From every angle: Dr. Von Nguyen brings rare background to quest for high-value specialty care

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!