BROADCASTS.com

First of all, a shout-out to all of you listeners who have shared this show with colleagues and LISTSERVs\u2014really appreciate it. It\u2019s because of you and your efforts to share that Relentless Health Value maintains its spot as one of the top podcasts reaching health care executives, executives who take the insights shared by our guests to drive actual change and transformation across our industry. So, thank you. Leaving a rating and/or a review on iTunes is also the bomb and really helps our RHV team stay motivated and keep it going. Weekly shows take a ton of work! Feedback is super appreciated.

On to the topic this week: Who has read that white paper put out in February by the University of Pennsylvania, specifically, Penn\u2019s Leonard Davis Institute for Health Economics? It\u2019s called \u201cThe Future of Value-Based Payment: A Road Map to 2030.\u201d I mentioned this paper last week, too. So, if you still haven\u2019t read it, go back after this show and take a look. There\u2019s links in show notes.\xa0

As with every interesting white paper, while you\u2019re reading it, you start thinking of more questions. That\u2019s why I was thrilled to get a chance speak with Mai Pham, MD, MPH. She is one of the paper\u2019s 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\u2019s 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\u2019ll get to in a second.

Here\u2019s some highlights from my discussion with Dr. Pham:

• Markets get distorted when insane quantities of dollars rush in. I\u2019m 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\u2019t just keep trying to sweeten the value-based care pot. You don\u2019t 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\u2014those IDNs (independent delivery networks) with huge market clout\u2014to 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\u2014and here\u2019s something I never considered\u2014commercial 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 \u201cwhy\u201d 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).\xa0

The last 6 minutes of this podcast is Dr. Pham\u2019s insight about the scope and impact of not caring adequately for people with neurodevelopmental disabilities. We\u2019re talking about somewhere between 10 and 16 million people, as Dr. Pham notes for perspective. That\u2019s 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\u2019s 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\u2019s 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\u2019s 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 \u201cFor the first 10 years of \u2026 value-based care, it was right in order to generate momentum and get as much participation as possible.\u201d
06:41 \u201cWhen you leave yourself open to tackling prices, now you open up a whole world of possibilities in terms of how you could redirect sources.\u201d
08:00 \u201cNot all providers are the same.\u201d
09:24 \u201cIt\u2019s time to stop tracking the phenomenon and actually pay for change.\u201d
10:29 \u201cWe haven\u2019t done our best to actually make the alternative to value-based payment as bad as it could be.\u201d
12:14 What\u2019s the path forward in value-based care, especially for specialists?
15:43 \u201cThere has been tremendous business opportunity in Medicare Advantage, not to the benefit of the trust funds.\u201d
17:13 \u201cAs a citizen, I gotta ask, \u2018How much is enough?\u2019\u201d
19:03 \u201cIt\u2019s not like we\u2019re talking about replacing a really superlative gold standard.\u201d
19:34 EP263 with Andrew Eye from ClosedLoop.ai.
22:02 \u201cIt\u2019s not just about taking dollars away from certain subsectors; it\u2019s about reallocating some of those dollars.\u201d
23:34 \u201cPolicy making itself tends to be siloed.\u201d
25:02 \u201cThis is about paying some people in health care modestly less.\u201d
25:35 \u201cMost of the costs are driven by fixed costs.\u201d
29:25 \u201cValue-based care is not what has driven consolidation.\u201d

@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

\u201cFor the first 10 years of \u2026 value-based care, it was right in order to generate momentum and get as much participation as possible.\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\u201cWhen you leave yourself open to tackling prices, now you open up a whole world of possibilities in terms of how you could redirect sources.\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\u201cNot all providers are the same.\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\u201cIt\u2019s time to stop tracking the phenomenon and actually pay for change.\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\u201cWe haven\u2019t done our best to actually make the alternative to value-based payment as bad as it could be.\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\u201cAs a citizen, I gotta ask, \u2018How much is enough?\u2019\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\u201cIt\u2019s not like we\u2019re talking about replacing a really superlative gold standard.\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\u201cIt\u2019s not just about taking dollars away from certain subsectors; it\u2019s about reallocating some of those dollars.\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\u201cThis is about paying some people in health care modestly less.\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc

\u201cValue-based care is not what has driven consolidation.\u201d @HoangmaiPham discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc