7/7
We have traded the art of healing for the business of data collection.
The result isn't better care—it's burnout, consolidation, and a massive illusion of accountability.

More: https://www.pcplens.com/p/the-scorekeepers-of-american-medicine

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.

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.

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

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

2/7
In the 90s, #HMOs faced backlash for cutting care. To regain trust, the industry needed "proof" of standards.
Enter #NCQA & #HEDIS measures.
#Quality became a standardized checklist to help insurers compete, not necessarily to help patients heal.

I created the image using Google Gemini NanoBanana AI model.

More detailed post here substack.com/@sudeepbansa...

4/4

Every metric answers one question: Who gets to define quality?

When payers write the rules, “quality” becomes compliance—and accountability stops where the contract ends.

#HealthPolicy #QualityMetrics

3/4

Decades in, #ValueBasedCare hasn’t shown consistent gains in outcomes or costs.

But it’s done wonders for administrative overhead, #consolidation, and #burnout.

www.pcplens.com/p/value-base...

2/4

The irony? “Quality” measurement was born to fix the #HMO backlash of the 1990s.

When denial-based cost control failed, payers rebranded it as #ValueBasedCare. Same logic—new language.