Preserving True Choice via Diversity of Organization and Universal Standards for Outcomes

Healthcare delivery is inherently local. Every community has its own history; its own needs; and its own resource base. This is especially true in Maryland, with unique communities among its beautiful coasts, soaring mountain ranges, and vibrant urban areas. Indeed, Maryland’s strength comes from this diversity, which is carefully maintained through the deliberate promotion of thoughtful policy, purposeful actions, and local solutions.
In a similar fashion, the Maryland Comprehensive Primary Care Proposal must deliberately promote strategies to strengthen and advance diversity among providers and Care Transformation Organizations (CTOs).
The proposal highlights a desire for competition among Care Transformation Organizations (CTOs); we wholeheartedly agree that competition is the best tool for improvement. However, competition can present tremendous challenges, especially in health care, and many organizations will seek to minimize the level of competition for their own benefit. Competition in health care must be deliberately supported through the selection process and model design so that various options present attractive options on their own, aside from the need to subsidize the CTO-practice relationship. Prior models have shown this to be the case; indeed, the recent trend towards consolidation is evidence enough.
The CTO selection process should not just value having two or more options for practices, but rather seek different types of CTO offerings. By example: choosing between two systems whose integration is based on common ownership is fundamentally different that choosing between a wholly-owned integrated system and a networked system whose integration is based on shared patients and shared data.
An effort to spur and maintain true competition among CTOs would enhance the strength of the state’s Proposal and greatly increase its chances of success.

Reinforcing the Primary Care Physician – Patient Relationship

Every Medicare beneficiary benefits from a strong primary care physician relationship. Primary care physicians “quarterback” their patients’ health care. Those who do so in their own practices maintain the independence that makes their practices unique and trusted.
There are certainly rare cases where the only health need a patient has in a year is a singular acute issue. There are also cases, usually towards the end of life, that a patient’s needs are so intensive they are removed from the community.
However, most health care needs—and most health care spending—are driven by patients with multiple chronic conditions or who suffer from preventable or otherwise avoidable illnesses and injuries. These patients remain in their community, and benefit most from the one-on-one relationship with their primary care physician.
Attribution should revolve around that relationship and the model CTO – practice contract should seek to preserve that relationship. Only in the rarest of cases where it is inescapably obvious that primary care is no long primary to the patient’s health care needs for a given year should specialist or facility attribution be employed.

We launched Aledade on June 18th, and by the end of July we had recruited 80 primary care physicians in 4 states to join us in creating the very first Aledade ACOs. We have been work together ever since- but haven’t been able to talk about our wonderful practices until the official notification from CMS that came today.

We are thrilled to announce that beginning January 1, our two new Aledade ACOs will be taking accountability for the care of over 20,000 attributed Medicare patients, and stewardship of nearly a quarter of a billion dollars of health care expenditures each year. We’re building a new delivery system on the foundation of trust between patients and the physicians who have been caring for them in their communities for decades, and enabled and accelerated with cutting-edge technology and analytics.

One ACO will operate in the state of Delaware, in close collaboration with our physician partners and our field team, Quality Insights of Delaware. Our second ACO, the Primary Care ACO, will take the same model spanning three states — New York, Maryland, and Arkansas, where we are also working with local partners like the Arkansas Foundation for Medical Care. Our hand-picked ACOs physician partners are some of the most capable and inspiring primary care physicians in the country. They are leaders in their local, state and national physician associations; they are pioneers of Meaningful Use and Patient Centered Medical Homes; they are much-decorated top doctors in quality; but most of all, they are the pillars of their communities.

Our regional Medical Directors and local field teams in each state have already been busy helping our partner practices:

  • Extracting practice management data and establishing interfaces to EHR data and Admission-Discharge-Transfer notifications.
  • Identifying individuals with multiple chronic conditions at high risk of complications
  • Working with practices on initiating workflows for patient recall, and rolling out lightweight apps to help prioritize and track the outreach
  • Customizing EHR templates and tracking wellness visits
  • Implementing an influenza and pneumonia vaccination program for high-risk seniors
  • Reviewing after-hours and weekend patient access protocols, and working together to make it easier for Medicare beneficiaries to reach their primary care doctors and schedule same-day appointments.

Our performance year for these ACOs will start on January 1, and we are excited to begin the work of delivering the best care possible for our entire population of patients.

We are also looking towards the future. We are looking to grow our base of top physicians in our existing four states, and expand into several new states (likely to include Virginia, West Virginia, Tennessee, and Louisiana). We’re recruiting the leading primary care providers in the country and field partners in these regions, as we continue to refine the customized applications and platforms that will help our doctors thrive.

Alongside this growth, our Aledade team has been growing apace. We’ve assembled a dynamic team with deep expertise in provider engagement and practice transformation, data analytics, technology, and health care policy. As we continue to scale quickly in 2015, we will further expand our team in the coming months. We are looking for talented individuals who are passionate about making a big impact on health care in the United States, who will cherish their colleagues and our primary care physician partners, who are data-driven and tech-savvy, and who are relentless in their pursuit of a better world.

You can learn more about the positions we are hiring for here.

2014 has been a really exciting year for the future of health care, and for Aledade. Far away from the political finger-pointing and ideologically-charged debates, real change is happening in American health care, and momentum is building around what matters most — the health of patients.

Especially at this time of year, I am grateful to be able to contribute to this transformation, and I’m so appreciative of the chance to be working with such a phenomenal team of doctors and colleagues committed to this movement.

– Farzad

On June 18, we launched Aledade – a company built on our belief that independent primary care physicians are best positioned to lead the next revolution in health care delivery – boosting quality of care and bringing down costs.  Over the past six weeks, we traveled across the country meeting doctors, discussing the future of independent primary care practice, and recruiting physician partners for our first wave of Accountable Care Organizations.

Meeting these doctors, from areas and backgrounds as diverse as the populations they serve has been a constant reminder of the reasons we founded this company.  One physician, having spent decades serving the same community from the same office, lamented that in the past, he felt more involved – and more informed – about all aspects of his patients’ care.  Today, he told us, fragmentation in care delivery had given him less insight into his patients’ health, and less influence in coordinating their treatment.

When we started Aledade, these were the type of doctors we wanted to empower.

Today, I am elated to announce that we have formally submitted applications to the Center for Medicare & Medicaid Services to form ACOs serving physicians in Delaware, Maryland, New York, and Arkansas for 2015.  We expect this first wave of Aledade ACOs to serve tens of thousands of Medicare patients beginning January 2015.

The choice of four dissimilar states was intentional. We intend to establish a model that can be replicated across the country, and the diversity in our practices matches the diversity of our country. Each state has strengths to build on. Delaware- ‘the First State’ has been a leader in electronic health record implementation. Maryland and New York’s health reforms set the stage for alignment and collaboration with acute-care facilities. Arkansas’ tradition of independent primary care practice is strong. We’ll also be serving very different patient populations in each state – from practices that serve urban neighborhoods to those that treat folks in small towns and rural communities.

In all four states, we will spend the next five months working closely with our physician partners to tailor custom administrative and technological solutions for their practice needs and help accelerate practice transformation.  Our previous work in policy and outreach has already given us some ideas about how physician-led ACOs can best leverage the value-over-volume care delivery model, and there’s been a great deal of writing on the advantages of physician-led ACOs. But we also know that successful ACOs are built specifically for the communities they serve.  That’s why we will develop tools for our doctors with the unique needs of their practices – and his or her patients – in mind.

As we do, we will focus on three key areas:

Greater Availability to Patients.   Doctor availability and attention to patient needs are not just the key to patient satisfaction; they also are important to avoiding hospital admissions and more serious medical issues down the road.  So we’ll also be encouraging our physicians to place a greater emphasis on wellness visits and preventative medicine – and helping them to do that in as an efficient and effective way as possible.

Tools to Succeed.  I’ve said many times: in today’s health care marketplace, technology is necessary – but not sufficient – for success.  Data doesn’t solve health care problems by itself, but the right information and the right technology can empower doctors to manage patient care, notice trends, and address medical issues before they become serious.  Our team has over two decades with cloud-based medical platforms and electronic health records (EHR) – we know the functionality needed.  Our CTO Edwin Miller will team up with each individual ACO to customize the technological solutions that fit best, and work with doctors and their staff to continually optimize how those tools are used and effectively integrate the EHRs into the practice’s workflow.  We are committed to the success of our doctors, and technology will be a huge part of that commitment.

Passion to Lead Change.  When recruiting partners, we sought out independent physicians eager to participate in – and lead – the trends transforming our health care system.  Doctors in each of our ACOs will work together to explore opportunities for improvement, and share ideas for improving practice operations, technology, and patient management.  We want our doctors to communicate and exchange best practices – we expect to learn a great deal from their daily experience, and we expect them to be active partners in the process of continual improvement.

We founded Aledade on the belief that physician-led ACOs can be the leading edge of health care transformation in the United States.  Our doctor partners share that belief and are equally eager to prove that hypothesis right.

This first wave of sign-ups is over, but we’ll continue to sign up new practices in other states across the country. That means we now have to build as we grow – and we couldn’t be more excited to start.