EP325: The Show in Which Dr. Mai Pham Disagrees With Three of My Value-Based Care Premises

In Episode 325, Stacey Richter talks with Mai Pham, MD, MPH, former chief innovation officer at CMS and co-author of Penn's "Future of Value-Based Payment" white paper, about three premises of value-based care she disagrees with — plus the massive, under-addressed gap in care for people with intellectual and developmental disabilities. WHAT YOU'LL LEARN ✅ Why sweetening the value-based care pot with more money isn't a sustainable path to adoption ✅ How commercial prices actually drive up Medicare prices, not the other way around ✅ Why value-based care may need to become a mandate, alongside making fee-for-service less attractive ✅ Why value-based care isn't really what has driven health system consolidation ✅ The scope and impact of inadequate care for the 10–16 million Americans with intellectual and developmental disabilities WHY THIS MATTERS Markets get distorted when huge quantities of dollars rush in — look no further than Medicare Advantage and all the brainpower devoted to upcoding at scale. Dr. Pham argues policymakers can't just keep sweetening the value-based care pot; at some point, cost-driving health systems need a mandate to get on board, and fee-for-service needs to become less attractive. She also makes the case that commercial rate negotiations by hospital systems are themselves driving up Medicare prices — a dynamic worth understanding before blaming Medicare rates alone. === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === MENTIONED IN THIS EPISODE === 🔗 EP263 (Apple) / EP263 (Spotify) with Andrew Eye from ClosedLoop.ai === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction. 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."