Jun 10, 2021
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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:
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.
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.”
@HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc
What are the nuances within the promises of value-based care? @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc
“For the first 10 years of … value-based care, it was right in order to generate momentum and get as much participation as possible.” @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc
“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.” @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc
“Not all providers are the same.” @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc
“It’s time to stop tracking the phenomenon and actually pay for change.” @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc
“We haven’t done our best to actually make the alternative to value-based payment as bad as it could be.” @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc
“As a citizen, I gotta ask, ‘How much is enough?’” @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc
“It’s not like we’re talking about replacing a really superlative gold standard.” @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc
“It’s not just about taking dollars away from certain subsectors; it’s about reallocating some of those dollars.” @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc
“This is about paying some people in health care modestly less.” @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc
“Value-based care is not what has driven consolidation.” @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc