Episode Details

So, let me just cut to the chase here with very little preamble, and all of this is a setup to the interview that follows, although it is not really what the interview that follows is all about. A mentor of mine used to say, you can't legislate the heart. Let me also suggest you can't give someone in finance financial incentives and then expect them to not prioritize financial incentives.

It stands to reason that if the healthcare industry is found to be quite attractive to those who are money focused, then do I need to say this? The money focused amongst us will, of course, do the whatever to the extent that they can make money. They aren't gonna be throwing their backs into quality or cost effectiveness or taking care of patients. They are throwing their backs into making money. Is anyone shocked?

Now, don't get me wrong; I'm not a Pollyanna. And in this country, in order to run a healthcare business, you have to make money; otherwise, you'll go out of business. So, do well by doing good and all of that. But how much money is too much money? This is an important line to figure out because that's where you are doing well but you've stopped doing good—you've tipped into financial toxicity. You are taking more than the good you are doing, and the net positive becomes a net negative.

But complicating fact of current life, it's becoming increasingly obvious that in order to stand up a practice that can take advantage of value-based care payments—payments where primary care docs mainly at this time can get paid more and likely more fairly to care for patients well—you need a lot of infrastructure. You need data, you need tech, you need a team. Translation: You need money, maybe a lot of money, to invest in all of this. And let me ask you this: Who has a lot of money in this country?

Here's the point of everything I just said: These are the external realities that hit anyone trying to do right by patients from every direction. But on the other hand (or maybe different fingers on the same hand), as Amy Scanlan, MD, says in this healthcare podcast, physicians are the backbone of this system. Dr. Scanlan talks in the interview today about the opportunity, and maybe the responsibility, that physicians have here for patients; but also the Eric Reinhart article comes up again about rampant physician moral injury (unpaywalled link with my compliments).

Right now might be a great time to read something from Denver Sallee, MD. He wrote to me the other day. He wrote, "Like many physicians, I did not have much understanding of the business side of medicine, as I mistakenly thought as long as I helped take great care of patients that I was doing my job. More recently, it became apparent to me that by ceding the management of medicine to nonclinical administrators and to companies interested primarily in value extraction for the benefit of shareholders that I needed more education in order to truly help patients."

Today as aforementioned, I'm talking with Amy Scanlan, MD, who is chief medical officer of the clinically integrated network (CIN) that is the new joint venture between Intermountain Health and UCHealth in Colorado.

We talk about what it's like to be in the kind of messy middle of transformation to integrated care in a clinically integra