This encore episode is with Amy Scanlan, MD. It was, in fact, one of our most popular episodes of the past year. It is still just as relevant today in a slightly different way. It’s interesting how things which were said maybe a year ago have shades of meaning which become evident as time goes on. So, I liked this show a lot in the second listen with the advantage of time passing.

To read the show notes with mentioned links and a transcript, head over to our site.

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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.

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 Dr. Amy Scanlan 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, and 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 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 integrate care in a clinically integrated network, trying to figure out how to help physician practices and the CIN itself navigate the external environment in a way that empowers different kinds of practices at different points in their transformation journey that empowers physicians to be in charge, and considering clinical and financial outcomes (ie, the business of healthcare).

Dr. Scanlan brings up four main factors to consider when plotting strategy from here to there. Listen to the episode or read the show notes to learn about the four factors.

06:35 How is Dr. Scanlan thinking about the transformation process and the shift to value?

09:16 “It is really trying to think about, how do we help practices get there?”

11:48 “The hard part is the in-between spaces.”

13:21 EP407 with Vivek Garg, MD, MBA.

14:12 “Team-based care done badly is really just a series of handoffs.”

15:52 “We have to get to that point where the culture of collaboration is more pervasive.”

19:58 “How do we as healthcare providers step in and solve this problem?”

20:06 Why do providers have a responsibility to step in and try to fix the healthcare system?

20:22 Article (unpaywalled) by Eric Reinhart, MD, PhD.

21:51 Why do physicians need to be accountable for the cost of care as well as outcomes?

23:38 Why does physician burnout give Dr. Scanlan hope?

24:26 What is the solution to changing fee-for-service incentives?

25:43 What are some of the challenges facing changing incentives?

27:16 Why is data so important?

28:54 EP393 with David Muhlestein, PhD, JD.

30:13 “It’s important to understand that we are in the middle of this change.”

31:18 Dr. Scanlan’s advice for those trying to stand up a CIN.