This time of year, I often put together an article highlighting my favorite quotes from interviews and conferences I covered over the past year. It occurred to me that in 2024 I had the privilege of interviewing so many inspiring physicians, managed care executives, IT professionals, and entrepreneurs working to make alternative payment models successful that it would be fun to present a value-based care version of my favorite quotes. So in no particular order, here are my top 10 with some context for each.
1. In November, Dr. Sanjay Doddamani, CEO of Guidehealth, spoke with me about his company’s new partnership with Emory Healthcare Network, a clinically integrated network in Georgia.
“The first decade in value-based care was really focused on risk adjustment without much improvement in actual health outcomes… I think we’ve reached a point where we need to consider V 28 exposure than the true Population health has to improve quality. of care and reduce not only the total cost, but also improve health outcomes. And I think that’s what we’ve found: that by collaborating together, what we’re seeing is very early movement in quality performance and health outcomes that will continue to evolve as we work together.” —Sanjay Doddamani, MD
2. Vytalize Health, a risk-taking provider enablement platform, was ranked No. 1 on the 2024 Inc. 5000 list of fastest-growing private companies in the United States. In August, its co-founders, Faris Ghawi, MBA, CEO, and Amer Alnajar, MD, Chief Medical Officer, discussed their business model and notable growth rate.
“Value-based care is a great opportunity. It’s basically combining all the complexities of insurance with all the complexities of being a provider, with all the complexities of being a technology company and all the complexities of being a FinTech company, because a lot of this is also financial. Each of those things has its own unique set of challenges and solutions. You miss one of those and you’re toast, right? —Faris Ghawi, MBA
3. In September, we reported on an appearance by Susannah Bernheim, MD, MHS, chief quality officer and interim medical director of the CMS Innovation Center, in which she described how CMS’s alternative payment models are evolving to include measures informed by the patients.
“We fundamentally believe that incorporating patient-reported measures into the model will allow us to know what improvements are important to beneficiaries. “We are amplifying the voice of patients, helping to drive innovations in care that we hope will increase the likelihood that people receive care aligned with their own goals.” —Susannah Bernheim, MD, MHS
4. In September, Caitlin Walsdorf, a partner at HealthScape Advisors, a Chartis company, spoke with me about a survey-based report exploring the implementation of value-based care in dentistry.
“Both payers and providers think that the other is motivated primarily by financial gain, and if we want to move forward, we certainly need to overcome that deficit. But, you know, despite not trusting each other today, payers and providers are more aligned in their commitment to improving patient outcomes and care than they appreciate. “I truly believe the commonalities can be used as a starting point for more productive conversations in the industry about all things value-based care.” —Caitlin Walsdorf
5. In August, I interviewed Deepak Sadagopan, COO of Population Health Management at Providence. Providence Population Health Management leads the multistate health system’s Medicare Shared Savings Program (MSSP) initiative, which is the largest ACO in the country.
“When it comes to integrating these value-based care programs into the health care delivery system, I would say that not just within Providence, but across the industry, we have an incredible capacity gap.” — Deepak Sadagopan
6. To partner with self-insured employers, Nashville-based Vanderbilt University Medical Center has developed value-based care bundled payment programs for some of the most common and costly health conditions, including maternity, orthopedics, and cardiology. In April, I spoke with Brittany Cunningham, DNP, MSN, RN, who has led efforts to launch and expand VUMC’s direct-to-employer business packages. I asked if there is any difference between the way Vanderbilt offers direct-to-employer packages and those of Medicaid or Medicare.
“There are some similarities, but I think the biggest difference is the way we have structured our definitions. We go directly to our doctors and tell them not to worry about the payer. We are very clinically focused. We let them decide how they want to provide patient care and what they think is the best evidence-based care. Then we built a payment model around it. With Medicare and Medicaid, they come to us as payers and are trying to cut costs out of the system, and then we have to provide the underlying clinical care. So we’re turning it around. We say what the best possible clinical care is and then we implement a payment model for it.” —Brittany Cunningham, DNP, MSN, RN
7. In October, four large nonprofit health systems (Baylor Scott & White Health, Memorial Hermann Health System, Novant Health and Providence) announced the formation of Longitude Health with the goal of improving core operational functions and transforming performance of the health system. In December I spoke with Craig Samitt, MD, who leads the organization’s new value-based care enablement company, Longitude PHM, about the impact they hope to have on population health and value-based care.
“We have a lot of data in the industry and little information. I believe that understanding important elements of data in order to maximize quality and reduce the cost of care is simply a weakness we all have. “We need to focus on what data sources and what data processes, methods and solutions will get us to the right, cheapest, fastest and most effective answer.” -Craig Samitt, MD
8. During a webinar in November, Jennifer Moore, Ph.D., RN of the Institute for Medicaid Innovation, described the results of IMI’s annual survey of Medicaid managed care plans, noting that nearly all plans Medicaid health care providers participate in value-based initiatives. However, he highlighted some obstacles.
“As we have observed for years, in more than half of health plan value-based payment arrangements, providers are unwilling to accept downside risk. This raises questions about whether value-based payment models will achieve the benefits promised by these models. The percentage of health plans reporting that providers engage in negative risk arrangements has remained below 50% and is not expected to increase.” —Jennifer Moore, Ph.D., registered nurse
9. At a congressional hearing in June, Elizabeth Fowler, Ph.D., JD, director of the Center for Medicare and Medicaid Innovation (CMMI), was pressed to explain why so few of the payment models CMMI alternatives have produced cost savings. I think the concerns expressed by U.S. Rep. Cathy McMorris Rodgers (R-Wash.), chair of the House Energy and Commerce Committee, are worth considering.
He began by noting that CMMI was created to help improve the way Medicare and Medicaid pay for health care and to be a driver in our push toward value-based care.
“CMMI was given a 10-year, $10 billion budget and extremely broad-ranging authorities with limited built-in oversight from Congress. The only directives Congress gave CMMI were to achieve two goals: reduce the cost of providing care and improve patient outcomes.”
Over the past decade and a half, CMMI has tested more than 50 models to achieve both goals. When CMMI was created, the savings it was projected to generate would be used to offset Affordable Care Act spending, Rogers continued. Originally, CBO estimated that CMMI would save $1.3 billion over its first decade of operation. That same model also projected that CMMI would save up to $77.5 billion in its second decade, from 2020 to 2023.
“However, when the CBO examined actual results in a September 2023 report, the disparity between those expectations and reality turned out to be staggering. Instead of reducing spending by $1.3 billion in the first decade, CMMI increased spending by $5.4 billion. For the second decade, instead of saving $77.5 billion, the CBO now projects that CMMI will increase spending by $1.3 billion. I find it hard to believe that any objective observer could look at the results so far and describe CMMI as a success. So how do we move forward?” — U.S. Representative Cathy McMorris Rodgers
10. In April, I spoke with April Venable, senior vice president of operations, strategy and transformation at New Jersey-based Inspira Health. He talked about the challenges of having different payers request different quality measures.
“I think we have 41 different quality metrics that we need to pay attention to across the eight value-based programs we have in place. And the mammogram in one is not always the mammogram in the next. You would think that if HEDIS had these definitions it would be easier to standardize, but payers put in their own custom exclusions and inclusions that make it a challenge.” — April Venable
