Episode Details

Why Advanced Primary Care Doesn't Scale: Conflicting Incentives, Complacency, and a 3-Step Roadmap

Stacey Richter interviews Ryan Jacobs (SVP Strategy and Partnerships, Marathon Health) on why evidence-backed advanced primary care (APC)—focused on managing risk, improving outcomes, and lowering costs—still isn't widespread.

They argue APC struggles to scale due to two root barriers: conflicting fiduciary duties (health systems and payers driven by volume, "heads in beds," and market-power growth, while APC keeps patients out of hospitals) and a "black box of complacency," where innovators often lose to the status quo because dominant organizations can rationally avoid investing without gaining share.

Jacobs offers a three-step roadmap: perform a reality-based assessment by following the money and identifying who is financially harmed by prevention; anticipate stakeholders' math by framing value as CFOs, benefits leaders, and plan sponsors do; and proceed from strategic conclusions such as direct contracting to bypass misaligned intermediaries.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP504

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00:00 A refresher on advanced primary care (APC).

02:36 Why APC isn't everywhere.

04:39 The problem of complacency in the healthcare system.

05:27 Ryan Jacobs' roadmap.

08:59 The pitfalls of advanced primary care.

09:58 What primary fiduciary responsibility means.

10:51 Growth on the payer side.

11:51 SUMS5 with Jacob Asher, MD.

12:36 EP483 (Part 1 and Part 2) with Jonathan Baran.

12:48 EP465 with Chris Crawford.

13:27 The reality of the healthcare system in the United States.

14:11 The flywheel created by the tension within the healthcare system.

15:25

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