The Euphemism That Has Become Value-Based Care, With Elizabeth Mitchell—Summer Shorts 9

In this Summer Short Episode, host Stacey Richter discusses the hidden costs and inefficiencies of value-based care with Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health (PBGH). They uncover how value-based care, often touted as the ideal system, can be manipulated by middlemen to extract more money from plan sponsors without delivering real value to patients. Elizabeth argues for for-real alternative payment models that are transparent to employer plan sponsors: prospective or bundled payments, with warranties that are measurable, delivering integrated whole-person care in a way most health plans (i.e., middlemen) either cannot or will not administer. She says cooperation between employers, employees, and primary care providers is crucial — direct contracts — and that this effort is urgently needed given the affordability crisis affecting many Americans, with 48% of Americans with commercial insurance delaying or forgoing care due to cost.

WHAT YOU'LL LEARN

✅ How value-based care, often touted as the ideal system, can be manipulated by middlemen to extract more money from plan sponsors without delivering real value to patients

✅ Why most health plans can't or won't administer real alternative payment models like prospective or bundled payments with measurable warranties

✅ Why direct cooperation between employers, employees, and primary care providers is crucial to achieving actual care that delivers value

✅ Why fee-for-service structurally can't support effective primary care, and why "no one makes money in a fee-for-service system if people are healthy"

✅ Why 48% of Americans with commercial insurance are delaying or forgoing care due to cost — and why that matters even for self-insured employers with highly compensated employees

WHY THIS MATTERS

"We do not have value in the US healthcare system." Elizabeth Mitchell's case is urgent: billions of dollars are being siphoned off the top by middlemen and their shareholders — dollars partially paid for by employees and plan members. Real alternative payment models, not more incremental value-based care rhetoric, are what she says is actually needed.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction

10:36 What are members and providers actually asking for in terms of value-based care?

10:56 Why won't most health plans administer alternative payment models?

12:17 "We do not have value in the US healthcare system."

12:57 Why you can't do effective primary care on a fee-for-service model.

13:30 Why have we fragmented care out?

14:39 "No one makes money in a fee-for-service system if people are healthy."

17:27 "If we think it is not at a crisis point, we are kidding ourselves."