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.

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.