ON THE COVER
APG’s New President Being the Change We Want to See BY S U S A N D E N T Z E R , M S , P R E S I D E N T A N D C EO, A M E R I C A’ S P H YS I C I A N GROUPS
Greetings and welcome to the APG Annual Conference 2022 edition of the Journal. I am looking forward to meeting with all of you in San Diego and sharing insights, knowledge, and experiences with so many APG members, partners, and friends. Since taking the proverbial baton from my distinguished predecessor, Don Crane, in mid-March, I’ve been captaining the APG team as we assist our members— and the nation—in continuing the vital transition to value-based healthcare. As everyone engaged in this process knows, it has been an ultra-long-distance relay race, with innumerable obstacles to overcome along the way.
THE STRUGGLE FOR VALUE-BASED CARE Case in point: the recent controversy over Medicare’s Direct Contracting model, which has now been replaced by the Accountable Care Organization REACH model. (See page 10 for a thorough breakdown of this new model, from my APG colleague Garrett Eberhardt.) Another obstacle has been the ongoing controversy over Medicare Advantage, which some critics have blasted as a “money grab,” even as these arrangements provide needed healthcare and social supports to millions of the nation’s elderly and disabled, while also insulating them from egregious out-of-pocket costs. Why would I, or anyone else for that matter, want to be engaged in these controversies—and the political and operational struggle to move the country away from fee-for-service healthcare? Because I have learned over my long career that the phrase “U.S. healthcare system” is an abysmal misnomer for what is too often an unnavigable mire. Because value-based models ideally create “system-ness” where there isn’t any, through arrangements that unite physicians and patients around a common goal of coordinated and integrated care that is accountable for both quality and costs. Like many people, I have derived these insights not just as a longtime student of U.S. health policy, but also as a caregiver of people struggling with serious illness, frail old age, and eventually, death. The way that healthcare providers are paid isn’t the sole reason for the fragmentation and lack of coordination in U.S. healthcare, or for the fact that no one in this non-system is truly accountable for the total care of a given patient. But the fact is that classic fee-for-service payment offers no real incentive for any entity in the system to assume that role. Even after linking such payments to quality or cost metrics, there is relatively little incentive under fee-for-service to provide the totality of care in truly patientcentered, cost-effective ways. It is painful to watch our loved ones suffer from poor and uncoordinated care in this non-system. It’s also difficult to accept the reality that no single caregiver,
6 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS
Spring 2022
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Value-based models … unite physicians and patients around a common goal of coordinated and integrated care.”
