Q&A: Dr. David Lim on the future of value-based specialty care

Joining Evolent this summer as chief clinical officer, Dr. David Lim brings a background as a physician, executive and startup entrepreneur with experience in value-based care. Most recently, Dr. Lim was chief medical officer and employee number-one at RightMove Health, a musculoskeletal health startup guiding high-quality physical therapy and patient triage. We spoke with him about the unique career path that led him to Evolent and his outlook on the next horizon in the pursuit of value and quality in care.

Early in your career you were a molecular virologist. How did you wind up in the value-based care space?

I was an academic, MD-PhD physician, deeply immersed in the field of infectious diseases. My research focused on retroviruses. I was very motivated to help patients with HIV. Yet, I had a moment of pause where I asked myself if I wanted to continue down the academic path. Working in a lab is wonderful, important work, but the pace of change is very incremental. I was attracted to doing something that was faster and more immediately impactful on a broader scale. I decided to explore a transition into the business side of healthcare. 

How did you make that switch?

I got into consulting, expecting that my background would lead me into a career in the pharmaceutical industry. But I was presented with a wonderful opportunity to work for a year with Michael Porter, Harvard Business School professor, renowned leader in value-based care. Together we launched the International Consortium for Health Outcome Measurement, ICHOM, a nonprofit that has created a set of rigorously defined outcome measures by medical condition. These measurement sets have since been adopted worldwide and have helped to standardize and accelerate healthcare value creation. That experience launched me into a career path into value-based technology startups and ultimately to Evolent.

What interested you in Evolent?

This is a chance to take my experience in value-based care to improve the patient and provider experience in a much larger setting. Evolent is working with so many plans, and we are using multiple levers to drive value across many medical conditions in a comprehensive way. 

Evolent’s culture was also a selling point. I have known people at Evolent from before the company’s IPO a decade ago. To see some of the same individuals still here is a testament to the leadership team’s commitment to the mission to transform healthcare. People love it here, and they wake up every day excited to make a difference. 

Much of your experience has been with startups, sometimes as employee number one. What do you like about that work and how does it translate to working at an established company like Evolent? 

I love taking a great idea, bringing together a group of motivated people, and building something that has never existed before. That’s not only what startups do. It’s what innovative companies do. Identifying a need, describing the current state, and quickly exploring and developing solutions is something I’m very accustomed to doing. Evolent has been working to go beyond utilization management and create new models to drive value throughout members’ experience with complex health conditions. I’m excited to bring my background and entrepreneurial mindset to help meet that challenge.

What do you see as the next step in the evolution of value-based specialty care? 

I believe that employers and health plans are seeking top-to-bottom specialty care services. Today, members unfortunately take a convoluted journey through the healthcare ecosystem that is too variable, full of risk, and almost always much too expensive. Traditional utilization management can help avoid individual services that are inappropriate, but often by the time the request gets to us there’s already been a lot of waste, confusion, and delays. I think high-value specialty care will evolve to where we’re cutting a lot of the noise from that experience and working with providers to rapidly get patients on the right track from the start. Evolent is bringing together the tools and capabilities to make that happen, whether it’s care navigation programs that support excellent communication and engagement, or networks of high-value specialists. 

What do you think could be a game changer in the industry in the next 1-2 years? 

I am cautiously optimistic that with the upcoming CMS requirements for FHIR-based APIs, we will see an explosion of data access from all health plans and soon EMRs. Massive data will drive key insights and findings as companies layer in large language learning models, machine learning, and AI-diagnostic tools. It is only a matter of time before the most innovative companies, such as Evolent, begin pushing real-time, accurate, evidence-based care path recommendations to providers live in their patient interaction workflows. Of course, we should preserve the decision-making autonomy of providers, but we can inform those decisions in the moment with data on the efficacy, risk profile, and costs — to the plan and patient — of different treatment options. The most transformative companies can leverage all these capabilities to engage providers in value-based reimbursement models. I believe such a day is coming soon!