My Favorite Quotes of the Year —Value-Based Care Edition

At this time of year, I often I pull together a feature 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 clinicians, managed care executives, informaticists 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 provided for each one.

1. In November, Guidehealth CEO Sanjay Doddamani, M.D., spoke with me about his company’s new partnership with the Emory Healthcare Network, a clinically integrated network in Georgia.

“The first decade in value-based care was really focused on risk adjustment without too much of actual true health outcomes improvement….I think we’ve come to a moment of reckoning with V 28 exposure that true population health has to be improving quality of care and reducing not just total cost, but actually improving health outcomes. And I think that’s what we’ve uncovered — that collaborating together, what we’re seeing is very early movement in quality performance and health outcomes that will continue to evolve as we’ll work together.” —Sanjay Doddamani, M.D.

2. Vytalize Health, a risk-bearing provider enablement platform, ranked No. 1 on the 2024 Inc. 5000 list of fastest-growing private companies in America. In August, its co-founders, Faris Ghawi, M.B.A., CEO, and Amer Alnajar, M.D., chief medical officer, discussed their business model and remarkable growth rate. 

“Value-based care is a big opportunity. It’s basically combining all the complexities of insurance with all of the complexities of being a provider, with all the complexities of being a technology company, and all of the complexities of being a FinTech company, because a lot of this is finance as well. Each one of those things has its own unique set of challenges and solutions. You miss one of those and you’re toast, right? — Faris Ghawi, M.B.A.

3. In September, we reported on an appearance by Susannah Bernheim, M.D., M.H.S., chief quality officer and acting chief medical officer with the CMS Innovation Center, in which she described how CMS alternative payment models are evolving to include patient-reported measures. 

“We fundamentally believe that bringing patient-reported measures into the model will let us know which improvements matter to beneficiaries. We’re 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, M.D., M.H.S.

4. In September, Caitlin Walsdorf, a partner at HealthScape Advisors, a Chartis company, spoke with me about a survey-based report that explores value-based care implementation in dentistry.  

“Payers and providers each think the other is primarily motivated by financial gain, and if we’re going 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 improving care than they appreciate. I really think that commonality can be used as a launching point for more productive industry conversations on all things value-based care.” — Caitlin Walsdorf

5. In August, I interviewed Deepak Sadagopan, chief operating officer of Population Health Management at Providence. Providence Population Health Management leads the multi-state 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 healthcare delivery system, I would say that not just within Providence, but across the industry, we have an incredible capacity deficit.” — 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, such as maternity, orthopedics and cardiology. In April, I spoke with Brittany Cunningham, D.N.P., M.S.N., R.N., who has led efforts to launch and expand VUMC’s direct-to-employer commercial bundles. I asked her if there is a difference between how Vanderbilt does bundles in direct-to-employer vs. in Medicaid or Medicare.

“There are some similarities, but I think the biggest difference is the way that we have structured our definitions. We go directly to our clinicians and say don’t worry about the payer. We are very clinically focused. We let them decide the way they want to provide the care for the patient, and what they feel is best evidence-based care. Then we create a payment model around it. With Medicare and Medicaid, they are coming to us as the payer and they are trying to cut costs out of the system, and then we have to provide the clinical care underneath it. So we’re flipping it around. We say what is the best clinical care possible — and then we put a payment model around it.” — Brittany Cunningham, D.N.P., M.S.N., R.N.

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 enhancing core operational functions and transforming health system performance. In December I spoke with Craig Samitt, M.D., who is heading up the organization’s new value-based care enablement company Longitude PHM, about the impact they hope to have in population health and value-based care.

“We’ve got a lot of data in the industry, and not a lot of information. I think understanding important elements of data for the purposes of maximizing quality and lowering cost of care is just a weakness that everyone has. We need to focus on what data sources and what data processes and methods and solutions will get us to the right answer, cheapest, quickest and most effectively.” — Craig Samitt, M.D.

8. During a November webinar, the Institute for Medicaid Innovation’s Jennifer Moore, Ph.D., R.N., described results of IMI’s annual survey of Medicaid managed care plans, by noting that nearly all Medicaid health plans participate in value-based initiatives. However, she emphasized some headwinds.

“As we’ve noted for years, in over half of health plans’ value-based payment arrangements, providers are not willing to accept downside risk. This raises doubts about whether value-based payment models will achieve the promised benefits of these models. The percentage of health plans reporting that providers participate in downside risk arrangements has remained below 50% and is not expected to increase.” — Jennifer Moore, Ph.D., R.N.

9. At a June congressional hearing, Elizabeth Fowler, Ph.D., J.D., director of the Center for Medicare and Medicaid Innovation (CMMI), was pressed to explain why so few of CMMI’s alternative payment models have produced cost savings. I think it is worthwhile to consider the concerns voiced by U.S. Rep. Cathy McMorris Rodgers (R-Wash.), chair of the House Energy and Commerce Committee. 

She started out by noting that CMMI was created to help improve how Medicare and Medicaid pay for healthcare and to be an engine in our drive toward value-based care.

 “CMMI was given a 10-year, $10 billion budget and extremely wide-ranging authorities with limited built-in congressional oversight. The only directives Congress gave CMMI were to achieve two goals: lowering the cost of delivering care and improved patient outcomes.”

Over the last decade and a half, CMMI has tested over 50 models to accomplish both those goals. When CMMI was created, the savings it was projected to generate were to be used to offset spending by the Affordable Care Act, Rogers continued. Originally, CBO estimated that CMMI would save $1.3 billion over its first decade of operation. That same model also projected CMMI would save as much as $77.5 billion in its second decade from 2020 to 2023.