Equity as Funder* 07:08 - Step 5: Outcomes* 10:51 - Step 6: Multi-Year Projections* 12:48 - Final ThoughtsLink to Written Article Link to VideoSubscribe to my YouTube Channel Please see the Disclaimer on the PCPLens "About" Page. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.pcplens.com
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Podcast - Good Intentions, Bankrupt Doctors
Mar 1200:13:48Tap to summarizeDescriptionValue-based care is supposed to save money, but for independent physicians, it's often a structural trap. Using a custom financial simulation model, I break down the mechanics of these contracts when well-meaning insurance companies try to help independent ACOs by funding the infrastructure costs. Discover how and why primary care physicians can go bankrupt even when they get “free money” under value-based care.Chapter Markers* 00:00 - Intro* 00:48 - Step 1-3: Setting up ACO, Pot of Gold, and Reality Sets in* 03:19 - Step 4: Insurance Company as Funder* 05:54 - Step 5: Outcomes* 10:01 - Step 6: Multi-Year Projection* 10:24 - Step 7: Monte Carlo Simulation* 12:27 - Final ThoughtsLink to Written Article Link to VideoSubscribe to my YouTube Channel Please see the Disclaimer on the PCPLens "About" Page. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.pcplens.com
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Podcast - The Math Behind Hospital-Based ACOs
Feb 2600:16:00Tap to summarizeDescriptionValue-based care is supposed to save money, but for independent physicians, it's often a structural trap. Using a custom financial simulation model, I break down the exact contract mechanics of what happens when independent ACOs partner with hospital systems for funding. Discover how this setup actively works against independent doctors and accelerates healthcare consolidation.Link to access the modelChapter Markers* 00:00 - Intro* 00:55 - Step 1: Financial Model Setup* 02:07 - Step 2: Opportunity (Pot of Gold)* 02:52 - Step 3: Cost of Running an ACO* 04:05 - Step 4: Hospital as the Funding Partner* 07:32 - Step 5: Year 1 Outcomes* 14:37 - Final Thoughts on Hospitals Funding ACOsLink to Written Article Link to VideoSubscribe to my YouTube Channel Please see the Disclaimer on the PCPLens "About" Page. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.pcplens.com
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Podcast - VBC Financial Simulation Model
Feb 1200:48:41Tap to summarizeDescriptionI created a financial simulation model to mimic value-based care contracts. This screencast explains how the model is structured, what the different variables mean, and shows some of the capabilities. It also demonstrates how a value-based care contract works in real life and often why it paradoxically increases the total cost of care.Chapter Markers* 00:00 - Intro* 02:20 - Step 1: Financial Model Setup* 09:01 - Step 2: Opportunity (Pot of Gold)* 10:46 - Step 3: Cost of Running an ACO* 16:09 - Step 4: Choosing a Funding Model* 19:28 - Step 5: Year 1 Outcomes* 24:18 - Step 6: Multi-Year Projection* 33:13 - Step 7: Monte Carlo Simulation* 44:05 - My Thoughts Based on Model FindingsLink to Written ArticleLink to YouTube Video VersionSubscribe to my YouTube ChannelPlease see the Disclaimer on the PCPLens "About" Page. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.pcplens.com
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Podcast - Health Determinants at Check-In
Dec 1100:16:40Tap to summarizeDescriptionWhy is the healthcare system demanding that doctors “fix” homelessness and food insecurity during a 15-minute visit, while refusing to fund the actual solutions?In this video, I will show you how our system has created a “social to clinical funnel” that forces doctors to answer for societal failures they cannot fix. This is the story of how a political problem became a clinical burden, driving the moral injury of modern medicine.Chapter Markers* 00:00 Intro* 02:34 SDOH Enters the Clinic* 06:51 The Words That Shift Blame* 08:31 Policy vs Clinical Dilemma* 09:29 Screening Without Solutions* 11:35 Medical Abundance, Social Scarcity* 14:31 The Choice We Refuse to Make * 16:28 OutroLink to Written Article Link to VideoSubscribe to my YouTube Channel Please see the Disclaimer on the PCPLens “About“ Page. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.pcplens.com
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Podcast - The Ritual of Care
Dec 400:14:14Tap to summarizeDescriptionThe Annual Physical is an $8 billion+ ritual. But major studies show it doesn’t reduce mortality. So why is it still the center of American primary care?This video explores the surprising history and modern-day transformation of the “annual physical.” I trace its journey and show you:* How the exam began not just as a medical idea, but as an actuarial tool for life insurance companies in the early 1900s.* Why corporations and the AMA championed the exam, linking it to workplace productivity and a new “moral duty” for individuals to manage their health.* How the visit was repurposed in the 1990s as a data collection tool to feed HEDIS quality measures.* Why today’s “Value-Based Care” models have doubled down, turning the physical into a surveillance machine for insurance risk-adjustment and financial calculations.Chapter Markers* 00:00 - Intro* 00:45 - The Data on the Annual Physical Exam* 02:18 - Historical Origins of the Annual Physical* 03:34 - Life Insurance and Annual Physicals* 06:01 - Employers Embrace Annual Physicals* 06:33 - The Perfect Storm* 07:16 - Relationships to Data Collection* 08:22 - Returning to Actuarial Roots* 10:06 - Why Does the Annual Exam Persist?* 11:44 - Annual Physical in Other Countries* 14:01 - OutroLink to Written Article Link to Video Subscribe to my YouTube Channel Please see the Disclaimer on the PCPLens “About“ Page. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.pcplens.com
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Podcast - The Scorekeepers of American Medicine
Nov 1300:14:10Tap to summarizeDescriptionAre healthcare quality metrics truly objective? This podcast dives into the strange history of performance measures, revealing how they evolved from clinical tools into powerful political ones used to control costs, legitimize decisions, and shift blame from systems to front-line doctors.Chapter Markers* 00:00 - Intro* 01:21 - Birth of Quality Measurement* 02:33 - Medicare’s Bargain* 05:34 - The Pioneering Role of Private Sector in Quality Measurement* 07:07 - NCQA* 07:55 - The Medical Surveillance Machinery* 08:50 - Manufacturing Blame* 09:04 - Technocratic Legitimacy* 10:05 - Discursive Framing* 11:15 - Manufactured Consent* 12:26 - The Path Dependency Trap* 13:56 - OutroLink to Written ArticleLink to VideoSubscribe to my YouTube ChannelPlease see the Disclaimer on the PCPLens “About“ Page. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.pcplens.com
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Podcast - Everyone is Pre-Sick
Oct 3000:12:49Tap to summarizeDescriptionIn this video, I explore how the rise of risk-factor medicine, combined with America’s social fragmentation, made people morally and socially responsible for their own health.This is the 3rd article in my series “Healers to Healthkeepers.”Chapter Markers* 00:00 - Intro* 01:11 - Birth of Risk Factor Medicine* 03:14 - The Moral Transformation to “Individual Choice”* 06:06 - Prevention Becomes Virtue* 07:06 - Healthism* 09:19 - The Tradeoffs* 12:35 - OutroLink to Written ArticleLink to VideoSubscribe to my YouTube ChannelPlease see the Disclaimer on the PCPLens “About“ Page. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.pcplens.com
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Podcast - The Cathedrals of Modern Medicine
Oct 1600:12:03Tap to summarizeDescriptionThis video explores the rise of the hospital-insurance duopoly after WW-II, especially the unintended consequences of the Hill-Burton Act. The Hill-Burton Act provided funding to build hospitals in America, cementing them as the default choice for healthcare.This video is the second in my series “Healers to Healthkeepers,” which explores the history and path dependency that led America from building public health infrastructure to holding doctors accountable.Chapter Markers* 00:00 - Intro* 01:23 - Post WW-II Hospital Crisis* 02:29 - Hill Burton Act* 04:39 - The Rise of Healthcare Insurance* 08:20 - The Problems with Hill-Burton Act* 11:49 - OutroLink to Written ArticleLink to VideoSubscribe to my YouTube ChannelPlease see the Disclaimer on the PCPLens “About“ Page. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.pcplens.com
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