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Healthcare policy from the front line | PCP Lens newsletter | Metrics, money, and madness in medicine
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#Healthcare AI won’t be won by the “best LLM.”
Once #LLM is good enough, the bottleneck is #malpractice risk and regulatory approval/capture.
So the real moat for "doctor-as-a-service" is not #AI model--it’s the insurance stack.
#healthpolicy #medsky
Once #LLM is good enough, the bottleneck is #malpractice risk and regulatory approval/capture.
So the real moat for "doctor-as-a-service" is not #AI model--it’s the insurance stack.
#healthpolicy #medsky
December 13, 2025 at 4:12 PM
#Healthcare AI won’t be won by the “best LLM.”
Once #LLM is good enough, the bottleneck is #malpractice risk and regulatory approval/capture.
So the real moat for "doctor-as-a-service" is not #AI model--it’s the insurance stack.
#healthpolicy #medsky
Once #LLM is good enough, the bottleneck is #malpractice risk and regulatory approval/capture.
So the real moat for "doctor-as-a-service" is not #AI model--it’s the insurance stack.
#healthpolicy #medsky
Health Determinants at Check-In Funneling Social Problems into the Exam Room https://www.pcplens.com/p/health-determinants-at-check-in
December 11, 2025 at 7:08 PM
Health Determinants at Check-In Funneling Social Problems into the Exam Room https://www.pcplens.com/p/health-determinants-at-check-in
The Ritual of Care How the Annual Physical Became a Billion Dollar Surveillance Machine https://www.pcplens.com/p/the-ritual-of-care
December 4, 2025 at 5:12 PM
The Ritual of Care How the Annual Physical Became a Billion Dollar Surveillance Machine https://www.pcplens.com/p/the-ritual-of-care
#Claude AI getting more cynical than me on #quality measurement in #HealthcareAI
The correct answer for Domain C (clinical care) is "No Quality Measurement."
What do you think?
#healthpolicy #medsky #imsky
The correct answer for Domain C (clinical care) is "No Quality Measurement."
What do you think?
#healthpolicy #medsky #imsky
December 2, 2025 at 8:18 PM
#Claude AI getting more cynical than me on #quality measurement in #HealthcareAI
The correct answer for Domain C (clinical care) is "No Quality Measurement."
What do you think?
#healthpolicy #medsky #imsky
The correct answer for Domain C (clinical care) is "No Quality Measurement."
What do you think?
#healthpolicy #medsky #imsky
The Scorekeepers of American Medicine The History of Quality Measures and Why They Persist https://www.pcplens.com/p/the-scorekeepers-of-american-medicine
November 30, 2025 at 9:28 PM
The Scorekeepers of American Medicine The History of Quality Measures and Why They Persist https://www.pcplens.com/p/the-scorekeepers-of-american-medicine
Commercial payors pay PCPs lower than PCPs employed by large systems — and often below Medicare and Medicaid rates.
https://pubmed.ncbi.nlm.nih.gov/41044451/
#healthpolicy #medsky #imsky
https://pubmed.ncbi.nlm.nih.gov/41044451/
#healthpolicy #medsky #imsky
November 30, 2025 at 4:53 PM
Commercial payors pay PCPs lower than PCPs employed by large systems — and often below Medicare and Medicaid rates.
https://pubmed.ncbi.nlm.nih.gov/41044451/
#healthpolicy #medsky #imsky
https://pubmed.ncbi.nlm.nih.gov/41044451/
#healthpolicy #medsky #imsky
#Fastfood ads don’t sell food; they sell feeling in 4 steps:
👉 Vibrant colors & sizzle = Attention
👉 Slow-mo bite = Interest
👉 Pure joy on screen = Desire
👉 Limited-time offer = FOMO
Outome = Obesity
Where’s the line between clever persuasion and personal choice? 🤔
#medsky #imsky #healthpolicy
👉 Vibrant colors & sizzle = Attention
👉 Slow-mo bite = Interest
👉 Pure joy on screen = Desire
👉 Limited-time offer = FOMO
Outome = Obesity
Where’s the line between clever persuasion and personal choice? 🤔
#medsky #imsky #healthpolicy
November 29, 2025 at 8:30 PM
#Fastfood ads don’t sell food; they sell feeling in 4 steps:
👉 Vibrant colors & sizzle = Attention
👉 Slow-mo bite = Interest
👉 Pure joy on screen = Desire
👉 Limited-time offer = FOMO
Outome = Obesity
Where’s the line between clever persuasion and personal choice? 🤔
#medsky #imsky #healthpolicy
👉 Vibrant colors & sizzle = Attention
👉 Slow-mo bite = Interest
👉 Pure joy on screen = Desire
👉 Limited-time offer = FOMO
Outome = Obesity
Where’s the line between clever persuasion and personal choice? 🤔
#medsky #imsky #healthpolicy
6/7
Why persist? We are in a "Path Dependency Trap."
👉 #HealthPlans need metrics for risk-adjustment.
👉 Health orgs sank billions into reporting tech.
👉 Politicians staked their careers.
Everyone is financially locked into a model everyone knows is broken.
Why persist? We are in a "Path Dependency Trap."
👉 #HealthPlans need metrics for risk-adjustment.
👉 Health orgs sank billions into reporting tech.
👉 Politicians staked their careers.
Everyone is financially locked into a model everyone knows is broken.
November 28, 2025 at 2:00 PM
6/7
Why persist? We are in a "Path Dependency Trap."
👉 #HealthPlans need metrics for risk-adjustment.
👉 Health orgs sank billions into reporting tech.
👉 Politicians staked their careers.
Everyone is financially locked into a model everyone knows is broken.
Why persist? We are in a "Path Dependency Trap."
👉 #HealthPlans need metrics for risk-adjustment.
👉 Health orgs sank billions into reporting tech.
👉 Politicians staked their careers.
Everyone is financially locked into a model everyone knows is broken.
5/7
This is "Discursive Framing."
The language of metrics systematically hides structural issues (like poverty) & reframes them as individual failures.
#Doctors are tasked with solving society's problems and are penalized for not being able to do so.
This is "Discursive Framing."
The language of metrics systematically hides structural issues (like poverty) & reframes them as individual failures.
#Doctors are tasked with solving society's problems and are penalized for not being able to do so.
November 28, 2025 at 2:00 PM
5/7
This is "Discursive Framing."
The language of metrics systematically hides structural issues (like poverty) & reframes them as individual failures.
#Doctors are tasked with solving society's problems and are penalized for not being able to do so.
This is "Discursive Framing."
The language of metrics systematically hides structural issues (like poverty) & reframes them as individual failures.
#Doctors are tasked with solving society's problems and are penalized for not being able to do so.
4/7
Take the "High Blood Pressure" metric. If a patient lives in a food desert or high-stress zone, BP stays high.
The metric, however, frames this strictly as a doctor’s failure to treat or a patient's "non-compliance."
#SDOH
Take the "High Blood Pressure" metric. If a patient lives in a food desert or high-stress zone, BP stays high.
The metric, however, frames this strictly as a doctor’s failure to treat or a patient's "non-compliance."
#SDOH
November 28, 2025 at 2:00 PM
4/7
Take the "High Blood Pressure" metric. If a patient lives in a food desert or high-stress zone, BP stays high.
The metric, however, frames this strictly as a doctor’s failure to treat or a patient's "non-compliance."
#SDOH
Take the "High Blood Pressure" metric. If a patient lives in a food desert or high-stress zone, BP stays high.
The metric, however, frames this strictly as a doctor’s failure to treat or a patient's "non-compliance."
#SDOH
3/7
This created "Technocratic Legitimacy." By turning messy debates about what good care means into numbers, decisions appear neutral.
But this masks the reality: we prioritize what is easily countable over what actually matters for patient outcomes.
#HealthPolicy
This created "Technocratic Legitimacy." By turning messy debates about what good care means into numbers, decisions appear neutral.
But this masks the reality: we prioritize what is easily countable over what actually matters for patient outcomes.
#HealthPolicy
November 28, 2025 at 2:00 PM
3/7
This created "Technocratic Legitimacy." By turning messy debates about what good care means into numbers, decisions appear neutral.
But this masks the reality: we prioritize what is easily countable over what actually matters for patient outcomes.
#HealthPolicy
This created "Technocratic Legitimacy." By turning messy debates about what good care means into numbers, decisions appear neutral.
But this masks the reality: we prioritize what is easily countable over what actually matters for patient outcomes.
#HealthPolicy
1/7
We assume measuring #healthcare #quality makes it better. It sounds objective.
But what if these #qualitymetrics aren't improving health?
What if they are primarily a surveillance tool to shift blame and protect profits?
Why and how in thread below 👇
🧵
#medsky #imsky #healthpolicy
We assume measuring #healthcare #quality makes it better. It sounds objective.
But what if these #qualitymetrics aren't improving health?
What if they are primarily a surveillance tool to shift blame and protect profits?
Why and how in thread below 👇
🧵
#medsky #imsky #healthpolicy
November 28, 2025 at 2:00 PM
1/7
We assume measuring #healthcare #quality makes it better. It sounds objective.
But what if these #qualitymetrics aren't improving health?
What if they are primarily a surveillance tool to shift blame and protect profits?
Why and how in thread below 👇
🧵
#medsky #imsky #healthpolicy
We assume measuring #healthcare #quality makes it better. It sounds objective.
But what if these #qualitymetrics aren't improving health?
What if they are primarily a surveillance tool to shift blame and protect profits?
Why and how in thread below 👇
🧵
#medsky #imsky #healthpolicy
The #Healthcare Trolley Problem. 🚋
Train (i.e. costs) has two paths: 1️⃣ Patients & Docs (Burnout/Debt) 2️⃣ Corporate Profits
Policymakers hold switch, but lobbying bind their hands. ⛓️
The result? The train always crushes care to protect margins.
#medsky #nanobanana #healthpolicy
Train (i.e. costs) has two paths: 1️⃣ Patients & Docs (Burnout/Debt) 2️⃣ Corporate Profits
Policymakers hold switch, but lobbying bind their hands. ⛓️
The result? The train always crushes care to protect margins.
#medsky #nanobanana #healthpolicy
November 22, 2025 at 8:16 PM
The #Healthcare Trolley Problem. 🚋
Train (i.e. costs) has two paths: 1️⃣ Patients & Docs (Burnout/Debt) 2️⃣ Corporate Profits
Policymakers hold switch, but lobbying bind their hands. ⛓️
The result? The train always crushes care to protect margins.
#medsky #nanobanana #healthpolicy
Train (i.e. costs) has two paths: 1️⃣ Patients & Docs (Burnout/Debt) 2️⃣ Corporate Profits
Policymakers hold switch, but lobbying bind their hands. ⛓️
The result? The train always crushes care to protect margins.
#medsky #nanobanana #healthpolicy
The #freemarket innovation of #qualitymeasures in #healthcare.
Quality Measures = Profit for Medical Industrial Complex
Quality Measures ≠ Better Care
More: www.pcplens.com/p/the-scorek...
#healthpolicy #medsky #imsky #preventivecare
Quality Measures = Profit for Medical Industrial Complex
Quality Measures ≠ Better Care
More: www.pcplens.com/p/the-scorek...
#healthpolicy #medsky #imsky #preventivecare
November 22, 2025 at 4:06 PM
The #freemarket innovation of #qualitymeasures in #healthcare.
Quality Measures = Profit for Medical Industrial Complex
Quality Measures ≠ Better Care
More: www.pcplens.com/p/the-scorek...
#healthpolicy #medsky #imsky #preventivecare
Quality Measures = Profit for Medical Industrial Complex
Quality Measures ≠ Better Care
More: www.pcplens.com/p/the-scorek...
#healthpolicy #medsky #imsky #preventivecare
#Health is no longer a binary state — sick or well.
It is a probability distribution where everyone is “pre-sick.”
How did this architecture, from Framingham's risk factors to our fitness trackers, get built?
And what does it obscure?
Full Article: www.pcplens.com/p/everyone-i...
It is a probability distribution where everyone is “pre-sick.”
How did this architecture, from Framingham's risk factors to our fitness trackers, get built?
And what does it obscure?
Full Article: www.pcplens.com/p/everyone-i...
November 16, 2025 at 6:13 PM
#Health is no longer a binary state — sick or well.
It is a probability distribution where everyone is “pre-sick.”
How did this architecture, from Framingham's risk factors to our fitness trackers, get built?
And what does it obscure?
Full Article: www.pcplens.com/p/everyone-i...
It is a probability distribution where everyone is “pre-sick.”
How did this architecture, from Framingham's risk factors to our fitness trackers, get built?
And what does it obscure?
Full Article: www.pcplens.com/p/everyone-i...
VC-backed companies chase the "law of diminishing returns" section on the Risk-Factor Yield curve, while we blame people for being unhealthy who are struggling to make ends meet.
There is more money in building products to reduce the "risk of risk factors" than #SDOH.
#health #medsky #imsky
There is more money in building products to reduce the "risk of risk factors" than #SDOH.
#health #medsky #imsky
November 6, 2025 at 6:58 PM
In 1980, Robert Crawford coined the term “healthism”: treating #health as a personal moral duty.
The result? When people get #sick, we blame their #choices instead of #SDOH.
www.pcplens.com/p/everyone-i...
(And yes, choices play a role, but so do #determinantsofhealth).
#medsky #healthpolicy
The result? When people get #sick, we blame their #choices instead of #SDOH.
www.pcplens.com/p/everyone-i...
(And yes, choices play a role, but so do #determinantsofhealth).
#medsky #healthpolicy
November 4, 2025 at 7:29 PM
In 1980, Robert Crawford coined the term “healthism”: treating #health as a personal moral duty.
The result? When people get #sick, we blame their #choices instead of #SDOH.
www.pcplens.com/p/everyone-i...
(And yes, choices play a role, but so do #determinantsofhealth).
#medsky #healthpolicy
The result? When people get #sick, we blame their #choices instead of #SDOH.
www.pcplens.com/p/everyone-i...
(And yes, choices play a role, but so do #determinantsofhealth).
#medsky #healthpolicy
New article: Everyone Is Pre-Sick
Risk Factor Yield Curve:
Payment models assume everyone lives in the “effective zone.”
Left = poverty overwhelms care
Right = diminishing returns
We need to fix the premise
www.pcplens.com/p/everyone-i...
#medsky #healthpolicy #imsky #valuebasedcare #SDOH
Risk Factor Yield Curve:
Payment models assume everyone lives in the “effective zone.”
Left = poverty overwhelms care
Right = diminishing returns
We need to fix the premise
www.pcplens.com/p/everyone-i...
#medsky #healthpolicy #imsky #valuebasedcare #SDOH
October 30, 2025 at 4:41 PM
New article: Everyone Is Pre-Sick
Risk Factor Yield Curve:
Payment models assume everyone lives in the “effective zone.”
Left = poverty overwhelms care
Right = diminishing returns
We need to fix the premise
www.pcplens.com/p/everyone-i...
#medsky #healthpolicy #imsky #valuebasedcare #SDOH
Risk Factor Yield Curve:
Payment models assume everyone lives in the “effective zone.”
Left = poverty overwhelms care
Right = diminishing returns
We need to fix the premise
www.pcplens.com/p/everyone-i...
#medsky #healthpolicy #imsky #valuebasedcare #SDOH
Blaming #doctors for causing #chronicdisease would be like blaming doctors for causing cholera in the 19th century.
The root causes of diseases are upstream.
www.pcplens.com/p/from-sewer...
#primarycare #preventivecare #healthpolicy #medsky #imsky
The root causes of diseases are upstream.
www.pcplens.com/p/from-sewer...
#primarycare #preventivecare #healthpolicy #medsky #imsky
October 8, 2025 at 2:06 PM
Blaming #doctors for causing #chronicdisease would be like blaming doctors for causing cholera in the 19th century.
The root causes of diseases are upstream.
www.pcplens.com/p/from-sewer...
#primarycare #preventivecare #healthpolicy #medsky #imsky
The root causes of diseases are upstream.
www.pcplens.com/p/from-sewer...
#primarycare #preventivecare #healthpolicy #medsky #imsky
3/
Now we measure physicians on blood pressure, diabetes, and “compliance”—outcomes that failing systems once prevented.
No tools. No time. All the blame.
#quality #qualitymeasures #ACA
Now we measure physicians on blood pressure, diabetes, and “compliance”—outcomes that failing systems once prevented.
No tools. No time. All the blame.
#quality #qualitymeasures #ACA
October 4, 2025 at 4:16 PM
3/
Now we measure physicians on blood pressure, diabetes, and “compliance”—outcomes that failing systems once prevented.
No tools. No time. All the blame.
#quality #qualitymeasures #ACA
Now we measure physicians on blood pressure, diabetes, and “compliance”—outcomes that failing systems once prevented.
No tools. No time. All the blame.
#quality #qualitymeasures #ACA
2/
Flexner’s 1910 report professionalized doctors and made them the face of “health.”
But it also pushed public health to the sidelines.
#doctors #pcp #primarycare
Flexner’s 1910 report professionalized doctors and made them the face of “health.”
But it also pushed public health to the sidelines.
#doctors #pcp #primarycare
October 4, 2025 at 4:16 PM
2/
Flexner’s 1910 report professionalized doctors and made them the face of “health.”
But it also pushed public health to the sidelines.
#doctors #pcp #primarycare
Flexner’s 1910 report professionalized doctors and made them the face of “health.”
But it also pushed public health to the sidelines.
#doctors #pcp #primarycare
1/
Life expectancy rose before antibiotics. Sewers, not stethoscopes, saved lives.
#healthcare #publichealth #managedcare #medsky #healthpolicy #imsky
🧵👇
Life expectancy rose before antibiotics. Sewers, not stethoscopes, saved lives.
#healthcare #publichealth #managedcare #medsky #healthpolicy #imsky
🧵👇
October 4, 2025 at 4:16 PM
1/
Life expectancy rose before antibiotics. Sewers, not stethoscopes, saved lives.
#healthcare #publichealth #managedcare #medsky #healthpolicy #imsky
🧵👇
Life expectancy rose before antibiotics. Sewers, not stethoscopes, saved lives.
#healthcare #publichealth #managedcare #medsky #healthpolicy #imsky
🧵👇
Life expectancy rose before antibiotics.
Building Sewers saved more lives, not doctor visits.
Yet today, we penalize doctors for bad outcomes that public health infrastructure prevents.
www.pcplens.com/p/from-sewer...
#publichealth #healthcare #healthpolicy #imsky #medsky
Building Sewers saved more lives, not doctor visits.
Yet today, we penalize doctors for bad outcomes that public health infrastructure prevents.
www.pcplens.com/p/from-sewer...
#publichealth #healthcare #healthpolicy #imsky #medsky
October 2, 2025 at 6:53 PM
Life expectancy rose before antibiotics.
Building Sewers saved more lives, not doctor visits.
Yet today, we penalize doctors for bad outcomes that public health infrastructure prevents.
www.pcplens.com/p/from-sewer...
#publichealth #healthcare #healthpolicy #imsky #medsky
Building Sewers saved more lives, not doctor visits.
Yet today, we penalize doctors for bad outcomes that public health infrastructure prevents.
www.pcplens.com/p/from-sewer...
#publichealth #healthcare #healthpolicy #imsky #medsky
2/3
#Obesity is not an individual failure.
It’s the predictable outcome of how we build #environments, #markets, and #policies.
#Obesity is not an individual failure.
It’s the predictable outcome of how we build #environments, #markets, and #policies.
September 24, 2025 at 3:26 PM
2/3
#Obesity is not an individual failure.
It’s the predictable outcome of how we build #environments, #markets, and #policies.
#Obesity is not an individual failure.
It’s the predictable outcome of how we build #environments, #markets, and #policies.