Interview with CVS Accountable Care Leader Dr. Mohamed Diab

Can value-based care  transform the American healthcare system? In this episode, we dive deep into this pressing question with Dr. Mohamed Diab, president of CVS Accountable Care. Dr. Diab highlights systemic challenges, such as physician burnout and the inadequacies of primary care funding. With an emphasis on primary care's critical role in managing chronic conditions and preventing illness, he reveals how a shift to value-based care can lead to better health outcomes by focusing on holistic, patient-centered approaches that tackle social determinants and behavioral health.

We also address the complexities of this transition, specifically for healthcare executives who are navigating the shift from fee-for-service to value-based models. Learn about Medicare's ambitious plan to achieve 100% value-based care by 2030 and discover how CVS Health's Accountable Care Organization is leveraging technology, analytics, and clinical programs to support providers and Medicare beneficiaries. 

As of March 2025 HealthBiz is part of CareTalk. Healthcare. Unfiltered and can be found at the following links:

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Host David E. Williams is president of healthcare strategy consulting firm Health Business Group.

Episodes through March 2025 were produced by Dafna Williams.

Transcript

0:00:00 - David Williams
The US healthcare system is really a sick care system that kicks into gear only to treat illness. Value-based care promises a focus on prevention and managing chronic conditions in primary care rather than the hospital. But it's easier said than done. Hi everyone. I'm David Williams, president of Strategy Consulting Firm Health Business Group and host of the Health Biz Podcast, a weekly show where I interview top healthcare leaders about their lives and careers. My guest today is Dr Mohamed Diab, president CVS Accountable Care and Senior Vice President CVS Health. If you like the show, please subscribe and leave a review. Mohamed, welcome to Health Biz Podcast. Thank you. 

0:00:50 - Mohamed Diab
David, and thank you for having me. 

0:00:52 - David Williams
We're going to talk about the very exciting topic of value-based care, accountable care, but we're going to wind back the clock first and I'd love to hear a little bit about your background, your upbringing, any childhood influences that have stuck with you throughout your career. 

0:01:11 - Mohamed Diab
Sure, yeah. So I grew up in a household where my father was a primary care physician who used to, at the dinner table every night, tell us a story about his patient that he treated during the day. And there was a lot of life lessons from this experience. And he used to take me with him to the practice when I was a little kid and I was watching and witnessing. You know how he cares for his patients holistically and taking the time and trying to understand, you know, any socioeconomic barriers to care, what's going on in their life as human beings. So because he understood that, you know, sometimes these issues can have more impact on the health outcome than the disease itself. So I was fascinated by this experience and you know that's why I love medicine and I, you know, and that's why I ended up going to the medical school. And also that shaped how I look at the delivery system today was the importance of primary care as a true quarterback of care, caring for the population holistically. And so I finished medical school, I did my residency in OBGYN because my father kept telling me primary care is hard, yeah so. 

But then I wanted to expand my impact and so I went to, did my MBA and start, you know, working in the healthcare industry and, you know, worked in multiple. So I, as a provider of care, that gave me the experience of the direct patient care. And then I did a lot of consulting for large health systems. I worked on local, regional, national health plans, so I also, you know. So how is the health plan view of the industry? And then I, you know, I was always passionate about value-based care and population health management and that's how that got me into this focus on building this business of CVS accountable care to support the various providers in this transition, in this journey from the like you called it, the sickness system of fee-for-service to the value-based care that focus on value and outcomes. 

0:03:52 - David Williams
That sounds great. You know, sometimes they say that there's nothing new under the sun and although I doubt, your father talked about social determinants of health and all that. He understood that it's the whole person and what happens in their house and with their family and if they have food to eat and a job and the stresses and so on that have a big impact. So I'm glad to hear that. I will say your experience parallels that of a number of my guests. Some of them decided to become physicians and to go into healthcare. Some were talking about like they remember how hard it was, you know, for their, their father, their mother to get paid and so they went into more like the business side of it right away, and it sounds like you had at least some sense of primary. Care is hard, you know. Maybe delivering babies is a little easier, although it's not that much easier. That lifestyle is not that much better. 

0:04:42 - Mohamed Diab
Yeah, no, it's actually to your point. It broad. Develop this perspective about. You know that the system that we have today is not working. It's not working for the physician, it's not working for the patient, it's not working for the society at large. We have a huge waste in the system. We almost spending 20% of the national GDP on healthcare but we don't have the outcome to show for it. The physicians are burned out. In the recent survey, 38% of physicians said that they want to retire next year. The very interesting one and it's depressing two-thirds of them are telling their kids don't go to medical school. 

We have huge shortage in primary care. 

One out of every 10 US counties don't have a primary care physician at all and we don't spend enough on primary care. 

Medicare spends only 2% on the total spend on primary care, which here is where the problem is, because the patients end up going to emergency room or hospitals or specialty care, where the primary care as a quarterback of care, where we can manage all the chronic conditions, understanding the social determinants of health, understanding behavioral health. That doesn't happen because now the primary care physician have only 15 minutes to give to the patient, because we have a payment system that that encourage volume and transaction versus holistic approach. I have one of the top executives in the health system told me, mohamed, in a fee-for-service system, nobody paid me to care about the patient. Once they leave my four walls, which is true In a value-based care system, the picture is different. Right, there is accountability and there is focus on the population holistically. So there is lots of challenges that we are facing today in healthcare system and that's why I'm very passionate about this value-based care and accountable care and the role that it plays. 

0:07:17 - David Williams
That's good. I want to emphasize what you said about primary care and the small percentage. I was just having this conversation with another person on the podcast recently and he said you know primary care is so important and everybody acknowledges that. But you know, it's actually the percentage is on the fingers of one hand and I say the number of fingers is going down. It's actually been dropping Even though we talked about transformation, but there's less primary care now than there was probably five years ago. 

0:07:42 - Mohamed Diab
Yeah, and that's why there was a huge shortage. We have around 60,000 primary care physician shortage and there is an access problem to primary care. That's why you see people running to emergency room and very costly alternative sites of care because there is no primary care access right. And try to imagine that for a senior population who have multiple chronic condition and have you know the impact of COVID on their depression and anxiety and all this stuff, and there is nobody to really look at this patient holistically and understand what's going on. So that's where the significant opportunities are, that sounds good. 

0:08:31 - David Williams
Well, let's talk about solutions in a minute. But I will talk about problems for one more minute before we get into that. And I want to bring up what you said about the emergency room. So we once worked on a project, and it was in a Midwestern city, and the idea was to reduce emergency room visits because people should be in primary care. But the hospital CEO told me he said you know, look, the only thing we make money from is emergency care visits. If I reduce emergency care visits, I'm out of business. 

0:09:02 - Mohamed Diab
So I can't do that, even though it's the right thing to do. Yeah, and that's why I believe in value-based care, because when you design a payment system and an incentive system that incentivize and pay for outcomes and not for the volume of activity, that's when the mind shift of these hospital executives and the providers at large is you know what I can get value from the value-based care? That can overcome what I'm losing on this emergency room or the heads and beds, overcome what I'm losing on this emergency room or the heads and beds. And I'm not saying it's easy, it is hard and it's also depend on what percentage of the patient population that they care for enrolled in a value-based care. There is a tipping point. 

When you reach it, the value-based care program can be more lucrative for the health system than the fee-for-service. But we are living in this dichotomy. We are living in this schizophrenic system where the provider is still deeply rooted in fee-for-service system and reimbursement, and we need to shift fast. Medicare announced a couple of months ago that they have a goal of having 100% of their Medicare population into value-based care by year 2030, which is a very aggressive goal, and you cannot get there without addressing the fee-for-service system and looking at the payment models together and see how can you really incentivize a provider to stop thinking the way you just mentioned about. No, I want heads in beds. I want more ED visits, because that's where I make my money. 

0:10:48 - David Williams
So let's talk about CVS Health and the accountable care role within there. So CVS, of course, originally a regular drugstore pharmacy, added Aetna, added Caremark added Signify Health. How does what you do in terms of the accountable care group fit into the broader CVS Health and what are the main things that you offer? 

0:11:09 - Mohamed Diab
Perfect. So CVS Enterprise, cvs Health Enterprise has as part of the strategy CVS Health Enterprise has as part of their strategy is to really support this movement to transform the healthcare system and support the primary care providers nationally and really play a role in this movement to value-based care. That's why we created this know, created this CVS accountable care organization to support the providers in this country, to help them, because we understand that the move from fee-for-service to value-based care is very complex and requires significant investment in technology and analytics and clinical programs and resources. So today CVS Accountable Care have more than 70,000 providers around the nation in various forms of value-based care contracts and we are caring for more than a million Medicare beneficiaries in the various models in Medicare short savings program, aco, reach and Medicare Advantage. 

And we have a very diversified group of providers, from independent primary care physician in rural communities to federally qualified health centers, to multi-specialty physician groups, to large clinically integrated networks, to large academic medical centers. So we have a very good view of all the different types of providers and we partner with them and meet them where they are in their journey and try to support them and continue the journey and accelerate the journey to value-based care, because we understand this is not easy transformation and our offering is very simple. We say to the providers let's help you and support you. We built the end-to-end program, so we have, you know, various population health management programs, clinical programs and solutions, analytics technology, so you know, help them with the risk adjustment and we see where they are, what capability, what infrastructure they have, and augment and complement and support them and start moving them from low levels of accountability and risk all the way to the highest level of full risk on the population. 

0:13:53 - David Williams
So one of the things that has been talked about you mentioned before how it's not easy, it could be difficult, and you just mentioned risk adjustment. So the idea of risk adjustment is that the provider is getting paid, you know, to take care of somebody that's sicker. They're getting paid accordingly. Part of the problem has been that there's been some competition just to you know, raise those risk adjustment scores to get paid more without necessarily doing more for the patient. Now that's had some backlash against that. There's some adjustments that are going on. What are the dynamics? How do you see the risk adjustment working? How do you make sure that that patient that has those chronic illnesses is getting the proper treatment? 

0:14:30 - Mohamed Diab
No, the focus is how to for the provider to accurately document the condition that this patient has. 

Right, and because this is part of all the value-based care models is how you capture the risk of the population that you're caring for, because the provider who is taking care of a senior who has three or four or five different chronic conditions, this is different and that's what we've been talking about. You know addressing the patient holistically and that takes time and effort. So you know the provider wants to accurately document these conditions that the patient has. So it gets reflected in what are the benchmarks for these patient populations and what is exactly the type of risk that the patient has to deal with, because that would require investment in the population and adding more care management support and a lot of efforts from the provider on time to take care of these patient populations. That is more complex. So that's the focus and the CMS and the government has guardrails around these risk adjustment to make sure that everything is appropriate and accurate and that there is no everything is appropriate and accurate and that there is no either upside or downside kind of approach to it. 

0:16:03 - David Williams
Now I've understood now that the concept between getting paid for just fee for service, whatever you're doing versus overall value and I understand the population level Can you give an example of a program or an initiative that's been successful? Maybe from the perspective of a patient, how does it feel different to be in an accountable care setting as opposed to what the baseline would have been? 

0:16:29 - Mohamed Diab
Yeah, so one of the things that we do is we create a care team around the primary care physician because we believe that the primary care physician, because we believe that the primary care physician cannot do everything, because that requires a lot of time and effort and we want them to practice at the top of their lives right. So we create a multidisciplinary care team around the primary care to analyze the population. We have wealth of data around the population. We analyze it, not only the condition that they have and the diseases and the diagnosis, but also we look at their social determinants of health and combining these data together, trying to stratify and segment the population into the different cohorts that require different type of intervention. 

0:17:15 - David Williams
that require different type of intervention. So, as you mentioned, cvs Health is into a variety of things at the enterprise level and I wonder the extent to which the different divisions cooperate. So certainly pharmacy and retail pharmacy is actually an important part of managing chronic conditions, preventing hospitalizations and so on. What's the tie-in between pharmacy and what you do on the accountable care side? 

0:17:40 - Mohamed Diab
Yeah. So we try to connect all the assets the clinical assets that the enterprise has to serve the provider community in value-based care as well as the patient population that we are caring for. So one of the clinical assets is the retail pharmacy. So we work closely system to say that this patient has a gap in care or they are not taking their medication, or that, whatever the gaps in care is, and the pharmacist can intervene at the point of care and we see a significant improvement based on this activity. 

The other asset that we also incorporate in our program is the retail clinics. So our retail clinics that are in the retail stores. We also include them as part of our provider clinically integrated network and they serve as an extension of the primary care physician of the providers, because they have more access from a timing standpoint and after hours and weekends, as well, as they have also a virtual option. So these access points can be a lower cost alternative to emergency room visits or even urgent care visits when the patient is needed, and because they are operating on certified electronic health records, their data can be viewed by our provider partners. So we create this connection between them and our provider partners in value-based care them and our provider partners in value-based care, and also the CVS, who has a lot of experience and expertise in managing high-cost medications. That's also one of the assets that we use in our program. 

0:19:50 - David Williams
That makes sense because it's not just the retail pharmacy Some of the very expensive prescriptions are outside of that but a big contribution overall. A lot of retail pharmacies stepped up a lot during the COVID-19 pandemic and that made a lot of shifts. Some of that's going back, but they've changed their role forever in a sense, for better, for worse. There's other public health crises that are coming. You know opioid epidemic, covid-19 isn't gone, and then there's emerging threats like avian flu. How does accountable care overlay with those? In other words, does the framework work or you just have to say, hey, there's a huge crisis, we have to throw everything out and just go back to fee for service and people go to the emergency room? How do you think about that? 

0:20:36 - Mohamed Diab
to fee-for-service and people go to the emergency room. How do you think about that? No, actually, what COVID taught us and it was a tough lesson is that we as a society were not managing people with chronic condition in an effective and efficient way. That's why these were the folks who started dropping when COVID came right. So part of the focus of value-based care is, as you said, the prevention doing annual wellness visits for as many of our Medicare beneficiaries as we can so we can detect early problems and early chronic condition. But also the focus on managing the population was multiple chronic conditions, which they become the most vulnerable population when you have a public health crisis and a pandemic. 

So taking care of these folks and also addressing some of the behavioral health issues that comes with it, whether it's a depression or an anxiety, and providing them more access to primary care, because we work with our provider partner to open their schedule and bringing these high-risk patients more frequently so they can be managed more effectively and we make sure that they take their medication. They do their lab work. That, if there is any behavioral health issue gets addressed. Do their lab work. That, if there is any behavioral health issue gets addressed and also, if there is any health disparity, that gets addressed right, because this is one of the focus of our program also addressing and improving health equity and we do a lot of work and collect a lot of data and analytics to identify these high risk population and really help them. So I think that would help, you know, because you don't want to wait until the crisis comes. You want to be able to manage the population better and address the conditions so they are not as vulnerable as we saw in the COVID pandemic. 

0:22:37 - David Williams
My final question for you, mohamed, is sort of changing the topic, and I'm wondering if you read any good books lately, or even in the past, anything that you would recommend to our audience. 

0:22:48 - Mohamed Diab
Yeah, I've been reading lately a book called Moonshot that talking about the Pfizer experience and transforming itself. So it was ready before when the pandemic came and that's why and how they became the first one to introduce a vaccine within nine or 10 months from the start of the pandemic. So it was a. It was a fascinating, you know, read about how you transform an organization to focus on innovation and excellence and they become focused on doing the right thing for the society and the population they serve and that serves them well as well. 

0:23:31 - David Williams
So Great Well, dr Muhammad Diab, president CVS Accountable Care and Senior Vice President of CVS Health. Thank you for joining me today on the Health Biz Podcast. Thank you. 

0:23:43 - Mohamed Diab
David, very much for having me. 

0:23:47 - David Williams
You've been listening to the Health Biz Podcast with me, David Williams, President of Health Business Group. I conduct in-depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website, healthbusinessgroupcom.