Listen to this super-high energy exchange with Farzad Mostashari, Founder and CEO of Aledade, a young company with the ambitious goal of helping doctors get back in control of healthcare.
Since its launch less than a year ago, Aledade has had a number of significant accomplishments—not the least of which is having two of the physician-led ACOs they partner with be approved for the 2015 Medicare Shared Savings Program (MSSP). One is their Delaware ACO, the other is their Maryland/New York/Arkansas ACO. There are approximately 22,000 attributed lives in those ACOs accounting for about a quarter billion dollars per year of healthcare spending under management.
According to Farzad, the company is growing nicely. They are signing participation agreements with practices in West Virginia, Kansas, Louisiana, and Florida to add to their existing states of Maryland, New York, Delaware, and Arkansas. As Farzad says, the time is right for this type of change:
“The idea of independent primary care practices being able to band together and say we want to be the quarterbacks of care, we want to take accountability for the total cost and quality of care, and we want to be able to capture some of the value that we create is taking off. We are seeing so much interest. It is a good product-market fit. What we are selling, people are interested in and that is huge.”
In addition to helping to create new ACOs, Aledade has also started working with an existing 2014-start ACO comprised of three Community Health Centers in New York. Farzad says that these are fantastic Federally Qualified Community Health Centers. The staff really understands the psychosocial and community aspects of healthcare and population health. But, he cautions, there is a lot to forming an ACO. It is not enough to be great at doing quality improvement. In order to be able to assume the risks of the total costs of care, you don’t have to just be good at what you do, but to also understand what everyone else in the darn system is doing to your patients.
Farzad gives as an example the management of transitions of care, particularly hospital discharges. He says we know that this is a tricky time for patients who may have new medications to take and new recommendations to follow. He also says we know that getting a patient in to see his/her PCP within 7 days of discharge is a key to a successful transition. But all too often doctors not only don’t know their patient has been discharged, they may not have even known they were admitted.
Since statewide Health Information Exchanges, HIEs, such as the ones in Delaware and Maryland are receiving notifications of admissions, discharges, and transfers via an HL7 feed, it is a question of getting that critical information into the hands of those who need to know, such as the patient’s primary care provider. But, he emphasized, just notifying doctors is not enough. The practices also need response protocols so they can effectively manage the outreach to discharged patients in a manner that fits into their workflows. Aledade has developed a simple, cloud-based app, that they call Outreach, that manages this workflow and makes it easy for the doc to communicate office staff to arrange an appropriate and timely follow-up.
Farzad says it is so satisfying to meet with doctors in participating practices and hear them say that this is the type of practice they have always wanted to have. In fact, he told me that just last week, a doctor told him that from now on his practice is having patients who leave the hospital come directly to the office—now that’s a great idea!.
PCPs do a great job managing their individual patient’s health problems, but we need to remember they are not health IT experts, data analysis experts, or regulatory experts, and they don’t have the ability to raise capital easily. That is where the partnership with Aledade comes in. Farzad says,
“We are both going to invest in this thing—the practice is going to invest their time and Aledade is going to invest our capital, our IT, our tools, and our people. In the end, if there are shared savings, we will jointly share in those savings with them. We like to say to the practices ‘we are with you in this.'”
Everything we do is predicated on creating a holistic set of “strategy goes to data goes to insight goes to tools goes to workflow.” It is all part of one change package. And, the focus is on outcomes, for example, did the patient get admitted to the hospital or not.
Aledade and the practices are continually learning and tweaking what they do. When I suggested that perhaps he should turn the book he wrote with Mark McClellan, “Adopting Accountable Care: An Implementation Guide for Physician Practices,” into a continuously updated Wikipedia-style document for ACOs, he laughed and said how impressed he is with how open people in the ACO community are and how willing they are to share what they have learned. They are not the competition, he emphasized,
“The true competition is fee-for-service (FFS) and what we are aiming for is FFS demise.”
To that, I can only say, “Amen!”