Recently, Aledade announced a new agreement to expand value-based care in Delaware, West Virginia, and Utah. Aledade has now signed 24 value-based agreements covering commercial fully insured, self insured, Medicare Advantage, and Medicaid lives. Our providers now have over 260,000 attributed patients in these contracts (in addition to over 300,000 lives attributed through the Medicare Shared Savings Program). We are proud to be bringing high-value care to more people across the country.

PUTTING INDEPENDENT PRIMARY CARE PHYSICIANS FIRST

Aledade’s primary goal is to maintain independent practices as the foundation of our health care system. We help independent physicians succeed in value-based care arrangements. We start by enrolling them in the Medicare Shared Savings Program, but our physician partners want to provide high quality care to all of their patients regardless of their insurance. So, simply signing up for a Medicare ACO is not enough. We discuss with our physicians their goals and then find partnerships with other payers that align with those goals.

By taking a practice-centric approach, we ensure that the physicians in our network have a voice at the negotiating table with payers. Historically, primary care providers, particularly those in small and independent practices, have not had the opportunity to voice their opinions to national payers and, therefore, had little control over the design of  through value-based incentive programs. We’re changing that. And our payer partners welcome the opportunity to hear from primary care providers committed to transforming the care of their patients.

THE RIPPLE EFFECT

Part of what makes the Aledade approach to payer partnerships unique is the ripple effect of value-based care throughout the physician’s patient population. Every time we sign a contract, the payer agrees to share claims data with Aledade and our partner physicians; for the first time, our providers can see in the Aledade population health tool, our “App,” the opportunity to improve the health and cost of their patients. That’s important because it allows physicians to practice medicine the way they have always wanted to. When we establish ACO agreements with payers, we enable physicians to apply new workflows to these payer’s members. Providers can then use data-driven insights on more of their patients and be properly rewarded for all the value they are generating. This allows true practice transformation with benefits for payers, providers and patients.  

EVERYONE WINS

Our commercial contracts are good for doctors, good for patients, and good for society, because these contracts may generate revenue when patients get better care at lower cost. Aledade is proud to help align these interests in all of the work we do with practices and health plans.

Payers, physicians, patients, and Aledade all want the same thing—the best possible care at the lowest possible cost. We are excited to partner with Aetna so our providers in Delaware, West Virginia, and Utah are paid for health and cost improvement and not volume. Now begins the fun work of applying our analytics and practice transformation support so the patients who need extra support and care receive it.

For more information about how to join an Aledade ACO, please email us at outreach@aledade.com.

After attending University of Kansas for undergrad and medical school, I knew I wanted to stay in Kansas to practice medicine. Rural Kansas isn’t a resource-rich environment, but the patients here deserve the best care. I began an independent family practice to provide my community with the full-spectrum care so many lacked.

Soon after starting my practice, I knew the transition to value-based care was inevitable. As a new, forward-looking physician, I wanted to lead that movement, but I didn’t know how. Aledade equipped me with invaluable technology, tools, and guidance to navigate the transition.

Aledade’s app prepares me for patient appointments so I can play the offensive in my patients’ care. The app lists preventive services for which my patients are eligible. This allows me to monitor their health before something goes wrong. It also includes critical information to help me coordinate patient care, such as other doctors my patient is visiting, additional medications they’re taking, and new diagnoses they may have received. Most importantly, Aledade recommended my practice hire a Care Manager. Our Care Manager acts as an accessible point of contact who has reduced emergency department utilization, provided additional assistance to patients with chronic diseases, and improved communication with the large number of Spanish-speaking patients at my practice.

Aledade’s support has led to positive outcomes in my practice and throughout the entire Aledade Kansas ACO. Our ACO has been able to participate in a quality program with Blue Cross and Blue Shield of Kansas. We recently received the exciting news that our ACO reduced the total cost of patient care by 5.8 percent. As a result, practices in the Kansas ACO received a shared savings check! We did this all by working to keep our patients healthy. We decreased ED utilization by 8 percent and reduced inpatient admissions from 73.6 to 70.3 inpatient admits per 1,000. We also focused on preventive care services. For example, we increased breast cancer screenings by 17.9 percent and annual well child checkups by 31 percent.

After my staff saw the impact Aledade’s best practices had on our work, they become even more excited to utilize the Aledade app. They check the app every morning and recommend preventive care options at every opportunity!

I know Aledade will be critical to my practice’s future. Demand is the biggest problem we face. Rural Kansas has so few primary care physicians, my practice faces a challenge of more patient requests than we can serve. By offering shared savings, enhanced patient outcomes, and the opportunity to put primary care doctors back in charge of their patients’ care, Aledade incentivizes doctors to practice primary care. Redirecting doctors to primary care will improve the healthcare system and country as a whole. In this way, Aledade not only betters my practice and the care my patients receive, but leads to a brighter future in healthcare in Kansas and beyond!

President Trump’s administration has made it clear that they plan to greatly alter, if not repeal, the Affordable Care Act. To both sides of the political isle it may come as a surprise that altering the Affordable Care Act will likely have little impact on a core outcome of health reform: the fact that private insurance companies increasingly pay primary care providers for improved health outcomes. Since the presidential election, we have met with a dozen payers in both red and blue states: Arkansas, Florida, Louisiana, Mississippi, Missouri, New Jersey, Pennsylvania, Utah, and West Virginia. Not one payer has mentioned that they plan to stop their efforts, or pull back resources dedicated to moving physicians away from the fee-for-service paradigm and towards paying for outcomes. In fact, every payer we meet is intent to continue to innovate by paying providers in a manner that lowers cost and improves health.

A key piece of the Affordable Care Act created the Medicare Shared Savings Program, and private payers quickly followed with their own efforts to move physicians to shared savings contracts. Years later, private payers continue to dedicate significant resources to move providers away from fee for service and towards value payments. And payers have committed to move all of their providers, across all business lines (commercial, Medicare Advantage, and Managed Medicaid), to value. This investment has been significant. For example, Cigna established CareAllies, a service company that works with provider organizations of all types to focus on improved patient outcomes and better health care quality and affordability. Similarly, UnitedHealthcare (via Optum) has gone further and purchased providers in order to create high value networks and their own Accountable Care Organizations. Humana has a well-established value path (the Accountable Care Continuum) that moves its Medicare Advantage providers away from fee for service on a path towards global capitation. Each of these national payers have undertaken vast strategic efforts that require significant resources for staff and infrastructure, and a change in culture.

Commercial payers believe, and have the data to demonstrate, that paying for value lowers their cost and improves the health of their members. For example, UnitedHealthcare has noted up to 6 percent lower medical costs across a range of value-based care programs, and overall, commercial ACOs have lower expenses per Medicare enrollee and slightly higher quality-of-care scores.

Despite the threat of repealing parts or all of the Affordable Care Act, our payer partners continue to move ahead with their payment reform efforts. The political battle over Obamacare has had no impact on payers’ dedication to reform provider payments; the future of primary care provider payment remains value-based. Though there is still much unknown about the potential repeal and replacement of the Affordable Care Act, the future of physician payment reform is clear.