The Reverse Mullet Healthcare Podcast

The magic bullet of value-based care: Dr. Eliza Ng

• BP2 Health

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Ever wondered how a physician-led organization achieves exceptional results in one of healthcare's most challenging environments? Join us for a fascinating conversation with Dr. Eliza Ng the Chief Medical Officer of CAIPA, a New York-based Independent Physician Association managing 500,000 lives with remarkable success.

Dr. Ng shares her journey from delivering babies as an OBGYN to transforming healthcare delivery for 350,000 lives under value-based care arrangements. With 85% Medicaid enrollment, COIPA has achieved what many consider impossible: MLRs in the high 70s and shared savings of $80-100 million. The key? Access to care and relationship-building that creates patient "stickiness" where others struggle to even locate their members.

We explore the real-world business case for lifestyle medicine in value-based care settings, addressing both opportunities and barriers. Learn how organizations can demonstrate both direct revenue and indirect benefits from lifestyle interventions, with each 1% reduction in A1C potentially saving $500-2,000 per patient annually. Dr. Ng candidly discusses the challenges of convincing financial decision-makers of lifestyle medicine's value when most contracts operate on 12-month cycles while interventions require years to show full impact.

Whether you're a clinician looking to incorporate lifestyle medicine into your practice or a healthcare leader navigating value-based transformation, this episode delivers actionable insights on maintaining the "mom-and-pop" feel patients crave while operating within sophisticated risk-bearing arrangements. 

Justin Politti:

Welcome to the Reverse Mullet Healthcare Podcast from BP2 Health. We are live here at the ACLM Conference in Orlando, Florida. I'm your host, Justin Politi. I'm Dave Pavlik.

Ellen Brown:

And I am Ellen Brown, and we are here at the American College of Lifestyle Medicine Conference and we have our special guest, liza, and before we got started, we were talking about our shared passion in payment, transformation, value-based care and all of those fun things so clearly we have a lot to talk about, but we only have 15 minutes. So yeah, so tell us, tell us about your work, tell us about yourself, sure.

Eliza Ng:

So a little bit about myself first. I am an OBGYN by training, delivered tons of babies, but really spent my last two decades in the business, or in the coat, of managing risk and managing population, the entire value-based care and ACO proliferation. I moved over to the provider side, because I see that's where innovation and transformation can occur. I'm currently a chief medical officer of COIPA, Coalition of Asian American IPA. We are a 1,200 physicians group in New.

Dave Pavlik:

York City.

Eliza Ng:

IPA. We are a 1,200 physicians group in New York City managing over 500,000 lives, out of which 350,000 of them are under a continuum of value-based care. We also have a CMS, mssp.

Justin Politti:

I know them well because Oxford Health Plans actually was. That's where I started my career.

Ellen Brown:

Oh, Gason Yep, yep, oh there, yes, yeah, it was. I need to switch chairs, yeah we started taking risk right.

Eliza Ng:

That was before my time certainly, uh, 26 years ago and so I'm passionate about value-based care and I processed your claims. I did that?

Dave Pavlik:

Okay, don't worry. Yeah, you went through. Don't even get me started.

Justin Politti:

There was Pulse and PIC. Those were the systems that didn't talk to one another, but yeah, anyway, there was LeVon there.

Ellen Brown:

Inside baseball.

Dave Pavlik:

Yeah talk about inside baseball. I'll start going on about it.

Eliza Ng:

So, in the context of pay or mix, 85% of all populations under and the rest are Medicare and very small. Wait, 85% Medicaid. Yes, and we are one of the most successful Medicaid ACO in New York State. Overall, our share savings bonus is in the upwards of $80 to $100 million. That is amazing. Wow On what?

Ellen Brown:

kind of revenue or on what kind of benchmark.

Eliza Ng:

I should say Well, you know of an MLR basis. Our population is quite unique and I could talk a little bit about why, but our MLR is usually in the high 70s. Wow, now people will always say, well, maybe it's your population, it's low risk. Certainly I think our disease burden is not as high as some of the other cohorts. By the way, my previous life I was a senior medical director at Montefiore ACO, oh wow. And we managed a very different population where the MLR is in the 90s right, where the disease burden is tremendous.

Ellen Brown:

But the benchmark reflects that, though so fine, the disease burden is less but the benchmark's lower as a result of that. So I mean so the MLR says that tells the story.

Eliza Ng:

Yeah. So if someone were gonna come to me, especially from the provider side, and said how can I manage a population? Yes, you can talk about the infrastructures. You can talk about the data analytics, you can talk about the data analytics and innovation, but I would say one thing access. Throughout my career, I definitely see a large correlation between access to care, especially primary care, and population and medical expenditure. So give you some benchmark examples A typical Medicaid patient sees our doctors six times a year. Wow. A typical Medicare patient sees our doctor eight times a year.

Ellen Brown:

Yeah, so we're able to Very different. To even be able to find your Medicaid patient is a feat on its own. That's one of the biggest things that we hear from health plans is I't even find my patients. Right, they've been assigned to me, but I can't even find that contact there.

Justin Politti:

Yeah, but it's really unique in the populations that you know you're working with here in that it's so ingrained like again, I would see, because when again we worked at united healthcare after oxford purchased, you know um, I mean after united purchased oxford and it I mean after United purchased Oxford and it was just an eye-opening to me around like just how unique the access is within the population that you're working with.

Eliza Ng:

I understand and you're right, our patients have certain cultural affinity. That lends itself to a huge stickiness with their doctors. However, I do really believe, having worked in the Bronx for instance, that we can create environmental opportunity to create that stickiness Totally agree.

Eliza Ng:

That's when consumerism comes in, that's when you want to delight your patients and that's when you really want to build the trust with them so that they know right, if I have a fever or my child has a high fever, I can go to my doctors, I can call my doctors instead of going to the emergency yes, which is your access point 100%. That's hard, but I think that's really critical.

Justin Politti:

It is. That's very I can see it in the waiting room. I mean, honestly, I've been in many offices and I was like this is just, it's just different. You know, and you could tell I'm passionate about, you know about this, because I was like how do we deliver this or how do we implement this throughout the health care system to have that type of, I guess, engagement from your with your provider.

Eliza Ng:

Boots on the ground. I mean technology is very hard to replace that. You have to have presence in your community.

Justin Politti:

Yes, yes.

Eliza Ng:

And it's very mom and pop. So I think the opportunities for especially large corporations or entities is you need to deliver the same mom and pop type of practice. Feel you can corporatize medical practices. It's the high-touch touch, community based.

Ellen Brown:

It's the relationships. It's the third time in a row now that we've heard the importance of relationships with the clinician in lifestyle medicine. So so two questions. One I'm going to go back to the Medicaid ACO piece. So are you, do you have an ACO that works with the Medicaid MCOs in New York, yes, or do you have a direct ACO relationship with the state? So, new York?

Eliza Ng:

state we have both. Okay, we are one of the four what's called New York state innovators. That allows us to take full risk, delegated risk one of the four, but I would say in new york, not california, it's very difficult.

Ellen Brown:

oh to to get health plans to agree to delegate functions, yeah yeah, yep, no, so 100 and the state is not really doing a lot to push towards a direction that's, and that's why you caught my attention when you said medicaid acl is like wait. So what's going on with the state, like I have to know, are you?

Justin Politti:

agnostic as to which ones you're doing. So, in other words, are you going across the spectrum or will you align with one payer or two.

Eliza Ng:

No, no, we have multiple payers. We certainly have coupled predominant payers because of large volume.

Justin Politti:

Right, that's the thing that I would be if I'm on the payer side. I'm like I want you know I don't want you to sign.

Eliza Ng:

But one out of eight Medicaid patients are taken care of by our doctors in downstate, so we have to play with all payers and payers have to play with us, so we have multiple contacts directly through our own ACL state.

Ellen Brown:

ACL. So thank you for answering that technical question. So now I'm going to go to more of the global question of so tell us how you came into lifestyle medicine, how you bring this into such a mass scale, et cetera.

Eliza Ng:

Sure. So it's really through my personal journey and my through my own personal struggle as a someone who tries to manage my career, my family, my, my personal health that I stumbled upon lifestyle medicines principles and started learning a lot about it and practice it, and I see the tremendous outcomes not only on my health, but also on my productivity and lifestyle changes are very accessible, and so it becomes my mission to democratize lifestyle medicine to my population and also to my peers who also struggle in many ways like I do.

Dave Pavlik:

Yeah, Tell us about your. You're going to be on the stage tomorrow at some point. Tell us about what is your topic and what.

Eliza Ng:

Sure, I am part of a work group called Under the Business of Lifestyle Medicine and there are two parts to it. There is a part that aims to help folks who want to start a lifestyle medicine practice and give them the tools and support from a fee-for-service piece, and my talk, or my session, is really on how to integrate or start a lifestyle medicine practice within a system or medical groups that participates in value-based care.

Ellen Brown:

Yep that's where we are big champions with you of that is how do we bring we work with so many health systems and health plans that are very fee-for-service centric and maybe they've tried value-based care some but those especially those that have that are fully integrated, that have health plans that that have or are very committed to reducing the expense on their own employees right is, how do you help them see lifestyle medicine as not just a clinical service line but as an actual way to improve outcomes and pair into those outcomes-based contracts, those value-based contracts that right now are very chronic disease management centric? You know, like, just let's go after that one. You know what I'm saying. It's a night and day difference in terms of the focal point and opportunity.

Eliza Ng:

Yeah, so for me, right, if there were two? Separate line from this is number one. If you want to start a program or start to practice lifestyle medicine within a system or medical group, you don't want to be a cost center. However, you may not need to fully have a full, top-line revenue-driven program. The indirect benefit, the value of lifestyle programs include improving quality right, she does quality that are in every single value-based contract Blood pressure measurement, hemoglobin A1C lowering.

Eliza Ng:

These are very focused measures that almost all payers are focused on. You can improve the total cost of care of a certain subgroup population rising risk. I think it's the best suitable for. So you have to really create that revenue model from a direct but also from the indirect. So me, as a decision maker, or one of the decision making groups within my group, will look at what is the revenue line. Okay, you barely can cover your costs, but hey, based on evidence and based on the integrity of your program, I believe and it's been, you know, let's say, shown in other areas that you can decrease cost of care for that population. Let's say diabetes, for instance for every 1% hemoglobin A1C lowing, you can lower total cost of care from $500 to $2,000 per year. So those are the P&Ls that you need to include in your program.

Dave Pavlik:

Do you talk at all about barriers that somebody wanting to start a lifestyle practice within a group or within a system talk about any of the barriers that they're going to face? I?

Eliza Ng:

do and these are realistic right. Many, many decision makers, whether it's your CFO or your CEO, might not be able to agree right on especially indirect value that lifestyle medicine can bring in, because it has. No, the RV is not there, Right, Exactly Right. So that's number one. And number two, that time horizon most value-based care contracts are 12 months Exactly. Many lifestyle medicine programs are multiple year Right. That's why, to be honest, diabetic prevention program is really hard to make a business case, Absolutely.

Ellen Brown:

Because it's a three to seven year horizon and it's prevention, so it's avoidable cost.

Eliza Ng:

Yes, super hard, yeah. So these are realistic challenges, yeah.

Ellen Brown:

No, I always say to people. I don't want to have the debate about wellness and prevention. I understand the economics of it, but this is insurance and an insurance company, your homeowner's insurance. It doesn't pay to keep your roof fixed right. It pays when the roof blows off. It's your responsibility to make sure that you caulk the roof and you get new shingles and so this whole thing of like. Well, I let myself go for 20 years and now you have to pay for it. It's that 20 years that we. It's funky, so I feel like. But now we've gotten to this tipping point where we have 2 trillion in lifestyle disease costs. That's a big opportunity to go after that nobody's disagreeing over, right. It's like that we can solve and that we can share.

Eliza Ng:

And redistribute 100%, especially with the aging of the population. You're going to see right. Dsnp is the next frontier, in my opinion, around value-based care. You're going to get them all fired up again.

Justin Politti:

Yeah. We're fully integrated de-snipped in Massachusetts. Senior Care Options.

Eliza Ng:

Okay, let's talk, because waiver is here now in New York, everyone's just scrambling. Massachusetts has started earlier than us, so we'd love to learn from you.

Dave Pavlik:

Wait for him to wean off the caffeine.

Justin Politti:

He's ready when it comes to de-snips, I'm happy that I heard an acronym that I haven't heard in almost 20 years.

Dave Pavlik:

No.

Ellen Brown:

KIPA and CAPIPA.

Justin Politti:

KIPA and CAPIPA. That was the ones that you know. There you go Well.

Ellen Brown:

I know that we only had 15 minutes and it's 15 minutes, so we're going to have to say goodbye for now.

Dave Pavlik:

Thank you so much for being here.

Ellen Brown:

Thank you, this is definitely worthy of a much longer conversation, because this is the stuff that I think a lot of people everything we've talked about this week is important, but there's a whole group of folks that really want to understand this at a real detailed level. So thank you, okay.

Dave Pavlik:

Thank you, have a great day, all right.