The Toxicity in Fee for Service per Francois de Brantes

In this first of a four-part video series, Signify Health senior vice president of Episodes of Care, François de Brantes, speaks with Managed Healthcare Executive about value-based care, the toxic incentives in healthcare, how the Direct Contracting Model differs from Medicare Advantage and more.

Below you'll find a brief excerpt from the transcript of our recent podcast interview with François de Brantes. They have edited for clarity and length.

What are the toxic incentives in healthcare?

I've been convinced of this for several years, and continue to be convinced with every encounter I have with clinicians, and not just clinicians, but leaders in industry, in hospitals and health systems, the provider organizations and those who work in them, that they are primarily motivated by the desire to care for the patients that that come to see them and that they manage. It's a difficult job, because you're dealing with a myriad of health issues and co-occurring health issues. For a lot of these clinicians and healthcare leaders, when they get up in the morning, they get ready to go to work, the moment they step out of bed, they're faced with this tug of war, these conflicts between what feels right to do for the patient, and what feels what feels good, financially, and rewarding financially, and they're not always the same. And that's the struggle, right.

So the toxicity in fee for service is pulling you in a direction that that can be different than the direction that you would take based on your inherent professionalism and the motivation to care for the patients. So, for example, you'll recommend doing tests, even though that you know, perfectly well that there's very little evidence of their efficacy, or in some instances, at the margin, you'll recommend that a patient get a procedure done, because you justify, in your own mind, better safe than sorry. But at the end of the day, you know that there's no strong evidence, it's probably not going to harm the patient. And oh, by the way, it's also going to bring revenue into the organization. So that's the issue, right, which is, what should be done for the betterment of the outcomes of the patient isn't necessarily tied to the betterment financially of the organization that delivers the care. That tension, that toxicity, that friction is really what value-based payment reform is all about.