Episode 400

EP400: My Manifesto, Part 2: Where the Rubber Hits the Road

Apr 13, 2023

21:51

Episode Description

This is Part 2 of a two-part exploration of what host Stacey Richter calls her manifesto — not a mission statement so much as the practical framework she uses to decide who to work with and what to say yes to in an industry where nearly every stakeholder, patients included, has some measure of self-interest at play. Picking up from Part 1 (EP399), Stacey works through the messy calculus behind decisions large and small — from vetting a new consulting client to deciding whether to help a Medicare Advantage plan get patients to their annual wellness visit, a program tangled up in risk adjustment and star ratings. What emerges is a three-part personal manifesto for operating with integrity inside a financialized healthcare system where almost no one is unconflicted.

WHAT YOU'LL LEARN

✅ Stacey's three-part manifesto for deciding what to work on: the thing must be a net positive for patients, the timeframe is short- to medium-term, and the assumption is that transforming healthcare takes a village

✅ Why the financialization of healthcare means nearly every stakeholder — hospitals, payers, drug companies, even physicians — is operating with some degree of self-interest baked into their incentives

✅ The two-part calculus Stacey runs before taking on a client or backing an initiative: how much good does it actually do for patients, and where's the money coming from and who wins

✅ Why incremental change and disruptive change aren't in competition — and how the two can actually reinforce each other rather than requiring an either/or choice

✅ A real-world thought experiment — helping a Medicare Advantage plan get members to an annual wellness visit — that shows how risk adjustment and star ratings complicate even a seemingly obvious "yes"

✅ Why Stacey believes no single person or organization can fix healthcare alone, and how thinking of the industry as a village keeps her from freezing up over unintended consequences elsewhere in the system

WHY THIS MATTERS

Every dollar someone takes in profit under the banner of improving health, Stacey points out, is a dollar someone else paid — which is why figuring out who's genuinely aligned with patients versus who's just doing well by doing good matters. Her manifesto isn't a call for purity or a demand that everyone she works with be unconflicted; it's a practical filter for operating with integrity inside an industry where almost no one is. As she puts it, "It's basically up to us as individuals to do the right thing."

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

03:16 "It's a zero-sum game."

03:26 Is the amount of profit fair?