Four years ago, enticed by the vision of a better healthcare system in the hands of empowered and elevated primary care providers, I joined my longtime mentors, Farzad Mostashari, MD and Mat Kendall, on our third collective adventure – Aledade.

Since that fateful day, I’ve served in a handful of roles – teacher, learner, confidante, road warrior, doctor, and mediator. I could write of the way our incredible mission has motivated me, kept me centered and determined, driven me to keep learning. I could explain the feeling I get when one of our Aledade physicians relays to me an a-hah moment, having realized that the Annual Wellness Visit they just conducted just saved a patient’s life, simply by opening up a conversation about the patient’s circumstances and risk factors. I could tell of the pride and exhilaration born of gaining momentum, of extending our reach to new patients across the country.

Instead, I want to share the story of Aledade’s four years through its people.

Year One introduced me to our Chief Technology Officer Edwin Miller, fabled builder of Electronic Health Record systems and incredible humanist, who literally feels the pain of our providers in a way I never thought possible. He shares his passion for working on old cars with his son and has quietly amassed the most incredible t-shirt collection I have ever seen. Edwin taught me what it means to serve our providers, to put their needs first, to dive in and do whatever is necessary to reach our goals.

In that first year, Edwin and I both got to meet Becky Jaffe, one of our original Delaware family physicians, a tireless advocate for the independent primary care provider, and the doctor I would choose for myself or any one of my family members. Becky and our indomitable physician partners in Delaware, Maryland, Arkansas, and Staten Island pushed us to be better and helped us build this incredible rocket ship without an instruction manual (and while flying it). Our first Delaware Practice Transformation Specialist, Robin Senft, taught me that you can accomplish anything with a smile – and a homemade, hand decorated cake pop.

In our second year, we blossomed. I was lucky to get to know so many new members of the Aledade team as our company grew, including Christine Dang-Vu, Golden State Warriors’ number one fan and tenacious, brilliant practice advocate and implementation strategist (and executor). A veritable One-Woman Band, Christine exemplified for me the discipline and work ethic necessary to move the needle in this complex ecosystem.

Our third year introduced me to the miracle of motherhood and the challenges of being a working mom. My daughter Nina became the light of my life on October 21, 2016, and even after an extended maternity leave, I was just not ready to suffer being away from her. My Aledade family rose up around me and held my hand, gracious, gentle and patient. Countless colleagues – friends – counselled and supported me and helped me see that there was a balance and serenity to be gained through persistence, self-love and incremental progress. My eyes were opened to so many awe-inspiring examples of Aledade parents – Candice Cortes, Spring Lane, Joe Neumann, to name a few – who have navigated this complex and often heart-wrenching dance. I can’t imagine going back to a time without Candice’s incredible EHR and practice workflow knowledge, Spring’s enthusiasm, can-do-it attitude and results-orientation, or Joe’s quiet progress behind the scenes to get us the data we need to promote practice change.

In our fourth year, our ranks continued to swell with the most inspiring individuals, personally and professionally. We count among us Peace Corps volunteers, foster parents, mountain climbers, church leaders, yoga instructors, acupuncturists, chefs, world travelers, and rodeo athletes. Every day, my colleagues carry our core values of Grit, Service and Inclusion to their communities. I am so proud and grateful to work alongside this incredible team and I cannot wait to see where, and to whom, Aledade’s fifth year takes us.

Earlier this year, my mom was hospitalized with bilateral multifocal pneumonia and the flu. For most patients her age, these infections would have been unpleasant but ultimately manageable. For my mom, though — a patient with a complicated medical history and multiple chronic conditions — the confluence of these illnesses was devastating. She was having trouble breathing and barely getting enough oxygen into her blood to survive. Doctors and nurses gathered in her room, poking and prodding, dripping and injecting, questioning and documenting. But their interventions failed. She decompensated. As she was rushed to the Intensive Care Unit, I rushed back to Connecticut from Washington, DC to be by her side.

Sitting in her hospital room in the days that followed, I met at least a dozen providers, all of whom introduced themselves to me as “her doctor,” as if saying it aloud would somehow make it true. The reality is that although my mom has been passed among specialists like a prized specimen for years (perhaps ever since her first mitral valve replacement), no physician has been truly “her doctor” for as long as I can remember. She has no primary care champion.

She’s not alone. Nationally, 17 percent of women report having no personal doctor, and among those who share my mom’s Hispanic ethnicity, 32 percent (nearly 1 in 3!) have no health care provider.[1] The statistics are even higher for men. These numbers terrify me: primary care is eroding as independent practice gives way to corporate consolidation. This paradigm shift means that there are millions of patients in the United States who have no healthcare quarterback, whose care is not coordinated, who suffer the acute failures of our fragmented healthcare delivery system alone. Working at Aledade, we are lucky to get to whittle away at those statistics. Aledade partners with independent primary care physicians in 18 states, providing exceptional care and acting as the champion for over 200,000 Medicare patients and more than 100,000 patients with commercial health plans.

I’ve gotten to visit some of these primary care champions as part of my work here over the past year. One of my most salient memories is visiting a practice in Collegeville, PA, and shadowing Dr. Fiorillo, one of Aledade’s partner physicians, as he visited with his patients. I knew from having seen his schedule that his calendar was packed with back-to-back 15-minute visits and no breaks, but the moment he entered a patient room and closed the door it was as if he had all the time in the world. He listened intently as patients described their ailments. He asked about birthday parties and Little League baseball games. He knew them personally, and they trusted him. As a healthcare professional, this was my first experience seeing primary care done the right way.

By the fifth day of my mom’s hospital stay, one of “her doctors” began to start making small talk. We learned his name was Dr. Balboa, and that he was a hospitalist. And though he’d spoken only English on days one through four, on this day he asked her in her native language: “¿De donde eres tú?” Where are you from? “Medellín, Colombia,” she replied proudly. He laughed sheepishly. As it turned out, he was Colombian too. Over the next few days, he got to know her personally and she began to trust him. I was reminded of my visit to Dr. Fiorillo’s office.

As we talked with him, we learned that he used to be in primary care. “But, as a primary care physician, every year you work harder and you make less. And everyone says that primary care matters, but the powers that be have not prioritized primary care. I couldn’t afford it anymore. I had no choice; I left to work for the hospital.” Never had my work or our mission at Aledade felt more personal than that moment. By partnering with independent primary care docs, Aledade helps relieve the pressures of decreasing primary care compensation and increasing regulatory complexity, and in so doing helps keep top-notch primary care physicians like Dr. Balboa independent, allowing them to do what they do best by taking care of patients in their communities.

I am in awe of the work that Aledade’s field staff, my colleagues across the country, do each day, acting variably as advocates, healers, coaches, mentors, counselors, and friends to our providers and to our patients. I am lucky to get to contribute to this work myself as part of our tech team, helping to develop tools and reports that provide insights to our docs and their staff members at the point of care. Together, in partnership across our organization, Aledade delivers insights and knowledge that ensure patients all over the country are getting better care every day.

My mom is out of the hospital now and doing much better, but she still doesn’t have a primary care champion. I worry about her every day. I wonder if her various treatment regimens for multiple chronic conditions are being coordinated, or if there might be an adverse drug-drug interaction hidden within her cocktail of more than a dozen medications. As her son I try to help, but I’m no substitute for a primary care provider. If Dr. Fiorillo were her doctor, I would have nothing to worry about; surely he’d be able to keep track of it all. But alas, for now she’s navigating her healthcare journey alone, as she travels from neurologist to cardiologist and many -ologists in between. I can only hope that one day Aledade might expand into Connecticut — the moment we do, I’ll be sure to take her to visit an Aledade partner physician.

Happy Birthday Aledade. Here’s to many more years of health — for Aledade, and for its patients.

[1] https://www.kff.org/disparities-policy/state-indicator/no-personal-doctor/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Growing up in the Appalachian Culture of rural southwest Virginia was challenging, but until I began working with Aledade, I did not realize that my community and circumstances were unique. As a child, I did not aspire to be a nurse. I presumed I would follow the same path as my mom. She worked as a seamstress in our local sewing factories, which were essentially sweatshops. She did not graduate from high school, she was widowed at an early age and she had two children to raise. We knew we were poor but we couldn’t escape the circumstances because it was all we knew.

Survival was hard work, ingenuity, and poverty “smarts”. We knew how to stretch a meager income, grow our own food, and treat ailments, injuries, and illness naturally. Our house was always in need of repairs. A leaky roof with buckets and pots strategically stationed to catch the water, no air conditioning and only a wood stove for heat. Our clothes were hand me downs therefore I never was stylish in the 70s and 80s designs. We didn’t have an indoor bathroom until I was 16, I never had my hair cut in a salon, rarely did I even get to go inside a grocery store, and the nearest mall or shopping centers were, in my mind, lightyears away, although it was a mere 35 miles. Our car was lucky to make it 5 miles before it puttered out or we didn’t have money for gas. This is what I knew, who I was and, to me, everything was normal in this environment.

The Appalachian Culture is difficult to leave because of the deep sense of place and pride. I was fortunate to have a mother who emphasized education. Without my education, I may have remained poverty stricken. Thankfully, I was led to a career in nursing through a choice I made to attend the high school vocational-technical school. Once I started nursing, I couldn’t stop. I started as a licensed practical nurse and eventually became a master’s prepared registered nurse.

I began my nursing career in 1988. Since then, I have seen incredible changes in health care. In those 30 years, I have worked in hospitals, home health, school nursing, community health, management and quality/patient safety. In November 2015, I stepped out of my box and accepted a Practice Transformation Specialist position with Aledade. Initially after joining the Aledade team, I felt intimidated by the “city folk”, the city, and the impressive educational and career backgrounds of our team. I thought, what does this country girl from southwest Virginia have to offer? As I soon found out, Aledade impacts the health care of my community and I play an integral role.

I always remember my mom telling me “you don’t go to the doctor unless it’s broke or you’re dying”. This mindset was driven by the lack of health insurance with the lack of adequate finances, poor health literacy, and a health care system built on the premise of reactive instead of proactive care. The history of medical care was based on treating illness and injury and lacked public health maintenance. It wasn’t until 2002 that the Institute of Medicine issued a report entitled “Who Will Keep the Public Healthy?” which concluded that public health professionals must develop a plan that identifies the impact of multiple determinates affecting health and address health for the 21st century.

Amazingly, it was just a few short years ago that we realized the need to change health care to improve the health of our people through prevention. Aledade wants to change health care across the nation and we are making a huge impact by working with our primary care providers to help them gain control of the health of their patients. Our team at Aledade HQ provides me data to help the providers in my community identify patients who have health risks and proactively address ways to prevent disease or injury. Aledade’s cutting edge technology gives providers insight to the patient’s medical care from all care transitions and sources including specialists, pharmacies, and hospitals. We also help them navigate end of life for patients who need quality instead of quantity of life planning.

I lost my mom suddenly 4 years ago. She was a smoker and had uncontrolled hypertension. She died unexpectedly of a massive heart attack at the age of 63. As I look back on her medical care now, I think about what I would have given for her provider to have been working with Aledade. Aledade would have worked with her doctor’s practice to implement Annual Wellness Visits to determine her risk factors and addressed smoking cessation, exercise, EKGs, diet and cholesterol control. Her provider would have been able to see, in the pharmacy data that Aledade provides, that she was not getting her blood pressure medicine filled consistently. Her hospitalizations for accelerated hypertension would have been evaluated through transitional care visits and a chronic care manager would have helped her if she couldn’t afford her medication but didn’t want to tell people because of her pride. This provider would have been equipped to proactively address her impending heart attack by educating her on the symptoms of a myocardial infarction. She would have known that the left arm pain she was having was not from overuse of carrying in wood to keep her fire going. If Aledade could have been there sooner, my mom could potentially still be here enjoying her grandson’s ballgames and watching him grow.

This is why I work for Aledade. I am part of a shift in health care delivery in our nation but most importantly, I can personally impact my community and my family. My mom always gave me this advice….”an ounce of prevention is worth a pound of cure.” She was so right.

Tucker

Two weeks ago, The New York Times showcased two Aledade partner practices in Kansas. I, like many of my colleagues, excitedly shared this piece with friends and family to explain what we do at Aledade, and how we have the power to impact health care. Are you curious about the people taking on this innovative problem solving?

Last month, the Aledade Fellows had a Friday afternoon happy hour, with Farzad, our CEO. He kicked off the summer celebration by asking, “What does it mean to be Aledadey?” Each fellow gave an answer, often supplying an anecdote with the value. After every answer, Farzad would dig deeper, “Why?” he would ask. “What it is it about this trait is Aledadey?”

Read what some other Aledade Fellows took away from this conversation on values:

Nicholas

As I looked around the room at my impassioned coworkers, I couldn’t help but think that this moment was really what Aledade was all about. The fact that the CEO cared enough to take the time out of his Friday evening to hear what group of recent college grads thought about company values is very unique to Aledade. It doesn’t matter what your role is, whether you’re a fellow or the CFO, if you have a well developed opinion or idea and articulate it, people are going to listen to you. Aledade is a place where you are judged on the quality of your ideas and the work that you do rather than on your title. This distinct culture inspires the kind of collaboration that has been instrumental to Aledade’s success.

One of the interesting points that Farzad made during this kitchen hangout happy hour was that each person at Aledade has a deck of playing cards – we each have a unique skillset to contribute. No one is an expert at everything. But as we get involved in new projects, we acquire new skills and expand our decks. A culture of continuous self-improvement is central to Aledade’s mission to improve primary care. In the short time I have been here, I have become better at data analysis, learned a new programming language, and participated in various projects both within and outside of my team. When I complete my fellowship and move on to pursue a medical education, I hope to bring my “Aledadiness” with me – that never ending desire to own what I do, share my passions with others, and find “scrappy” ways of continuously improving the world around me.

Selam

As we went around the room, we heard words like “scrappy”, “flexible”, and “collaborative” to describe our Aledade work culture. The Aledadey qualities list can go on and on but, simply put, it’s the supportive culture that encourages us to be innovative and always thinking outside of the box. At the core, Aledade gets it – invest and build something great, hire a talented, fun, and personable team that believe in the Aledade core values and success falls right into place.

Whether it’s through hangouts or staff retreats, the Aledadey culture constantly creates opportunities for togetherness that help close the gap between remote employees and HQ staff. Those relationships are key and contribute to the great work we do as a company. In my experience, the focus is more on doing something than being someone here at Aledade. Each day we are presented with new challenges and situations, which help us to stay focused and interested. Whether it’s being scrappy in Excel sheets or bringing Primary Care Providers and specialists together for meetings on referral processes, I know when I go home that I truly did something meaningful and important.

This happy hour itself contributes to being Aledadey. One example of Farzad’s that stuck with me was his advice on finding that one thing you’re good at, becoming an expert on that subject matter and using that as a growing point to learn around. I have never before felt that our leaders cared about our development, life outside of work, and general happiness with our roles more than the Aledade team. Individual success is celebrated as a team as much as team successes. The “work hard – play hard” attitude is very much alive in the Aledade world. While sticking to its core values, the empowering, Aledadey culture strives to deliver affordable, high-quality care across the country.

Molly

What are the things we do that make us Aledade?

As a recent graduate, it’s easy to answer this question with a litany of business clichés from the textbooks I read not so long ago. At Aledade we break down the silos, peel back the layers of the onion, think outside the box, move the needle, roll up our sleeves, get deep in the weeds and when that’s all said and done we stand back and look at the 30,000-foot view. Although there is some truth to the sentiments of many of these platitudes, they’re not what make us Aledade.

Google Hangout video calls allows our company culture to thrive across the country. Although this might sound like an exaggeration, these virtual interactions play a critical role in our daily operations. These calls provide more than just a channel for individuals across the country to speak to one another. They also allow us to understand the subtle nonverbal cues and facial expressions that often convey more than words, like seeing someone crack a smile when you slip a joke a presentation or noticing your coworker fail to hold back a yawn at 3pm and giving them knowing look. It’s these elements of human interaction that foster a sense of comradery and better enable us to openly discuss concerns, share ideas, and delve into the issues we face.

Another aspect of our culture is our shared understanding that working together is critical to our success. We believe in the importance of collaboration, respect and face to face conversations in relationship building so much, that each of our partner practices receives weekly in person practice transformation support.

Simply put, at Aledade, we still do business face to face.

Josh

Farzad posed a question to the gathering of Aledade fellows and summer interns: “What does it mean to be Aledadey?” We glanced at each other, uncertain of an answer, but sure that this adjective was not in any dictionary. As we reflected on our brief experiences at Aledade with its co-founder and CEO, it became evident that this short question did not have one finite answer.

I was anxious when I joined the team at Aledade as a summer intern. While I had developed an interest in working to improve health care from the perspective of government and policy, I did not know where to begin from the perspective of a start-up. Health care in America is complex, yet my team was undaunted. Quickly, I learned how Aledade is in the business of tackling systemic problems in health care, creating value for patient and provider alike.

In my first week, I confronted one of many challenges in Aledade’s mission to drive value in health care: I began working on a new initiative that focuses on improving the quality of care in the end of a patient’s life. With up to 25 percent of Medicare costs occurring in the last year of living and high levels of patient and family dissatisfaction – often due to excessive hospitalization – the motivation for making a change was clear and compelling. I was excited by the potential impact, but overwhelmed by the complexity of what seems to be some uncharted territory in value-based care: How do you realize gains for quality and value, and achieve these consistently at scale? Noticing my unease, Dr. Joshua Israel, the project lead, ended our first meeting with a smile: “I do not know, we will just have to figure all of that out together.”

This “can-do” approach in the face of complexity, uncertainty and high stakes serves as just one clue to respond to Farzad’s question. Being Aledadey is asking difficult questions and digging into the data and evidence to discover a solution. It is tackling complex problems and creating solutions that improve the lives of patients. Aledadey is the pathway to the brighter future of American health care.

Tucker

For me Aledadeiness is comprised of the people and their humility, integrity, and impatience for improvement. Humility is knowing we may try something and have unexpected results. A push here may not lead to a pull there. We are okay with re-charting a course, knowing we’ve learned something from it. This humility also promotes asking, asking for help from teammates or asking why. Data is important in everything we do, but isn’t always visible to an end user or to the patient who will end up coming in to see their doctor because of it. It’s knowing we would never use data that could shortchange a partner practice or put a patient at risk.

Finally, it’s a continuous improvement. Last summer, I worked on a relaunch of our website. This redesign was months in the making and included incredibly talented designers with feedback from every team. Before the new version was rolled out there was already a list of improvements for the next day and the next version.

For us, being Aledadey is being scrappy, and focusing on continuous improvement, collaboration, supporting your teammates, building relationships on face to face conversations, jumping into an unknown problem to discover an actionable solution, and people who demonstrate humility, integrity, and impatience for improvement.