At the HLTH Conference being held this week at the Aria resort in Las Vegas, Patrick Conway, M.D., the president and CEO of the Durham-based Blue Cross and Blue Shield of North Carolina (BCNC), and the former Chief Medical Officer, Deputy Administrator, and Director of the Center for Medicare and Medicaid Innovation (CMMI), a division of the Centers for Medicare and Medicaid Services (CMS), was interviewed onstage by Annie Lamont, managing partner at Oak HC/FT, a Greenwich, Conn.-based venture capital fund. Dr. Conway, who spent more than six years at CMMI, before joining Blue Cross Blue Shield of North Carolina in October 2017, shared his perspectives on healthcare change.
Interestingly, the recently appointed new Deputy Administrator and Director of CMMI, Adam Boehler, appointed last month to the post, had been scheduled to join Dr. Conway onstage, but Lamont revealed that Health and Human Services (HHS) ethics administrators had intervened over having both the current and former CMMI directors appear on the same discussion panel.
In any case, as Lamont noted, Dr. Conway was both the first, and the longest-serving, CMMI Director, serving in that position from May 2011 to September 2017, when he left to take the BCNC position the following month, and having served under three presidents (Bush, Obama, and briefly, Trump). What’s more, she noted, he is the first physician to run a Blues plan; and he still practices medicine, though nowadays as a volunteer in pediatrics (his medical specialty), in order to avoid any potential conflict of interest.
Annie Lamont interviews Patrick Conway, M.D. at HLTH
Meanwhile, asked what he is most proud of accomplishing at CMMI, Conway said, “A few things. I’m most proud that we really did shift the system, especially for Medicare, but really, across the board, in a major way. When I started at CMMI, we had zero percent of Medicare payments in alternative payment models. By 2016, we had reached President Obama’s goal at the time, of 30 percent of payments in APMs; we had $200 billion in some form of alternative payment, and 200 contracts with providers. That’s a huge shift. Don Berwick [Donald M. Berwick, M.D., the former CMS Administrator, and president emeritus and senior fellow at the Cambridge, Mass.-based Institute for Healthcare Improvement] said on a recent panel that we’ve made a huge shift, and that we still have a long way to go, and he’s right.” Meanwhile, Conway cited work on facilitating improved patient safety in healthcare, and the development of the several accountable care organization (ACO) shared savings programs, as further achievements, noting that shaving 2 to 6 percent off the costs of any group of providers, under any alternative payment model, is a significant achievement. What’s more, he said, “I think Adam will do a great job.”
One element that Lamont asked about was the limited involvement of for-profit organizations as partners in development work with CMMI. “Yes, that was a learning,” Conway said. “We shouldn’t limit the competition; whoever can build projects with you, should be involved. Also, the CMMI process ended up getting built somewhat like the rulemaking process. When I started, the time from idea to actual launch, of any concept, was three years—there’s no way that was the right answer. We got it down to six months. And I believe that working with smaller prototypes and moving faster, would be great. But initially, the federal government was convened about some of those smaller prototypes. I hope that’s changing over time.”
Another element in all of this was the staff-based team that Conway built during his tenure at CMMI, and starting from a very small base. “When I started,” he recalled, “we had 70-80 people, and when I left, we had 400. And it’s an amazing team. I recruited them from all sorts of industries, and gave everybody literally the same pitch: ‘You’re going to work really hard, and get paid less than in industry, but you’ll have the chance to help change healthcare. Want to sign up?’ So we got some experienced civil servants, which you need, but also people from outside government, which is also important.”
Looking at payers and payment questions
Lamont asked Conway to address some questions around reimbursement reform and payment systems. In particular, she asked him whether he thought that some kind of Medicare-for-all health insurance system could work in U.S. healthcare. “The beauty of Medicare for all is that you have quality and costs all aligned,” he responded; “but then there are challenges underneath it. Meanwhile, the beauty of Medicare Advantage is that it mimics the idea of Medicare for all,” and offers providers the opportunity to learn how to implement changes in a congenial environment, he added.