From every angle: Dr. Von Nguyen brings rare background to
quest for high-value specialty care
October 1, 2024
Von Nguyen brings a background in value-based payment
models, artificial intelligence and health plan operations to the challenges of
high-value specialty care.
Dr. Von Nguyen has spent
his career paving the way for better outcomes and affordability in healthcare.
With a background that includes designing federal value-based payment programs
in several specialties, guiding quality and value efforts at a Blues plan, and
helping to shape population health solutions at Google, he recently brought his
unique experiences and skills to Evolent as our new chief clinical officer. In
this role, he will focus on scaling operations and integrating artificial
intelligence (AI) to improve outcomes in specialty care.
Dr. Nguyen shared his perspective on multiple topics,
including AI's role in healthcare, how he approaches provider abrasion, and why
he says high-value specialty care is poised for growth.
Why did you decide to pursue a career in medicine and make
the move from practicing physician to medical executive?
I know this sounds cliche but watching M*A*S*H as a kid
inspired me. I grew up in a low-income family and didn't have any professional
role models, but the characters in the show suggested that life as a doctor
could be both fun and meaningful.
I've worked at clinics in underserved communities and as a
volunteer for Doctors Without Borders. While direct patient care brings me
great joy, I quickly learned that I could have more impact leading programs at
the population health level.
You've worn many hats in your career. What is the
perspective you have gained through the years about the pursuit of value and
better health outcomes?
At the end of the day, whether you're a provider, a health
plan or the government, we all want to serve people and communities. We all
want to ensure people have the right care, at the right time, and at the right
place that makes the most sense for them. That was always my goal regardless of
the role I held.
What excites you most about your new role at Evolent?
The opportunity to leverage all the skills I’ve acquired
throughout my career to improve the health of the members we serve and also to
advance value-based care. For 2025, experts are predicting upwards of an 8%
increase in healthcare costs. As healthcare continues to increase faster than
the rate of inflation, the environment isn't sustainable. There's been a lot of
innovation with ACOs and primary care, but less so in specialty care. Now it's
time. Evolent is on the cutting edge of innovation, and we have an opportunity
to transform healthcare.
What are some of the key projects you'll be focused on?
One of the most interesting areas I’m working on is
artificial intelligence (AI). When I was at Google, I was part of a research
team using large language models to build core capabilities for healthcare.
These models are great with general conversations but require additional
investment to be useful in specific applications. So we need to tune and train
these models to understand the complexities of healthcare.
Despite so much innovation and technology, healthcare still
lags behind other industries, and so many processes are still manual. I think
the industry single-handedly keeps the fax industry alive! AI can decrease the
administrative burden on providers and staff and free them up to use their
years of training and practice at the top of their licenses. AI can allow them
to spend more time delivering care, building trusted relationships with
patients, and ultimately improving quality and outcomes.
AI in healthcare is still in its infancy. What do you think
it will look like when it's "grown-up"?
Some people don't realize how pervasive and second nature AI
will become. But we shouldn't fear the "Terminator" scenario or think
that it will take over all our jobs.
Healthcare is a team sport, and we should look at AI as
another member of the team. We'll need to define roles and responsibilities and
assign tasks to AI that it can do well. Tasks that it doesn't do well should
stay in human hands. AI should never replace human judgment because it doesn't
have that capacity, nor would we want it to.
What are some of the best use cases for AI in specialty care
management?
AI is really good at recognizing patterns that humans can't
see. If you have enough data, it can help you understand risk and intervene.
For example, we can use AI to predict if a patient is likely to be
hospitalized.
AI is also useful for picking up needles in a haystack. If
you're a clinical reviewer who typically has to sift through pages upon pages
of documentation, AI can quickly find those key pieces of information you need
for a medical necessity determination. The technology can also capture an idea,
rather than just finding specific words, and summarize it based on all the
notes in a meaningful way.
Provider abrasion is a stubborn challenge. How can we best
minimize abrasion while still delivering value?
Above all else, we must prioritize trust and remember that
providers, health plans and Evolent are all trying to make the right decisions
for patients. Trusted relationships, however, don't happen overnight but
through engagement over time. That's the core of what we do at Evolent —
building trust and engagement with providers to drive value for patients and
our customers.
Technology also has a large role. Through AI, we can make
the prior authorization process more transparent, issue more
auto-authorizations, and reduce paperwork and administrative burden.
ACOs and other primary care VBC models have been around for
years. Where do you think we are with value-based specialty care?
All our early successes, such as the Medicare Shared Savings
Program, have been very important in helping us understand what's working and
what’s not. We're at that inflection point where we can think about specialty
models in a way we haven't before and impact the cost of care in complex areas
like oncology, cardiology and musculoskeletal care. We're ready to scale these
models to make them more accessible to more patients.
When you were at CMS, you worked on various
specialty-focused alternative payment models. What did you learn from that
experience?
I worked on Bundled Payments for Care Improvement, the
Oncology Care Model and the Comprehensive Care for Joint Replacement Model, and
I learned that they're just as complicated as ACOs.
Primary care and specialty models use the same general
principles to get positive outcomes. For example, we have to think about how
providers participate in risk sharing. Also, data is critical to help inform
decision-making because, I would argue, providers in general don't have good
information on costs and utilization. Yet if you provide them with data, they
will plan ahead to ensure patients get the right care and minimize unnecessary
services.
When you're not working, what do you do for fun?
I recently have been spending a lot of time with carpentry.
I just finished a giant Murphy bed and next up is a bookcase for one of my
daughters. She insists on reading paperback books and we're running out of
space — it's a good problem to have!
Career Highlights: Dr. Von Nguyen
GOOGLE
Clinical Lead, Population Health
Developed products at the intersection of population health and AI
BLUE CROSS NORTH CAROLINA
Chief Medical Officer and Senior Vice President
Led strategy and operations for population health, quality, provider relations,
and value-based care modeling
CDC
Deputy Associate Director, Policy & Strategy
Led population health collaborations across various sectors
CMS
Senior Advisor
Built several value-based care programs at the Center for Medicare and Medicaid
Innovation
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