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Doubling Up

by Farzad Mostashari

When we founded Aledade in June of 2014, it was with a tangible goal: to help independent primary care physicians succeed in leading the shift to a value-based health care system.

When we marked our first birthday we had stood up two Medicare Shared Savings Program ACOs with about 20,000 lives under management, and we announced a round of funding that would finance the growth of our model. We said that we would expand in geographies, but also in our capabilities, and in the patient populations we serve.

Since then, we celebrated our company’s second birthday, and it’s been a busy, busy time for the Aledade team. I’m proud to say we have surpassed another measurable benchmark in reaching our goal. It’s an incredible feeling to know that we are helping more than 1,100 physicians across 15 states deliver high-quality, coordinated care to their patients. Aledade’s ACOs now include over200 independent, physician-led practices who are accountable for the care of more than 200,000 patients and responsible for nearly$2 billion in health care spending.

But numerical growth is not the only marker of our progress. The past 18 months have seen our company take important steps as a business and as a network, with demonstrable results.

We got our first results.

While we did not realize shared savings in our first year, the two ACOs in our 2015 cohort delivered top-quality care and set us on the path to success. Last year, Aledade Primary Care ACO – with practices in Maryland, New York, and Arkansas – was in the 98th percentile of quality scores across all 327 ACOs that began in 2012 and 2014, and the Aledade Delaware ACO was in the 88th percentile. We cut down on avoidable emergency department visits, readmissions, and prevented hundreds of hospitalizations. Our primary care partners transformed their practices for value-based care and implemented Aledade’s model of primary care – and have seen the success of their efforts.



We are adding to our capabilities.

Our tech-enabled interventions to improve access, quality and care transitions are by now well developed, reproducible and scalable. But we know there is still much work to be done, and much to learn. We are developing additional core capabilities in care management and referral management that were recently highlighted in an excellent two-part series by Marketplace. I believe that our proprietary Aledade Technology Platform, is already the best tool on the market for embedding population health insights into practice workflows, and it continues to evolve and improve. We are closer to the problems than any software vendor could be, and have added over a dozen developers who use the real-world feedback from our partners to update and improve the tools that we and our practices use every day.

We expanded beyond Medicare.

We founded Aledade with an initial focus on the Medicare Shared Savings Program (MSSP), as Medicare led the way in encouraging value-based payment models. But our goal is to provide the best care possible to all of our practice’s patients, not just a portion. As we approached other payers, we have seen clearly that the shift to value over volume is being embraced and expanded across the country . We have already established commercial risk-sharing agreements with Blue Cross Blue Shield of KansasBlue Cross Blue Shield of LouisianaFlorida Blue, and West Virginia Public Employees Insurance Agency; and the pace of our commercial agreements are accelerating, with several important announcements still to come.

We strengthened our company.

Supported by funding from Venrock, ARCH Venture Partners, and Biomatics, Aledade has established our team, technology tools, and expertise across the company. We have added talent like Dr. Mark McClelland to our Board; our first Chief Commercial Officer, long-time tech exec Danny Krifcher, and Vice President of Finance and Operations, Molly Hill Patten. Aledade is now over 100 employees strong, and with amazing partners on the ground in each of our local markets.

We stayed at the forefront.

Aledade’s model of primary care and our network of ACOs rely on some key factors: the strength of the Aledade team, the commitment of our partner practices, and the direction of the health care marketplace. With deep confidence in the first two factors, we must continue to inform and anticipate the third. The past year has seen an unprecedented series of policy supports for our core concept of primary-care centric networks of independent practices taking accountability for the total cost and quality of care for their patients. In June, the MSSP Regional Benchmarking Rule created long-term sustainability for efficient ACOs, and the Comprehensive Primary Care Plus and 2017 Physician Fee Schedule created a path for smaller practices to deliver more intense care management to their patients who need it the most. But the grand-daddy of them all was the Medicare Access and CHIP Reauthorization Act (MACRA) rulemaking. By combining persuasive data and perspectives with practical regulatory solutions we helped ensure that the final MACRA rules included a pathway to advanced alternative payment models that leveled the playing field for smaller practices who are leading the wave of health reform.

Aledade’s growth in such a short amount of time demonstrates the real demand for a new model of primary care, one that empowers physicians to succeed. This appetite extends across the nation from providers, to both public and private payers. As we enter this next phase of Aledade’s growth, we will look for more opportunities for Aledade to enter new markets through public as well as private payers and partnerships that help our doctors deliver better care to patients, better health outcomes, and lower costs.