EP504: A Back-to-Basics Roadmap Through the Perverse Incentives to Advanced Primary Care, With Ryan Jacobs
Relentless Health Value
Why APC Should Scale but Doesn't
Stacey frames the puzzle: strong evidence for APC yet limited adoption and asks why it isn't ubiquitous.
Why Advanced Primary Care Doesn't 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)—focused on managing risk, improving outcomes, and lowering costs—still isn't widespread.
They argue APC struggles to scale due to two root barriers: conflicting fiduciary duties (health systems and payers driven by volume, "heads in beds," and market-power growth, while APC keeps patients out of hospitals) and a "black box of complacency," 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' 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 === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP504
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00:00 A refresher on advanced primary care (APC).
02:36 Why APC isn't everywhere.
04:39 The problem of complacency in the healthcare system.
05:27 Ryan Jacobs' 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's goals and fiduciary responsibility.
17:52 The black box of complacency.
19:25 EP436 with Elizabeth Mitchell.
20:05 What's 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's 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's discussion.
33:49 Better payment structures.
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