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On to the topic this week: Who has read that white paper put out in February by the University of Pennsylvania, specifically, Penn’s Leonard Davis Institute for Health Economics? It’s called “The Future of Value-Based Payment: A Road Map to 2030.” I mentioned this paper last week, too. So, if you still haven’t read it, go back after this show and take a look. There’s links in show notes.
As with every interesting white paper, while you’re reading it, you start thinking of more questions. That’s why I was thrilled to get a chance speak with Mai Pham, MD, MPH. She is one of the paper’s authors, a physician, and a trained health services researcher. Dr. Pham is a former chief innovation officer at the Centers for Medicare & Medicaid Services (CMS). She also spent time at Anthem doing value-based care (VBC) work for the enterprise on a national level. Further, she’s the parent of an autistic child and founded the Institute for Exceptional Care to transform health care for people with IDD (meaning intellectual developmental disabilities), which I’ll get to in a second.
Here’s some highlights from my discussion with Dr. Pham:
Markets get distorted when insane quantities of dollars rush in. I’m thinking about Medicare Advantage and all of its attendant suppliers right now. Think about all of the amazing brainpower captivated by figuring out how to upcode at scale, which, by the way, only a minority of the time corresponds to actual spend. Dr. Pham has some words on this.
Attaining value-based care results and adoption has a big problem. As a policy maker, you can’t just keep trying to sweeten the value-based care pot. You don’t want to plow even more money into the system. So, at a certain point, we all have to get real and realize that for the cost-driving entities in this country—those IDNs (independent delivery networks) with huge market clout—to get on the VBC bandwagon, value-based care probably has to be a mandate; and it also will mean making FFS (fee for service) much less attractive.
Thirdly—and here’s something I never considered—commercial prices drive up Medicare prices. You have hospital systems pointing to growing disparities between commercial rates when they negotiate for higher Medicare rates, when the hospital systems themselves created those deltas with their private-sector negotiations.
Lastly, we chat national versus local health care reform and about indie doctors and the “why” behind consolidation. It aligns quite a bit, our conversation in this health care podcast, with the insights from the show last week with Nicole Bradberry and Kelly Conroy (EP324).
The last 6 minutes of this podcast is Dr. Pham’s insight about the scope and impact of not caring adequately for people with neurodevelopmental disabilities. We’re talking about somewhere between 10 and 16 million people, as Dr. Pham notes for perspective. That’s the number of new cancer cases each year. Collectively, we spend as a country somewhere between 1% and 2% of the GDP all in on this patient population.
You can learn more at ie-care.org.
Hoangmai (Mai) H. Pham, MD, MPH, is a general internist and national health policy leader. She was vice president, provider alignment solutions, at Anthem, Inc., responsible for value-based care initiatives at the country’s second-largest health insurance company. Prior to Anthem, Dr. Pham served as chief innovation officer at the Centers for Medicare & Medicaid Services, where she was a founding official, and the architect of Medicare’s foundational programs on accountable care organizations and primary care. She was co-director of research at the Center for Studying Health System Change and has published extensively on provider payment policy and its intersection with health disparities, quality performance, provider behavior, and market trends. Dr. Pham serves on numerous advisory bodies, including the National Advisory Council for the Agency on Healthcare Research and Quality, the Maryland Primary Care Program, and the National Business Group on Health, and was a member of the Board Executive Committee at the Health Care Transformation Task Force. Dr. Pham earned her bachelor’s degree from Harvard University, her MD from Temple University, and her MPH from Johns Hopkins University, where she was also a Robert Wood Johnson Clinical Scholar.
04:22 What are the nuances within the promises of value-based care?
05:34 “For the first 10 years of … value-based care, it was right in order to generate momentum and get as much participation as possible.”
06:41 “When you leave yourself open to tackling prices, now you open up a whole world of possibilities in terms of how you could redirect sources.”
08:00 “Not all providers are the same.”
09:24 “It’s time to stop tracking the phenomenon and actually pay for change.”
10:29 “We haven’t done our best to actually make the alternative to value-based payment as bad as it could be.”
12:14 What’s the path forward in value-based care, especially for specialists?
15:43 “There has been tremendous business opportunity in Medicare Advantage, not to the benefit of the trust funds.”
17:13 “As a citizen, I gotta ask, ‘How much is enough?’”
19:03 “It’s not like we’re talking about replacing a really superlative gold standard.”
19:34 EP263 with Andrew Eye from ClosedLoop.ai.
22:02 “It’s not just about taking dollars away from certain subsectors; it’s about reallocating some of those dollars.”
23:34 “Policy making itself tends to be siloed.”
25:02 “This is about paying some people in health care modestly less.”
25:35 “Most of the costs are driven by fixed costs.”
29:25 “Value-based care is not what has driven consolidation.”