# EP511: The Tension When Clinical Teams Take On Risk for Policymakers and Others Looking to Rustle Up Future Perverse Incentives, With Dr. Siva and Monica Lypson, MD, MHPE

Page: https://stenobird.com/podcast/relentless-health-value-872220/ep511-the-tension-when-clinical-teams-take-on-risk-for-policymakers-and-others-looking-to-rustle-up-future-perverse-incentives-with-dr-siva-and-monica-lypson-md-mhpe
Text version: https://stenobird.com/podcast/relentless-health-value-872220/ep511-the-tension-when-clinical-teams-take-on-risk-for-policymakers-and-others-looking-to-rustle-up-future-perverse-incentives-with-dr-siva-and-monica-lypson-md-mhpe.md
Podcast: [Relentless Health Value](https://stenobird.com/podcast/relentless-health-value-872220)
Published: 2026-05-14T14:50:00+00:00
Episode link: https://cc-lnk.com/EP511
Audio file: https://traffic.libsyn.com/secure/healthvalue/RHV_EP511_Dr_Siva_and_Monica_Lypson2.mp3?dest-id=197686
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JSON: https://stenobird.com/v1/public/podcasts/relentless-health-value-872220/episodes/ep511-the-tension-when-clinical-teams-take-on-risk-for-policymakers-and-others-looking-to-rustle-up-future-perverse-incentives-with-dr-siva-and-monica-lypson-md-mhpe
Duration seconds: 1777

## Resource

In this episode, Dr. Monica Lypson and Dr. Ahilan Sivaganesan join the conversation to dissect the complexities of value-based payment models and the "perverse incentives" that often follow. By examining the parallels between Medicare Advantage upcoding and sliding-scale bundled payments, Dr. Lypson and Dr. Sivaganesan provide a masterclass on the systemic friction between financial risk and clinical equity. Key Discussion Themes - The Upcoding/Downcoding Tug-of-War: An analysis of how Medicare Advantage plans and health systems navigate risk adjustment, and why current models often incentivize "grading your own homework." - The TDABC Solution: Dr. Sivaganesan explains why physicians cannot truly manage risk without Time-Driven Activity-Based Costing (TDABC) to identify condition-specific costs. - Selection Bias in Care: A deep dive into the "cherry picking" (selecting low-risk patients) and "lemon dropping" (avoiding high-risk patients) dilemmas that threaten healthcare's moral compass. - Equity vs. Efficiency: Dr. Lypson explores how value-based care can either bridge the gap for underserved populations or inadvertently widen disparities through structural barriers. - The Path Forward: Why "whole-person health"—including non-clinical factors like housing—is the ultimate cost-saver, and the necessity of neutral, third-party risk scoring. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP511 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://…

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