Patrick Conway Cmmi OPTUM

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The subject is a physician with high national profile. He is a pediatrician who takes care of children. His DWI case and child abuse charges made national media attention. This is a substantial and notable part of his bio and needs to be included. — Preceding unsigned comment added by 108.28.166.10 (talk) 15:01, 29 January 2022 (UTC)

Here is the source police report: [redacted] 32.142.50.118 (talk) 11:05, 5 March 2024 (UTC)This PDF contains unredacted personal information of multiple people connected to the incident. This is doxing, and a major BLP violation. DatesAndTimes1337 (talk) 17:38, 5 April 2024 (UTC)

Patrick H. Conway (born 1974) is an American physician and the CEO of Optum as of May 2025.^[1] He is a practicing pediatrician formerly serving at the Cincinnati Children's Hospital and Children's National Medical Center. He was the chief medical officer and acting administrator at the Centers for Medicare and Medicaid Services (CMS) leading quality-of-care efforts for the nation.^[2] Conway also served as the Director of the Center for Medicare and Medicaid Innovation, and was responsible for new national payment models for Medicare and Medicaid focused on better quality and lower costs.^[3]

Biography

Conway was born in College Station, Texas in 1974 and was the youngest of four children. His father was a chemistry professor and his mother was an assistant dean at a business school. He received his bachelor's degree from Texas A&M University, and attended Baylor College of Medicine, followed by his residency at Boston Children's Hospital.

In 2007, Conway came to Washington as a White House fellow and worked for the then Secretary of Health and Human Services, Mike Leavitt.^[2] He served as the Deputy Administrator for Innovation and Quality for the Centers for Medicare and Medicaid Services from May 2011 to September 2017 and joined the Blue Cross Blue Shield of North Carolina in October 2017.^[4] Conway was CEO of Blue Cross NC from 2017 to 2019, was CEO of Care Solutions at Optum from 2019 to 2023, CEO of Optum Rx from 2023 to May 2025, and has served as Optum CEO since May 2025.^[5]

Advocacy

Conway is an advocate of value-based healthcare services.^[6][7] He introduced new payment models for hospitals and doctors under Medicare and led the efforts to measure the quality of care provided by the healthcare professionals,^[2] advocating for healthcare providers to be paid for the outcome of care provided rather than the fee-for-service model.^[8] Conway also helped create Accountable Care Organizations (ACOs) and the Medicare shared savings program,^[9] and led the CMS Innovation Center to transform the Medicare program, moving from zero payments in alternative payment models based on value to over 30% of Medicare payments.

DWI conviction and resignation

On June 22, 2019, Conway was charged with driving erratically on I-85 with his two daughters, ages 7 and 9, in a Cadillac Escalade.^[10] A motorist filmed Conway's vehicle swerving in and out of traffic, ultimately crashing into a tractor trailer. The station reported that officers performed field sobriety tests, and Conway had difficulty maintaining his balance during the tests.^[11] At the police station, WRAL reported Conway refusing a breath-alcohol test and cursing.^[10][11][12] He was convicted in North Carolina on October 8, 2019. No one in the crash was injured.^[10]

Conway resigned as CEO of Blue Cross and Blue of Shield North Carolina on September 25, 2019 following his arrest. In his resignation, Conway stated that he was ashamed and embarrassed about his actions and pledged to work hard to earn back the trust he had lost for his actions.^[13]

Associations and recognition

Conway is a board member of private organizations, Aledade, Intarcia Therapeutics, the Duke-Margolis Center for Health Policy,^[14] Help at Home,^[15] and Sound Physicians, and has been a member of the National Academy of Medicine since 2014.^[16] He has received the President's Distinguished Senior Executive Rank and HHS Secretary's Distinguished Service awards.^[17] He is an adjunct professor at the Perelman School of Medicine^[18] and has published over 100 peer reviewed articles on health care policy, value-based payment, innovation, delivery system transformation, and other healthcare topics.^[19]

References

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AM PROSP

The DOGE Czar’s Plan to Loot Medicare

Elon Musk’s coup plotters cut their teeth at an obscure Obamacare agency that burned $10 billion testing bogus cost savings initiatives.

by Maureen TkacikFebruary 14, 2025

Four and a half years ago, Department of Government Efficiency co-czar Brad Smith stumbled on a counterintuitive revelation: The most effective way to slash federal health care spending involved drastically raising Medicare and Medicaid reimbursement rates for hospital care.

At the time, Smith was running something called the Center for Medicare and Medicaid Innovation, an obscure off-the-books laboratory created by the Affordable Care Act for experimenting with “alternative payment models”—neoliberal for “larger sums with less accountability.” In its ten years of operation, CMMI had spent more than $10 billion testing various methods of tweaking reimbursement standards in (theoretical) hopes of improving health care outcomes for lower costs. They had worked with UnitedHealth, Aetna, Molina, and other insurers in 13 states to reward primary care physicians who administered more preventative care and collected more specific data on their patients. They’d worked with more than 100 hospitals and mega-practices to bundle payments for complex patients, in hopes of lowering the ultimate cost of treating chronic illnesses. CMMI had spent some $10 billion testing out dozens more schemes, nearly all of which subscribed to an ideology called “value-based care,” in which the central flaw of American health care is “volume-based” fee-for-service compensation schemes that incentivize “overutilization” of the health care system, and so the natural “solution” involves the government paying health care providers and various intermediaries to take steps designed to decrease said “utilization.”

More from Maureen Tkacik

Value-based care grew especially important during the Obama years, because the ACA mandated that insurance companies spend a minimum of 85 percent of patients’ premium dollars on “care,” wiping out profit drivers like the mandatory insurance policies UnitedHealth sold to college students that often boasted medical loss ratios as low as 10 percent. Insurers in turn began to focus their energies around their highest-revenue patients: seniors with a lot of complex health issues who were enrolled in the private Medicare offerings known as Medicare Advantage. They would soon buy up the medical practices, home health agencies, and surgery centers that treated these patients, in a move that enabled them to at once “align incentives” (i.e., control more of the medical decisions they were paying for), park the excess profit margins they weren’t allowed to report on their insurance sides, and find more Medicare patients to convert to MA plans.

Brad Smith was a value-based guy. He’d gotten in on the ground floor of the craze during the first term of the Obama administration, while helming the education reform foundation of former Senate Majority Leader Bill Frist (R-TN), whose billionaire brother Tom Frist founded the hospital behemoth HCA, whose long history of unnecessary overtreatment of Medicare patients perhaps ironically gave birth to the value-based revolution. Together, the two had built a home health care business with more than 650 employees that they had just sold for $440 million to health insurer Anthem.

Smith had been working as the chief operating officer of Anthem’s value-based business when he’d been tapped for the CMMI gig by one Adam Boehler, another value-based evangelist who often talked about how he wanted to “blow up” the “volume-based” ancien régime. Still, doctors, especially the types of doctors who complained about Obamacare and voted for Trump, hated value-based care, because it required spending way too much money on software and far more hours doing paperwork than the incentive payments could justify. Smith’s boss, Centers for Medicare & Medicaid Services (CMS) head Seema Verma, was value-based skeptical, and wanted to know whether CMMI’s programs were actually working as “intended.” So Smith ordered his staff to conduct a financial analysis of all 54 programs CMMI had bankrolled to test out the new approach to health care.

Smith and a 24-year-old deputy from his Nashville VC firm are said to be building the vision of what will replace everything that DOGE has eradicated.

The verdict was unambiguous: Value-based care was a bust. For two of its biggest programs, CMMI had spent $7 billion more than it had saved, just from compensating all the various intermediaries that had administered the trials. The reasons for this were twofold, say two individuals who worked on value-based care policy for the Obama administration: One, CMMI and CMS invariably outsourced the management of the trials to “venture capital or private equity firms or nonprofits where the CEO is making millions of dollars” that typically alienated and underpaid the clinicians they were ostensibly seeking to incentivize; and two, most of the policymakers involved were too preoccupied with “how they were going to monetize their expertise” to design programs that might actually save CMS money.

Lending credibility to that analysis, the shining star of the small agency’s roster of reform measures was the “Maryland All-Payer Model,” a state-operated system originally devised in the early 1970s by which an independent commission fixed flat hospital prices for the state that every payer—from Blue Cross to Medicaid—is expected to pay. The Maryland Model, which was modified in 2014 and discarded in favor of a more complex, almost European-style “global budgeting” system in 2018, is a rabbit hole with its own unique advantages and disadvantages, but it is decisively notvalue-based care, and sources familiar with CMMI said its affiliation with the initiative was something of a fluke, especially given that Medicare conclusively pays far higher rates for medical care in Maryland than anywhere else (though yearly per capita expenditures are higher in Florida). And yet the Maryland system saved CMS $1 billion over just five years tracked by CMMI, likely in large part by lacking the administrative middlemen and arbitrageurs in the system and the waste and fraud that tend to accompany them.

This analysis might have made for an embarrassing news cycle for CMMI and all the affiliated grifters who had cashed in on the value-based boom, like Smith’s predecessor Boehler, a college roommate of Jared Kushner’s who would soon sell his home health agency for $3.5 billion to UnitedHealth, or CMMI founding director Patrick Conway, who’d left the agency a few years earlier to become the richly remunerated CEO of Blue Cross in North Carolina, where he had rolled out a mandatory value-based care regime in conjunction with the CMMI-friendly healthtech Aledade, and recently been charged with driving under the influence after crashing his car with his two elementary school–aged daughters inside.

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