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.

4/
We built the wrong scoreboard.

The full story: 👉 pcplens.com/p/from-sewers-…#preventivecarer#healthpolicyc#ACAC#managedcarere

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

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

3/3

We often misapply the adage:
"Show me the incentive and I will show you the outcome" to blame doctors for not solving obesity.

I'd counter:
"Show me the neighborhood and I will show you the outcomes."

www.pcplens.com/p/obesity-a-...

2/3
#Obesity is not an individual failure.

It’s the predictable outcome of how we build #environments, #markets, and #policies.

7/
So the real question isn’t “does fluoride work?”
It’s whether we’ll sustain #populationhealth protections that work quietly in the background—or let politics unravel them.

More thoughts here: www.pcplens.com/p/the-curiou...

6/
Other countries that abandoned water fluoridation didn’t leave a vacuum—they built alternatives: salt fluoridation, school mouth-rinse programs, universal dental coverage. In the U.S., we often dismantle without replacing.

5/
The problem is that decisions about fluoridation aren’t made by weighing evidence. They’re driven by local politics, lobbying, and the loudest voices at council meetings. Evidence often matters less than ideology.

4/
Wealthier households barely notice—dentists, toothpaste, even filters make up the gap.
But for low-income families, fluoridated tap water may be the only preventive care they get. Without it, the burden shifts: more ER visits, extractions, and school days lost.

3/
Why? Because caries declined even in countries that don’t fluoridate water. But that’s not proof fluoridation failed—it’s proof fluoride toothpaste, lower sugar intake, and better dental care also help. Remove CWF, and disparities widen.

2/
Early studies showed #WaterFluoridation cut cavities in kids by 50–70%.

Even today, the best reviews still show benefit: 26–35% fewer decayed #teeth in children, lower extraction rates, and savings. Yet support is eroding.

5/ The goal isn't paternalism. It's giving people real agency.

When the healthy choice becomes the easy choice, that's when we see change.

More: www.pcplens.com/p/the-illusi...