Many of Evolent Health’s partners and employees have asked for my perspective on the important current debates about the future of our health care system. To do so, I find it useful to revisit our starting point.
We founded Evolent in 2011 when the need to stem unsustainable increases in health care spending were as clear as ever. We felt then, and still believe now, that the best way to bend the cost curve and improve quality is to shift payment models to reward high-value care instead of fee-for-service reimbursement. We set out to enable providers to take on more financial accountability for outcomes, and we’ve seen that enabling the provider community to manage the holistic health of populations is fundamental to improving quality of care, reducing cost and improving patient experience.
Although many of our physician-led partners have had success in reducing expenditures and driving value-based care in recent years, the Medicare and Medicaid programs as a whole continue to grow at a rate that will outpace GDP in a rapidly approaching timeframe.
For value-based care and population health management to effectively change the cost and quality paradigm, we need avenues to direct people into the health care system before their health declines and their costs increase. And that means people need access to care—especially the most vulnerable populations across the country—whether it be through insurance coverage, creative community outreach programs or other solutions that build relationships between providers and patients. We also know that providers need to invest in additional technology and resources to effectively personalize and integrate patient care, but that is an investment they cannot afford if they are not reimbursed for the additional support and proactive outreach they are providing.
Evolent has and will continue to support policies that enable providers on the frontlines to transform their reimbursement strategies through state, federal and commercial value-based payment models. In terms of current legislative efforts, I do appreciate the provisions intended to bring short term stability to individual markets, most importantly the extension of cost sharing reduction payments. I also want to acknowledge the areas that have been left largely intact: continued funding for CMMI (Center for Medicare and Medicaid Innovation) and its Next Generation Accountable Care Organization (ACO) program; the bipartisan-approved Medicare Access and CHIP Reauthorization Act (MACRA); and the preservation of Medicare Advantage.
However, the Congressional Budget Office estimates that the recently proposed legislation would significantly increase the number of uninsured Americans, decrease subsidies available to low- and middle-income Americans, and remove vital consumer protections for those with pre-existing health conditions. Furthermore, attempts to limit federal payments via a per-capita cap system within the Medicaid program will create serious coverage gaps among our nation’s most vulnerable citizens and bind public health care payments to an untenable and unaccountable formula. These aspects of the legislation run counter to both our company’s mission to change the health of the nation and our vision to do so by empowering providers to deliver higher-value care. I encourage members from all parties in Congress to work together on solutions that will stabilize the insurance markets, align public and private efforts to replace fee-for-service payments with value-based options, and pursue strategies for ensuring affordable and adequate coverage for low- and middle-income Americans.
As a part of the health care business community, I understand that Evolent also has a part to play in the shaping of policy and implementation on the frontlines. In support of transforming the industry, there are three areas where we will continue commit our time and focus:
- Being a resource for CMS and regulators on both sides of the aisle to think through policy options that are likely to result in higher-value care delivery;
- Using our scale in programs like Next Generation ACO, Medicare Shared Shavings Programs and Medicaid care management to highlight best practices and identify areas of need based on insights from the more than 2.8 million patients we’re serving today across our combined network of provider partners; and
- Representing the shared experiences of our provider partners with other industry thought leaders in the Health Care Transformation Task Force and Health and Human Services Learning Action Network.
Regardless of what policies are enacted at the federal and state levels in the future, we will remain committed to helping providers find innovative ways to use an integrated financial and clinical model to improve the health of the communities they serve.
About the Author
Frank Williams serves as Chief Executive Officer of Evolent Health. Prior to Evolent, Frank served as Chief Executive Officer and Chairman of The Advisory Board Company, a global research, technology and consulting firm that serves over 4,100 leading organizations across health care and higher education. During Frank's tenure as both its Chairman and CEO, The Advisory Board completed an initial public offering and grew to $450M+ in annual revenues with over 2,500 employees and $2B+ in market capitalization. Frank previously served as the President of MedAmerica OnCall, the President of Vivra Orthopedics and as a Consultant for Bain & Co. Frank currently sits on the boards of Peer Health Exchange and Head-Royce School. Frank received a BA with High Honors in Political Economies of Industrial Societies from the University of California, Berkeley and an MBA from Harvard Business School.More Content by Frank Williams