The Not Entirely New but Definitely Improved Way to Measure Primary Care, With Rebecca Etz, PhD (Encore! EP295) In this Encore, Stacey Richter revisits her conversation with Rebecca Etz, PhD, codirector of The Larry A. Green Center, about an 11-measure instrument built to fairly assess primary care performance — accounting for diverse patient populations without turning measurement into a procedural nightmare. WHAT YOU'LL LEARN ✅ Why measures are a form of communication, and why mismatched measures demoralize PCPs ✅ How financial incentives tied to hitting a target can distort what an EMR actually documents about patient health ✅ Why primary care is fundamentally a relational field, and why that matters for measuring quality ✅ How PCP practices can spend upward of $40,000 a year of uncompensated time reconciling mismatched measurement standards ✅ How the 11 measures performed differently during COVID, and what that revealed WHY THIS MATTERS Fair, well-validated primary care measures aren't a nice-to-have — they determine whether incentive programs reward the work PCPs actually do or push them toward gaming a target instead. Dr. Etz's 11-measure instrument, aligned across patients, clinicians, and payers, is a rare example of a measurement tool built from what primary care actually values rather than what's easiest to count. MENTIONED IN THIS EPISODE EP270 with Dave Chase: Apple Podcasts | Spotify (pod.link, unconfirmed — Spotify outage) | Other Apps EP272 with Guy Culpepper, MD: Apple Podcasts | Spotify (pod.link, unconfirmed — Spotify outage) | Other Apps === 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 04:58 Why is primary care one of the "best-kept secrets" of better health outcomes? 09:45 "Measures are a form of communication." 09:58 "If the way that you are assessed does not actually match up with the work you do…it's pretty demoralizing." 12:48 "It is the outcome of healthcare, but it is not the same thing as quality." 17:18 "It creates a financial incentive to hit a target by any means necessary." 18:53 "We incentivize people to have good outcomes…electronic medical records are no longer simply databases that tell us what the health of the population is." 21:54 "Primary care is a relational field." 23:02 "How does this relate to cost and utilization?" 27:45 How has the measure of PCPs in the time of COVID held up? 28:03 What measure performs worse in the time of COVID? 29:59 EP270 with Dave Chase and EP272 with Guy Culpepper, MD.

In this episode, Stacey Richter talks with Guy Culpepper, MD, founder and CEO of an independent physician group in North Texas, about why the COVID-19 pandemic is a game changer for primary care physicians and the employers and health plans who pay them. WHAT YOU'LL LEARN ✅ Why independent PCPs are furloughing staff and considering shuttering practices in the middle of a pandemic ✅ How the pandemic is a flash point that's triggering abrupt, transformational change in the business of primary care ✅ What direct primary care (DPC) and direct-to-employer models actually look like ✅ Why independent doctors, not those inside accountable care organizations, may be best positioned to drive real change ✅ What health plans and employers should be doing right now to support primary care WHY THIS MATTERS Guy Culpepper argues that the pandemic has exposed just how broken fee-for-service reimbursement is for primary care physicians, many of whom are furloughing nurses and questioning their practices' survival even as patient need for care is obviously high. He sees this moment as a flash point that could finally force a shift toward direct primary care and direct-to-employer contracting, cutting out traditional insurance and FFS altogether. Culpepper is blunt that if independent doctors don't survive this moment, there's nothing left to break the chain of a system he sees as often abusive to both physicians and patients. MENTIONED IN THIS EPISODE 🔗 EP270, with Dave Chase === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ 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 02:22 What a PCP's average day looks like during the pandemic. 03:48 How likely is it that PCPs can transition easily to telehealth? 06:00 Why the pandemic is a flash point game changer for telehealth and PCP reimbursement. 08:54 "It's like a perfect storm of multiple tragedies coming together." 10:47 How primary care is going to alter after this. 13:24 "We need to totally change the way that our country pays us." 14:29 What is the incentive for health plans and hospitals to change financial models in all of this? 16:26 "The ones who are going to change are the ones who need to change." 18:13 Why the employers will be demanding this change in financial model. 19:12 Why being independent vs being part of an accountable care organization matters during this pandemic. 21:07 "If we don't save the independent doctors, there's nothing to break this chain of abuse." 24:34 "Higher income doesn't always mean more happiness; it often means less sense of freedom." 25:53 "There's a point where a little bit more money and a loss of freedom are no longer properly balanced." 27:53 Untangling the FFS reimbursement. 30:00 Why right now is a flash point for PCP reimbursement. 30:38 "No one else can do what we can do in effective primary care. No one … in this market." 31:49 What payers should be doing right now. 33:27 EP270 with Dave Chase of Health Rosetta. 33:39 Dr. Culpepper's message to Medicare.

In this An Expert Explains episode, Stacey Richter talks with Brian Klepper, PhD, longtime healthcare analyst and former CEO of the National Business Coalition on Health, about the RUC — the AMA-run committee with a sole-source CMS contract to decide how many RVUs any given procedure is worth — and how its specialist-heavy makeup helped trample primary care. WHAT YOU'LL LEARN ✅ What the RUC is, and why it has roughly four times as many specialists as PCPs ✅ What the specialists on the RUC are ultimately trying to achieve ✅ Why health plans, not just health systems, played a role in this dynamic ✅ How the historical war between the hospital community and the HMO community shaped today's incentives ✅ Why primary care has an undeserved reputation for being the "easy" specialty WHY THIS MATTERS The RUC's specialist-heavy composition isn't a technicality — it directly shapes how much any given procedure or service is worth, and over time those incentives have been formidable enough to trample primary care while it earned an unfair reputation for being the easy specialty. === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ 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 01:00 What is the RUC? 03:18 What is the goal of the specialists in the RUC? 04:32 Why health plans and not health systems? 06:55 "All this time, the hospital community was waging war against the HMO community." 07:59 "The incentives that have been at play have been very formidable." 08:23 "Primary care has developed a reputation for being the easy specialty … and it's just not so."

In Episode 335, Stacey Richter talks with Brian Klepper, PhD, longtime healthcare analyst and former CEO of the National Business Coalition on Health, about why private equity is willing to pay as much as $55,000 per patient to primary care start-ups — and the three distinct flavors of primary care operating today, from fee-for-service to direct primary care to what Brian calls industrialized (or advanced) primary care. WHAT YOU'LL LEARN ✅ Why the 1990s HMO version of primary care was really a glorified, restrictive gatekeeper model ✅ The three kinds of PCPs operating today, and how they differ in the risk they take on ✅ What "industrialized" or advanced primary care (APC) requires to succeed — relationship, data, and digital capability ✅ Why a huge flurry of private equity investment into primary care can actually be a problem ✅ Why better patient-PCP relationships quantifiably translate to better care WHY THIS MATTERS Advanced primary care is, in Brian's view, one leg of a three-legged stool needed to transform healthcare — alongside high-performing specialty care and value-based reimbursement. But almost nobody in healthcare actually wants this transformation to happen, even though the math suggests we could get wildly better outcomes for 40% to 45% less than what's currently being spent. MENTIONED IN THIS EPISODE AEE5 with Alex Jung, Partner and Managing Director in Parthenon-EY, on why the HMOs crashed and burned EP295 with Rebecca Etz, PhD: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ 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 05:10 Is the HMO model of primary care a good model? 07:48 "Industrialized medicine is exciting." 08:59 What does primary care have the opportunity to do? 09:21 "The problem that goes along with that is that now immense amounts of money are being infused into primary care organizations." 10:15 Where does direct primary care and advanced primary care fit into this model? 13:35 "At the end of the day, what primary care really needs to be about is … the management of life issues as well." 14:05 EP295 with Rebecca Etz, PhD. 14:19 "Better relationships quantifiably translate to better care." 21:48 "Almost nobody in healthcare wants any of this to happen." 23:58 Why the huge amounts of money being invested into primary care is actually a big problem. 28:11 "We should be able to get wildly better health outcomes for about 40% to 45% of the money that we're currently spending."