My conversation today is with Will Shrank, MD. Dr. Shrank led the evaluation group at CMMI (Center for Medicare and Medicaid Innovation). He has spent time in the private sector, first at CVS Health and UPMC (University of Pittsburgh Medical Center) as chief medical officer of the health plan in Pittsburgh, and then as the chief medical officer for Humana. Now he is a venture partner at Andreessen Horowitz and doing some consulting for CMMI.

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We start out this conversation talking about waste in healthcare. In fact, Dr. Shrank was on a team who did a study about waste in the US healthcare system. (The article is, unfortunately, paywalled.) In that study, it says estimates suggest we have upwards of a trillion dollars of waste a year.

This waste can be categorized into administrative and clinical failures. Dr. Shrank emphasizes the need for aligning incentives with higher quality care, paying for patient outcomes, and highlights the potential rising power of PCPs. The discussion covers the progress made towards value-based care, the challenges faced by the current fee-for-service model, and the future landscape of primary care and healthcare delivery.

In sum, we have a waste problem in this country. Aligning incentives might be one way to curb that waste.

06:54 Can we cut healthcare waste while improving patient care?

07:33 What does “healthcare waste” consist of?

07:46 What are the six categories of “healthcare waste”?

10:23 EP363 with David Scheinker, PhD.

10:37 How much money does Dr. Shrank estimate is wasted each year in healthcare?

13:09 Where is that healthcare waste going, and why does it happen?

20:07 Uncaring by Robert Pearl, MD.

21:18 “We’ve built a backbone of extraordinary waste on a fee-for-service chassis.”

22:16 EP409 with Larry Bauer, MSW, MEd.

24:24 EP359 with Dan O’Neill.

26:02 Dr. Shrank’s warning to providers out there.

30:03 Summer Shorts 2 with Scott Conard, MD.

31:41 Why there might be a generational shift among younger providers looking to work with different models.