Shaping value-based care transformation

A record of wins for primary care

• 2024: Shaping the Primary Care Flex Model

  Our advocacy played a crucial role in shaping CMMI’s new Primary Care Flex Model in MSSP. Major elements of this model were significantly influenced by Aledade. We initiated the conversation around “MSSP as chassis for innovation,” and CMS adopted this language to describe the new model, which incorporates prospective primary care payment and enhanced payments for primary care.

• 2023: Introducing the Primary Care Flex Model

  Our state legislative achievements included creating primary care administrative burden reduction legislation in Arkansas and incorporating exceptions for value-based care in prior authorization legislation within the state.

• 2022: Making the case for continued growth in ACOS - MSSP as a chassis for innovation

  At Aledade, we believe there is opportunity for significant growth in ACOs. In the fall of 2021, we outlined the case for using the MSSP as a “chassis” for innovation. In 2022, we followed up with a series of policy briefs to engage policymakers to continue to build on the success in four ways: incorporating desired elements from the Next Generation ACO model, primary care capitation, value-based insurance design and addressing inequity in health care.

• 2021: Demonstrated through data how ACOs can lead to better health outcomes and reduced health care spending

  Aledade's retrospective case study, published in the American Journal of Accountable Care, shows that over four years, five Aledade MSSP ACOs prevented 10,917 hospitalizations, 19,338 emergency department visits and 8,859 skilled nursing facility visits compared to regional competitors. This was largely due to improved care transitions and preventive care, such as annual wellness visits, which were performed at 265% above the regional average in 2019. The study highlights that value-based care can reduce costs and improve care quality by increasing preventive care and reducing acute service utilization.

  Solidifying a state policy presence: Our state legislative efforts took shape this year by creating cohorts of engaged physicians and clinical staff across several states, all aiming to solidify the sustainability of primary care at the local level.

• 2020: Adjusting COVID-19 benchmarks

  Aledade played a crucial role in advocating for changes to the benchmarking methodology, which transformed a potential benchmarking disaster into the financial alignment we aim to achieve. By pushing for adjustments to trend benchmarks, Aledade ensured that the high level of response to COVID-19 by its partner practices was reflected in the savings. As a result, 2020 became a standout performance year for the ACO, showcasing the effectiveness of these adjustments.

  Protected independent practices during the pandemic: The pandemic created unprecedented financial challenges for the health care system and was especially difficult for primary care organizations, who generally operate on slim margins under normal circumstances. Aledade advocated for independent primary care practices to be able to take advantage of the financial support from federal relief program rulings.

• 2019: Demonstrated the value of ADT notices to CMS, leading to mandatory reporting:

  Showed CMS that Admission, Discharge, and Transfer (ADT) notices improve health and save money through compiling data and research, and broad advocacy. The next year, CMS included ADT notices as a condition of participation with Medicare under Medical Record services.

• 2018: Changing the definition of risk

  Previously, multi-billion dollar health systems and small primary care practices were required to take on the same dollar amount of risk. Aledade proposed linking risk to revenue, ensuring that primary care organizations would take on the same percentage amount of risk relative to their revenue. This proposal was successful and became part of the CMMI model (Track 1+), and it is now integrated into the permanent Medicare Shared Savings Program (MSSP).

• 2017: Helped bring about regional benchmarking for ACOS

  Regional benchmarking gives a more accurate picture of the savings ACOs provide to Medicare, and rewards ACOs that do a better job of controlling costs than their neighbors.