Mai Pham Interview
1. What do you think the future of value-based care will look like?
I think in the near-term, private payers will need to lead the way in designing and implementing innovative value-based payment programs. I came to Anthem because I believe we’re uniquely positioned to transform the health care system.
One very important next step for all of us interested in value-based care is to bring specialty medicine – and really the entire medical neighborhood – under a value-based payment structure. We absolutely did the right thing in establishing a foundation of value-based primary care first, but now it’s imperative that we look beyond the PCP’s office and drive value in some of the most costly care settings – in the operating room, the lab, the specialist’s office.
In the long-term, I think the greatest challenge for us will be to get past using the Medicare fee schedule as the underlying basis for payment across the board. We have to be willing to identify places where the fee schedule is at odds with the actual value to a patient – in both overvaluing and undervaluing services. We need to correct those distortions, because they limit the efficacy of everything else we do.
2. How do you think that health plans can help providers achieve their quality goals?
We have to be willing to share what are our most valuable assets – our expertise and our data. Providers are not all equipped to make the transition to value-based care, even if they are willing to do the hard work. Under our value-based primary care program, Enhanced Personal Health Care, we offered guidance and resources via online tools, live webinars and in-person support. We offer tailored clinical insights through a web-based population health management tool. That tool allowed participating providers to not only access our claims data, but make sense of it and prioritize interventions in order to succeed under the program.
For our next-generation value-based care programs, we will continue to enhance our reporting and data sharing, and will look for ways to integrate into providers’ own systems so that they can take accountability and manage their patient populations in a seamless way.
3. What can we do to improve relationships between all of the stakeholders to tackle value-based care?
I think there’s a general understanding at this point that we’re all in this together, and across the industry we even have broad agreement that we should align payment with value. But that doesn’t mean we all agree on the best first steps for moving to a value-based system. As with any other shift in policy and practice, each side will have to be willing to compromise – to give up something we want in order to get closer to the ultimate goal. I think trust is really at the heart of our ability to move forward together.
We also have to understand the value that each stakeholder brings to the table – payers, employers, providers and patients all deserve a seat at the table and can be part of getting our country to a better health care system. One we all understand what the others bring to bear toward the solution, we can get down to the hard work of change and compromise.
4. What were some of the biggest challenges you see in value-based care and how have you overcome them?
I think there are a couple of important lessons we have learned that have prompted us to change course or evolve our strategy: first, we realize that we can’t overhaul the entire health care system and make that shift invisible to consumers. As payers and employers, we’re going to have to get real with consumers whose benefits we design and offer. Unlimited choice has been the norm for years now, but its time is waning. Instead of giving every patient free rein and trying to figure out after the fact who is delivering high-value care, we want to give consumers the information, access and tools to understand which providers have proven to be best at delivering evidence-based care in an efficient way. The tradeoff for a narrower choice is the security of knowing that your provider has a solid track record of delivering the best care.
The second challenge we’ve had is similar, in a way – it involves really spending our time and attention on high performing providers, rather than holding every provider’s hand and trying to lead them gently into value-based care. We’ve learned the hard way that some hospitals, doctors and health systems are not willing or able to invest time, energy and money into the transition to value-based care. There’s an analogy about many providers having one foot in each canoe – the value-based payment world and the fee-for-service world – well, some providers still have both feet in the fee-for-service canoe, and they aren’t willing to change boats. We’ve learned this lesson and are ready to move forward with the providers who are paddling the value-based payment canoe. Those are the ones who are best serving our customers. I think we should spend more energy on keeping that forward momentum going than we spend trying to coax unwilling providers to come with us.
5. In the last year at Anthem, what is one value-based care initiative you have implemented that you are proud of?
After I joined Anthem, I challenged my team to leap-frog ahead to create a value-based payment arrangement that would take us far ahead of the competition. I’m proud to say that our team delivered, and we’re about to launch that program as a pilot in 2019. Maybe the best part of that creative process was the true collaboration that happened between us, employers and providers who literally sat around a table with us to work out the design. We started with a specific vision of care delivery and consumer experience, then we worked outwards to set expectations and select the providers, build the benefit design, the payment model and what the network would look like.
That select group of collaborators told us what really mattered to them and what they were willing to compromise on. The resulting payment arrangement is different because it’s married to a network and a product -- the combination of those things creates something entirely new. I am immensely proud of our team for getting us to this point, and look forward to sharing more about it in 2019.
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