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. 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.