As a primary care physician in a small, independent practice, my focus has always been on doing what is best for my patients and community. Over the past twenty years, I’ve continued to come back to this idea. My practice, Scott Family Physicians, has become a trusted, connected part of the community. Being an independent physician offers many benefits to my patients.  One example is the freedom to have open scheduling in my practice, allowing patients to set same day appointments, instead of an expensive, unnecessary visit to the ER. It also allows me to serve my community as the high school football team’s doctor every Friday in the fall.

But, running an independent primary care practice also comes with challenges and tough decisions. As the shift to value-based care gained traction, it became clear that this new model was a great way for primary care practices to be rewarded for the attentive, personal care we provide our patients.

That’s why, two years ago, I decided to join the Aledade Accountable Care Organization (ACO) with other local Acadiana primary care physicians. I knew what this meant for my practice, as the transformation to value-based care is an investment of time, staff, and finances, but was confident that we could succeed with our partner independent physicians in the ACO and with Aledade.

And, I am proud to say, now as the Medical Director of the Aledade Louisiana ACOs with over 30 of the highest quality primary care practices in Louisiana, my practice’s decision to embrace value-based care is showing returns in a big way.

Through the Aledade ACO, our group of local, independent primary care practices partnered with one of the largest payers in Louisiana, Blue Cross and Blue Shield of Louisiana. In our first year providing value-based care to our patients covered by Blue Cross in its value program, Quality Blue, we saw great results. Not only did our patients receive better quality care, our ACO achieved significant savings.

Through our clinical initiatives, population health management, and increased ability to access and share data, we reduced our patients’ total cost of care by 8 percent. But, more importantly, we kept them healthier. Our ACO kept patients out of the hospital and ER, reducing admittances from 65 to 57 per 1,000 patients. By focusing on chronic disease management, we helped increase our patients’ rate of control of diabetes (up 13 percent) and hypertension (up 20 percent) significantly. Through improved visibility into our patient population, we could proactively reach out to high-risk patients, identify patients in need of a PCP visit, and conduct more preventive care – such as mammograms, which we saw rise 5 percent across the ACO.

For my fellow physicians and I in the ACO, this is a sign of our hard work paying off. Many of our practices had been delivering this kind of care for years, but in Aledade’s ACO model we now have the technology, access to data, and ability to participate in value programs, like Blue Cross’ Quality Blue program, to see the benefits and results for our patients and practice. For my practice this means we kept our patients healthier and the savings we achieved let me breathe easier as a small business owner. The savings we shared in, can be the difference between keeping clinic doors open and remaining independent or having to close a practice.

If you drive by West Calcasieu Cameron Hospital (WCCH) in Sulphur, Louisiana, you’ll see eight healthcare offices. Inside are 13 physicians and their care teams, providing primary care, obstetrics, gynecology, and pediatric care to the families in Calcasieu and Cameron parishes, the hospital’s service area.
Some of the doctors have been in this community for over 60 years, establishing relationships as they care for generations of families. Throughout the decades, teamwork between the hospital, the primary care physicians (PCPs) who work for the hospital, and the surrounding independent primary care practices has been a constant. As Anne Billeaudeaux, WCCH’s Director of Business Relations and Physician Development, said, “the independence of the practices is just as important as our collaboration.”

At Aledade, our vision is a health care system based on value with independent, primary care practices at the center. WCCH proves that we’re not the only ones who share this guiding principle.

WCCH is working with the Aledade Louisiana ACO to improve the continuity of care, resulting in patients receiving a timelier follow-up and supporting care across the community. This effort started in March of last year, when WCCH’s IT department helped the hospital join an Admission Discharge Transfer (ADT) network. The ADT connects with the Aledade App, practices can find out in a timely way when their patients are in the ED and hospital. When patients are discharged, a case manager faxes practices if a patient isn’t discharged to their home.

Before, practices struggled to follow up if patients had been to the ED or hospital because notification was cumbersome and completely manual. When providers know about a hospitalization they are able to follow up in a timely way. A patient being discharged from the hospital with several new medications and changes in their daily care, can become overwhelmed navigating those changes alone. With the improved communication from the work between WCCH and Aledade PCPs can support their patients and help them better manage recovery.

WCCH wants to help prevent avoidable readmissions and keep patients healthier with the appropriate level of care. Because WCCH joined the ADT, many patients in Sulphur have visited their PCP after discharge and have been able to get the follow up care or education they need to stay healthy and out of the hospital.

Collaboration with the Aledade Louisiana ACO has been good for the hospital, the independent physicians, and most importantly, the patients. I asked a few of the key leaders from the hospital, as well as the independent primary care doctors, to talk about successes to date:

Kathy Doty, Director of Quality Assurance at WCCH

Our outcome-driven journey into quality started more than 10 years ago, with a CMS/JC project. We discussed sharing data with our partner physicians in a meaningful way on a regular basis. We learned how to use and apply this data, alongside our physicians. It led to a few uncomfortable talks, but we all knew this data could help drive improvements in care for our patients.
As care managers, we’re trained to avoid the rain clouds, which motivated us to embrace the shift to value-based care. We warned folks that if we missed the boat on value-based care not only would there be future financial penalties, we’d be left behind. We discussed both sides with our clinical team and chose to embrace the new system and implement at our own pace.

Janie Fruge, Chief Executive Officer at WCCH

We always focused on meaningful ways to share our data and be confident in the data we receive. Through effective communication and actionable plans, we’ve improved care in our surgical initiatives, reduced central line infections, and decreased pneumonia diagnoses.
Our physicians and clinicians formed a virtual medical community home; the experience was mixed. Some primary care providers joined in, some didn’t commit right away. For the doctors who did participate, they found success and started speaking in favor of it. They encouraged the others to join, then Aledade helped everyone get on the same page. Now, the people who were the most skeptical are the biggest fans.
For us, and the physicians around WCCH, joining Aledade was a natural extension of our quality work. Our early efforts showed us how data could promote quality care. Aledade brought the tools, and helped us share ideas in a complete plan that we can all execute, together.

Dr. Maureen Lannan, Cypress Clinic

As we enter agreements aimed at lowering costs and improving care for a defined group of patients, the hospital/PCP relationship is critical, especially when it comes to the discharge process of patients.  Better communication between the hospital medical team, patients, caregivers, and the outpatient medical team is vital, so that patients do as well as possible after they return home.

In conclusion, value-based care is good for our patients, and Aledade has helped improve our systems. At the center is a durable partnership between the hospital and the independent primary care practices in the community. We look forward to seeing what the coming years bring, and continuing to turn our data insights into quality initiatives to better serve the community we’ve served together for over half a century.

There aren’t too many opportunities when you can get the present and the future of primary care in the same room. But that’s exactly what we found at the Louisiana Academy of Family Physicians’ Annual Conference.

Emma Lisec and Nadine Robin at the Aledade booth

On Wednesday afternoon, we arrived at the historic Roosevelt Hotel in downtown New Orleans – Nadine Robin, Aledade’s Southeast Executive Director, and me, Aledade’s Fellow for the Southeast. We were caffeinated, excited and ready to join a massive room full of displays from local hospitals, pharmaceutical companies, and specialty groups. We set up our booth, with Aledade’s slogan: “A New Model of Primary Care”, and we waited to see who would come through the doors.

Right on cue, as the conference’s main sessions took a break, the showcase room flooded with health care professionals from across Louisiana – independent doctors, curious hospital employees, even medical students from Louisiana State University. (Geaux Tigers!)

They dropped by a number of different booths, but kept lingering by ours, wondering what that “new model of primary care” actually meant. So Nadine explained: with MIPS, the new payment program created by the 2015 Medicare Access and CHIP Reauthorization Act (or “MACRA”), quality reporting was taking center stage.

Small, independent practices are the key to that focus on quality. As our CEO Farzad Mostashari has pointed out, small, physician-owned practices offer more personalization for patients. They have lower average costs per patient, fewer preventable hospital admissions, and lower readmission rates than larger, independent- and hospital-owned practices. In other words, they’re in the best position to succeed.

Nadine explained how Aledade helps their independent partner practices report these quality measures all while maintaining their independence. I noticed that a few physicians’ ears perked up at this – the prospect of having a helpful guide through MACRA and MIPS seemed to be integral to their practices staying independent.

I remember one doctor in particular who pulled us aside. He felt like his clinic was short-staffed, and the pressure to sell his practice was only growing. Nadine and I listened to him, and explained that the whole purpose of Aledade is to help small, independent physicians like his stay independent – and thrive. But to do that, we have to start with an honest relationship. We weren’t going to pressure him into joining Aledade if it wasn’t going to be in the best interest of his practice and his patients. We agreed to pull his QRUR report and follow up to see if a partnership with Aledade would be his best step.

We also spoke with some of the physicians of tomorrow. A few medical students from LSU dropped by our booth, wondering what an ACO was. To many of them, the idea of opening their own independent practice seemed out of reach. The concept of a comprehensive approach to primary care, one where the independent practice is in the center of a high value network, sounded promising. They asked us if they could reach out to us later to get a better understanding of an ACO and value-based care.

Nadine and Matt Wheeler presenting at LAFP

That Friday morning, Nadine and Matt Wheeler, one of our inspiring Office Administrators from Bossier Family Medicine in Bossier City, gave a presentation about the new world of alternative payment models. They laid out the idea of value-based care – that physicians should be empowered to provide quality care, and rewarded for helping their patients stay healthy.

They explained what an ACO is – basically a group of health care professionals committed to the health and well-being of a specific group of patients. And they explained why this future – better health care at lower cost – was inevitable. It’s good for doctors, good for patients and good for society.

Nadine with Dr. Jose Mata, a family medicine doctor in New Iberia, LA

Nadine and Matt weren’t the only ones making the case for value-based care. A number of Aledade’s partner physicians in Louisiana were there too – each of them explaining to other doctors why value-based care works.

This whole move to a better health care system isn’t being led by any single practice or any single company, like Aledade. It’s a partnership – a network of practices who want to keep their patients healthy, and organizations working to help those practices succeed. Value-based care is the best model for today’s primary care physicians here in Louisiana, and tomorrow’s too.

Drew Brees, the quarterback of the NFL’s New Orleans Saints, the first quarterback to bring home a Super Bowl trophy to the Pelican State, has a pretty simple formula for success: “When you wake up,” he says, “think about winning the day. Don’t worry about a week or a month from now – just think about one day at a time. If you are worried about the mountain in the distance, you might trip over the molehill right in front of you.”

Every morning, not far from New Orleans, there are a few more Louisianans who wake up thinking about how to win the day. They’re the team at the practice run by Dr. Bryan LeBean – a primary care physician who’s been serving in the community of Lafayette for 23 years. And they have a name an NFL quarterback would appreciate – “Team LeBean.”

Just recently, Dr. LeBean’s practice joined the Aledade Louisiana Accountable Care Organization – to find new ways to provide better care to the families in Lafayette, while keeping the practice’s independence. Working closely with other practices in the area, Team LeBean shared some of the tactics and strategies that worked for them – how to properly conduct an Annual Wellness Visit, some ideas for good care management.

They also borrowed a few good ideas, one of which has paid off every morning. Before starting each day, Team LeBean sits down for a Daily Huddle. The entire care management team runs through a few standard questions, and then covers any other topics that came up.

They start by looking at how many AWVs have been scheduled for the day, and how many patients are in the hospital or recently visited the Emergency Department – information that they can find right on the Aledade app.

They then take a look at a few patients with chronic conditions – like diabetic patients, especially those in need of an eye exam, and patients enrolled in tobacco cessation. After running through a few other items, they wrap up by focusing on any particular patient complaints or concerns – always keeping an eye on how today can run even better than the day before.

That’s how you win the day. By working closely together – practices like Team LeBean, their patients, and Aledade are winning the day. And they’re well on their way to a better health care system with strong, independent primary care practices suiting up in the quarterback role they were always meant to play.

Aledade’s growth is about more than adding new practices or forming new ACOs. To us, true growth represents strengthening our network of primary care practices by giving physicians new insight into their patient populations.

This is made possible by creating access to one of the most vital resources primary care practices need – data. Access to timely, relevant data is empowering to practices and impacts everything from workflow to quality of care.

Since our founding, Aledade has emphasized the importance of getting data flowing to – and from – our ACO partner practices. And Aledade’s model is designed to focus on equipping primary care doctors with everything they need to utilize this data and deliver high-quality, coordinated care.

As we grow, Aledade continues to develop relationships with stakeholders throughout the national and local health care markets to equip our ACOs with the data they need. A big part of this is working with Health Information Exchange networks (HIEs) in the communities our ACOs serve.

That’s why Aledade is excited about connecting our ACOs with four new HIEs: Clinisync of Ohio Health Information Partnership, Healthix New York, Louisiana Health Information Exchange (LaHIE), and Mississippi Health Information Network (MS-HIN). Together, these HIEs will connect our partner practices in Louisiana, Mississippi, New York, and West Virginia with more than 130 hospitals.

Across all of Aledade’s ACOs, practices are connected to more than 500 hospitals through our HIE partnerships. The data that physicians access through these connections allows them to see a more holistic view of the care their patients receive, extending well beyond the four walls of their practice.

For instance, Admission Discharge Transfer (ADT) data from local hospitals lets primary care doctors know when their patients have been hospitalized. This allows them to coordinate with hospital providers and support patients with Transitional Care Management (TCM), proven to reduce hospital readmissions.

Connecting our ACOs to HIEs is only the first step in strengthening primary care through data. In addition to HIE data, Aledade ACOs pull together data from a number of sources such as Medicare claims and private payer data – all integrated in the Aledade app. The integration of data from multiple sources allows doctors to effectively manage population health by identifying and prioritizing patients for TCM, Chronic Care Management (CCM), and wellness visits – listing patients by their risk level or time since last appointment.

Aledade knows the value data offers to primary care practices. But, we also know that it is a three step process to use data to improve care. First, practices need to get the data. That’s why we focus on connecting to HIEs to deliver data to practices. Next, practices need to derive insights from the data. The Aledade app integrates all of practices’ clinical and claims data, giving doctors a full picture of patients’ health and care. Finally, practices need to act on the data, as it guides them to deliver high-quality, coordinated care.

The Affordable Care Act (ACA) has created a movement to change the way doctors can be paid; now physicians get paid if they can put in place processes to improve the health of their patients and proactively reach out to their sickest patients. Gain share contracts allow physicians to share in the “gains” of keeping their patients healthy and their cost down. Physicians’ salaries increase now when their care improves the health of their patients. And this payment reform has happened both for Medicare and private insurance payers.

One of the first tenets of our work at Aledade is that all patients benefit from the combination of a strong primary care relationship and population health. Delivering higher quality of care at a lower cost is beneficial for everyone and the quicker payers recognize primary care physicians as partners in that value equation the better for patients, the better for physicians, and the better for society.

Aledade helps independent providers navigate the complexity of commercial contracts, obtain gain share contracts for all their patients, and allows providers to improve their workflows so they can drive down the cost of commercial patients while improving overall health.

This week, we are pleased to announce that Aledade and our partner physicians now have nearly 50,000 commercially insured patients in value based contracts. We are announcing the completion of four gain share contracts with payers in states across the country: West Virginia, Florida, Louisiana, and Kansas. These contracts include Blue Cross and Blue Shield organizations, as well as a state employee self-insured group. Understanding how we got to this point and accelerating accountable care adoption is key to increasing the value of health care for everyone in the country.

Accountable care is at the heart of the transformation of health care promoted by the ACA. The ACA created the Medicare Shared Savings Program and turned Medicare into an accountable care leader. The impact of Medicare embracing accountable care has been profound. In January 2015, the federal government established a 50/90 initiative: a set goal to have 50 percent of Medicare patients in alternative payment models and 90 percent of Medicare fee-for-service payments in value-based purchasing by 2018.

Many commercial payers quickly followed with their own announcements: In March 2015, Cigna committed to the value-based payment goals set forth by HHS, and UnitedHealthcare currently delivers $49 billion in care annually through value-based contracts, or one-third of its total payments, with a goal to raise this amount to $65 billion by 2018. Today, every major national payer has established corporate goals to move their fee-for-services payer contracts to value-based contracts.

In the effort to translate the high-level goals into detailed gain share contracts, payers have developed gain share contracts that bear little resemblance to each other. Our providers are driven by the singular desire to improve their patients’ health, but most of the commercial gain share contracts we review typically have disparate quality measures. It is near impossible for small, independent providers to monitor their performance across quality measures that differ for each patient in their busy schedule. For example, one contract we reviewed included nearly 30 quality measures, yet another contained only nine measures. In addition, most payers use validated HEDIS quality measures, but many payers use “home-grown” measures that are not validated.

There is also significant variation among the key financial terms of each commercial payer contract. This lack of alignment of contract terms presents a barrier to providers negotiating gain share agreements with commercials payers. Add to that the complexity of gain share contracts – and it makes it difficult for an independent primary care provider to negotiate directly.

Yet, when we meet with commercial payers we are almost always met with a willing partner; private payers also want to empower primary care providers to drive down the cost of improving the health of their patients. Aledade offers a unique partnership opportunity, working with independent primary care physicians on workflow, population health and whatever they need to succeed in creating value. Research shows that independent physicians are the provider type most likely to keep costs down (as compared to providers aligned with health systems). At the same time, we are committed to working with the broader payer community to optimize and standardize accountable care design in the commercial space.

Our independent providers are hungry to move all of their patients, not just their Medicare patients, into gain share contracts that can account for patients’ total cost because at the end of the day they are all their patients. Nearly every week we connect with a new payer partner who shares the same goals for better value for the nation’s health care dollar. We look forward to continuing to work across the country with physicians, payers and patients to improve health and health care value.

The first year of our Aledade Louisiana ACO has been marked by excitement, growth, cooperation, and a deep commitment to population health. But, even as our network of providers and partners strives daily to improve quality of care through better coordination, we face a new challenge. This week, Louisiana experienced a 500-year flood in the areas surrounding our ACO. The Aledade family sends its heart out to our Louisiana ACO providers and patients affected by the flooding.

While no one can be fully prepared for the impact of a natural disaster, we are confident the primary care physicians in our Louisiana ACO are ready for the challenge ahead. The 2016 Aledade Louisiana ACO is made up of five leading practices in Acadiana committed to delivering the best possible care to the communities they have long served. In conjunction with our seven (and growing) new practices in our 2017 class, these providers will now serve as the first point of contact for thousands of patients who have been without medications, home monitoring, and even cell phone contact with their health care providers for the better part of a week.

One recent Aledade initiative has been particularly vital in helping the ACO respond to this disaster. This spring, Dr. Joshua Israel joined Aledade as the Mental Health Director. In this role, Dr. Israel leads Aledade’s efforts to integrate mental health into primary care practices. One in five American adults suffers from a mental health condition, and mental health treatment costs are $100 billion annually. Given this, ACO physicians who are responsible for their patients’ total health and cost of care must be prepared to manage their patients’ mental health issues. As the front line in a patient’s health care, primary care physicians are well positioned to identity, manage, and coordinate their patients’ mental health needs given their unique knowledge of and relationship with patients. In his first days at Aledade, Dr. Israel helped connect practices with behavioral health resources in a similar tragic flood in West Virginia, and he has helped us in Louisiana quickly provide our employees with tools to help our practices on the ground.

In addition to strengthening care capabilities through Aledade initiatives, the Louisiana ACO practices have benefited from local organizations committed to advancing value-based care. In particular, one local partner, iMedCORE, has become a great asset for their expertise in value-based care and the tools providers need to deliver it. In Louisiana, iMedCORE has led education efforts to support the shift to value-based care among Aledade providers and throughout the greater provider community. When expanding our network locally, we look for partners committed to helping our providers better serve their patients through care coordination, and iMedCORE has been working hard for our members to do just that.

That said, perhaps the biggest development for our Louisiana ACO this year is our partnership with Blue Cross and Blue Shield of Louisiana. As the first organization to bring a progressive group of independent physician practices to the Blue Cross of Louisiana Value Program/shared savings contract, Aledade has helped to align the payers and the practices as never before – setting the stage for future independent practice partners. We have also created a model for other Aledade ACOs to reach out to and better negotiate deals with the largest payers in their states.

The most effective piece of the partnership is Aledade practices’ access to Blue Cross patient data all integrated into the Aledade app. What this means is that rather than using two separate patient registry and care management platforms, the ACO primary care doctors can use the same technology for across their patient population – whether public or private payer. Not only does this reduce practices’ administrative and technology cost burdens, but increases practices’ ability to conduct population health management that leads to better health outcomes and lower costs.

At Aledade, our goal is to partner with primary care doctors to help empower them to deliver the highest quality care in a value-based health care system. While no community should have to deal with the terrible effects of a natural disaster, we are proud of our ACO providers in Louisiana who we know will fight through this challenge to support the communities and patients they care for so dearly.

When Aledade launched in June of 2014, we were a small, passionate staff fundamentally committed to a big idea: that independent primary care providers were uniquely positioned to help lead the biggest shift in the American health care system in more than a generation. We believed that if these doctors received practice support, technology, analytics, and regulatory expertise from a true partner, they could reassume their role at the center of their patients’ care – delivering the highest-quality care while bringing down costs across the health care system.

By the beginning of this year, we had partnered with 80 primary care doctors across four states, taking accountability for the care of more than 20,000 Medicare patients. Throughout 2015, we helped these physicians increase vaccinations and preventive care for their patients, decrease hospitalizations, and make investments that will keep patients healthier for years to come. We equipped these doctors with customized platforms that tie together EHR and Medicare claims data, enable them to connect with their high-risk patients, and provide instant notifications when their patients are admitted, discharged, or transferred between care facilities.

But we knew that 2015 would simply be the start.

So today, we are proud to announce that the Center for Medicare and Medicaid Services (CMS) has officially recognized five new Aledade ACOs:

• A Kansas-based ACO contracting with Kansas Foundation for Medical Care, Inc. for practice support
• A West Virginia-based ACO, centered around Charleston, in partnership with the West Virginia Medical Institute
• A Central Florida-focused ACO, partnering with Primary Health Partners LLC
• A Louisiana-based ACO, in partnership with the Louisiana Health Care Quality Forum
• A Mississippi and Tennessee-based ACO, partnering with the Mississippi Academy of Family Physicians, Arkansas Foundation for Medical Care, and Q Source

Beginning January 1, 2016 – less than 18 months after we started this journey – our team grew to include more than 700 physicians in over 110 practices, Federally Qualified Health Centers (FQHCs), and Rural Health Centers (RHCs) across 11 states. We are now responsible for nearly 100,000 Medicare patients, and more than $1 billion in health care expenditures.

In the year and a half since we founded this company, the health care system has accelerated its shift towards outcome-based health care. Early last year, the U.S. Department of Health and Human Services (HHS) set a goal of tying 50 percent of fee-for-service Medicare payments to quality or value through alternative payment models by the end of 2018. It was the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments. In April, the Medicare Access and CHIP Reauthorization Act set a foundation for Medicare’s outcome-focused future. Today, seven in 10 Americans live in an area served by an ACO.

As policy tailwinds have delivered additional momentum, we’ve continued to grow our team and doubled (and tripled) down on our emphasis on preventive care, our development of customized technology for Aledade practices, and the uniquely aligned financial partnership we have with our physicians.

In 2016, we will continue to expand initiatives that have already helped improve our doctors’ practices:

• Care management interventions for specific chronic conditions.
• Behavioral health interventions to support patients battling depression and anxiety.
• Tools and approaches to help ensure patients get the care that aligns with their personal goals at end of life.
• Skilled nursing facility (SNF) transition strategies to ensure patients receive effective care in a SNF and safely return home.

In 2014, Accountable Care Organizations saved Medicare nearly a billion dollars while improving on 80 percent of CMS quality measures – and most observers agree that both the quality and savings effects of these organizations will only grow as ACOs mature. Recent surveys have confirmed what doctors across the country already know – the health care industry’s move towards value-based payment is now inexorable. The question for most physicians – especially those in small, independent practices – is how to navigate this new health care economy.

Aledade was founded to provide an answer – and a resource – for these very doctors. Today’s CMS announcement proves that the appetite for our model, our team, and our services continues to grow. So too does our commitment to our practices and their patients. As we move into next year, our greater scale will enable us to draw more insights about the best way to keep health care costs down and the health of our patients up.