Encore! EP308: How Financial Toxicity Wreaks Havoc on Value-Based Payment Success, With Mark Fendrick, MD

How Financial Toxicity Wreaks Havoc on Value-Based Payment Success, With Mark Fendrick, MD (Encore! EP308)

In this Encore, Stacey Richter revisits her conversation with Mark Fendrick, MD, director of the University of Michigan Center for Value-Based Insurance Design, about why patient benefit design and provider value-based payment have to be aligned — because right now they often work against each other.

WHAT YOU'LL LEARN

✅ Why a doctor can get dinged on quality scores when a patient can't afford the follow-up care they were told to get

✅ How most benefit designs set patient cost-sharing based on a service's price, not its clinical value

✅ Why "almost all of the services we recommend to reduce cost sharing…do not save money"

✅ What V-BID's core pillars are for aligning consumer engagement with value-based reimbursement

✅ Why providers need both funding and courage to actually change how they reimburse for care

WHY THIS MATTERS

Value-based payment can't succeed in isolation — if a patient's benefit design punishes them financially for following through on high-value care, the provider gets blamed for a bad outcome that was actually a benefit-design problem. Aligning patient incentives with provider incentives, Dr. Fendrick argues, is the "sledgehammer to the scalpel" fix value-based care needs.

MENTIONED IN THIS EPISODE

EP176 with Robert Pearl, MD (co-hosted by Alex Akers): Apple Podcasts | Spotify | Other Apps (link unavailable)

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter

🫙 Support the podcast with a small donation to the Tip Jar

📺 Subscribe to our YouTube channel

🎤 Listen on Apple Podcasts

🎤 Listen on Spotify

=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction

05:00 Is back surgery high-value care?

05:51 If care is patient to patient, how is high-value care decided upon?

06:40 "Flintstones delivery: We have to move from the sledgehammer to the scalpel."

11:14 "Almost all of the services that we recommend to reduce cost sharing…do not save money."

12:30 "I didn't go to medical school to learn how to save people money."

17:03 "When a patient and their clinician agree…the patient should be able to get that [service] easily, and the clinician should be paid generously."

18:01 "When patients and providers are aligned, they do much better."

19:59 What services are deemed high value, and what services should be pre-deductible?

21:50 "Are primary care visits high value?…The answer is, it depends."

25:55 What are V-BID's core pillars to address value-based care?

28:04 How does Dr. Fendrick's method of value-based care and reimbursement actually enable better consumerism?

29:51 What do providers think about changing reimbursement on low-value and high-value care?

30:58 "We have incentives that are run amok."

32:12 EP176 with Dr. Robert Pearl.

32:49 "It's all about incentives."

33:43 "You do have the funding; you just have to have the courage."