EP322: Cherry Picking, Lemon Dropping, and Other Learnings for Value-Based Care Models, With Monica Lypson, MD, MHPE

In Episode 322, Stacey Richter talks with Monica Lypson, MD, MHPE, vice dean for education at Columbia University Vagelos College of Physicians and Surgeons, about cherry picking, lemon dropping, and other lessons value-based care needs to learn to serve underserved communities well. WHAT YOU'LL LEARN ✅ How perverse incentives in value-based care can worsen known health care disparities ✅ What cherry picking and lemon dropping mean, and why they're a real risk in VBC models ✅ Why fee-for-service isn't a real alternative, even with all of VBC's flaws ✅ What a "whole health" model of care actually requires ✅ Why a national framework is necessary to enable local value-based initiatives WHY THIS MATTERS Value-based care has real, serious problems worth taking seriously — but the answer isn't to throw it out and go back to fee-for-service, which got health care to where it is today. Dr. Lypson argues that critical thinking about VBC's flaws should inform creative solutions: closing loopholes that let people game the system, building equity into the framework from the start, and creating a national structure flexible enough to let local communities and their partners actually solve problems together. === 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 === MENTIONED IN THIS EPISODE === 🔗 EP319 (Apple) / EP319 (Spotify) with Grace Terrell, MD 🔗 EP312 (Apple) / EP312 (Spotify) with Douglas Eby, MD, MPH, CPE === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction. 04:08 Is value-based care good for underserved communities? 05:09 "If you create perverse incentives, you actually might make known health care disparities worse … to meet the demands' value." 06:29 "There actually might be systematic and structural ways that the health care system might say … we're not interested in taking care of you." 07:12 "The incentive to have a good outcome is not there; the incentive to have another visit is there." 08:33 "If you don't have any connection in that system, even the provider trying to … provide a good outcome might be disconnected because the system is not in place to … connect the dots." 08:55 "The only indictment I have on the fee-for-service system is that it's gotten us to where we are right now." 09:30 What are the must-haves for a value-based system that creates the patient outcomes we need? 09:58 What is a whole health model? 10:43 EP319 with Grace Terrell, MD. 11:08 EP312 with Douglas Eby, MD, MPH, CPE. 16:25 "We want to move money around with the accountability of the patient outcome. We want to be responsible stewards of that dollar." 17:14 What does it mean to keep an equity framework? 20:48 Do we know the impact of independent physicians closing their offices? 25:20 What do we need to be mindful of when constructing a value-based system of care? 27:52 "The large health care system needs their community partners at the table."