The Perverse Incentive Trap Hidden Inside Value-Based Care — and What to Do About It. EP511

Podcast: Relentless Health Value · Stacey Richter

Opublikowano: 2026-05-14

When Risk-Based Payment Becomes Its Own Upcoding Arms Race Medicare Advantage plans get paid more for sicker patients, which is why upcoding became a problem — and now health systems are upcoding visit complexity right back, with MA plans automatically downcoding in response. In this episode, Stacey Richter plays an unpublished clip from her conversation with Ahilan Sivaganesan, MD (Dr. Siva), a neurosurgeon and head of quality and value at Mishe Health, on why physicians must understand their own costs before taking on financial risk, then revisits an earlier conversation with Monica Lypson, MD, MHPE, vice dean for me...