{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"EP504: A Back-to-Basics Roadmap Through the Perverse Incentives to Advanced Primary Care, With Ryan Jacobs","description":"Why Advanced Primary Care Doesn\u2019t Scale: Conflicting Incentives, Complacency, and a 3-Step Roadmap Stacey Richter interviews Ryan Jacobs (SVP Strategy and Partnerships, Marathon Health) on why evidence-backed advanced primary care (APC)\u2014focused on managing risk, improving outcomes, and lowering costs\u2014still isn\u2019t widespread.  They argue APC struggles to scale due to two root barriers: conflicting fiduciary duties (health systems and payers driven by volume, \u201cheads in beds,\u201d and market-power growth, while APC keeps patients out of hospitals) and a \u201cblack box of complacency,\u201d where innovators often lose to the status quo because dominant organizations can rationally avoid investing without gaining share.  Jacobs offers a three-step roadmap: perform a reality-based assessment by following the money and identifying who is financially harmed by prevention; anticipate stakeholders\u2019 math by framing value as CFOs, benefits leaders, and plan sponsors do; and proceed from strategic conclusions such as direct contracting to bypass misaligned intermediaries.  === LINKS === \ud83d\udd17  Show Notes with all mentioned links:   https:\/\/cc-lnk.com\/EP504 \u2709\ufe0f  Enjoy this podcast? Subscribe to the free weekly newsletter: https:\/\/relentlesshealthvalue.com\/join-the-relentless-tribe \ud83e\uded9  Support the podcast with a small donation to the Tip Jar: https:\/\/relentlesshealthvalue.com\/join-the-relentless-tribe \ud83c\udfa4  Listen on Apple Podcasts  https:\/\/podcasts.apple.com\/us\/podcast\/feed\/id892082003?ls=1 \ud83c\udfa4  Listen on Spotify  https:\/\/open.spotify.com\/show\/6UjgzI7bScDrWvZEk2f46b \ud83d\udcfa  Subscribe to our YouTube channel   https:\/\/www.youtube.com\/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === \u272d LinkedIn   https:\/\/www.linkedin.com\/company\/relentless-health-value\/ \u272d Threads  https:\/\/www.threads.net\/@relentlesshealthvalue\/ \u272d Bluesky   https:\/\/bsky.app\/profile\/relentleshealth.bsky.social \u272d X   https:\/\/twitter.com\/relentleshealth\/   00:00 A refresher on advanced primary care (APC). 02:36 Why APC isn\u2019t everywhere. 04:39 The problem of complacency in the healthcare system. 05:27 Ryan Jacobs\u2019 roadmap. 08:59 The pitfalls of advanced primary care. 09:58 What primary fiduciary responsibility means. 10:51 Growth on the payer side. 11:51 SUMS5 with Jacob Asher, MD. 12:36 EP483 (Part 1 and Part 2) with Jonathan Baran. 12:48 EP465 with Chris Crawford. 13:27 The reality of the healthcare system in the United States. 14:11 The flywheel created by the tension within the healthcare system. 15:25 EP391 with Scott Conard, MD. 15:51 The tension between APC\u2019s goals and fiduciary responsibility. 17:52 The black box of complacency. 19:25 EP436 with Elizabeth Mitchell. 20:05 What\u2019s driven most of the change in the advanced primary care space. 20:54 EP398 with Jacob Asher, MD. 21:01 What would happen if there was a functioning market in healthcare. 21:41 EP286 with John Rodis, MD, MBA. 21:52 Why complacency may be a rational move in healthcare. 22:41 EP438 with John Lee, MD. 23:22 A roadmap to success in advanced primary care. 23:55 Step 1: Follow the money. 24:50 Step 2: Someone\u2019s gonna do math. 25:17 What strategic thinking looks like as an employer. 28:34 Step 3: Proceed based on strategic conclusions. 30:20 How self-insured employers have created their own market. 31:07 The strategic decision for physicians wanting to create change. 32:25 A reiteration of the episode\u2019s discussion. 33:49 Better payment structures. ","author_name":"Relentless Health Value","author_url":"https:\/\/relentlesshealthvalue.com","html":"