In health IT circles, most people probably know Farzad Mostashari, M.D., as the former National Coordinator for Health IT, a role he served in for more than two-and-a-half years before founding Aledade in 2014—a Bethesda. Md.-based company focused on physician-led accountable care organizations (ACOs). Since then, Aledade has formed ACOs in New York, Delaware, Maryland, Arkansas, West Virginia, Tennessee, Mississippi, Florida, Louisiana, Virginia, and Kansas, which collectively care for more than 100,000 Medicare patients.
Recently, Dr. Mostashari, and Travis Broome, Aledade’s healthcare policy lead, co-authored a report, published in the American Journal of Managed Care, that made the healthcare IT media rounds as it took a deep dive into how Aledade-initiated ACOs fared in the 2015 Medicare Shared Savings Program (MSSP) ACO class. The report also largely looked at ways the Centers of Medicare & Medicaid Services (CMS) could prove its federal ACO programs. Broadly speaking, the authors noted that “there is no magic bullet for ‘transforming healthcare’ overnight, and that the work of redesigning our delivery systems to meet the expectations of the outcome-based payment models will be slow, hard, and uneven.”
Indeed, in August, CMS released performance and financial data for more than 400 ACOs in the MSSP and Pioneer government-led programs, revealing more than $466 million in total program savings in 2015, although nearly seven in 10 of those ACO organizations did not generate enough savings to receive bonuses. It should also be noted that CMS paid $646 million in shared savings bonus payments to high performing ACOs, leading to a net loss of $216 million, or a loss of slightly less than 0.3 percent for the government. The mixed results of ACOs to date have been a popular talking point for many healthcare leaders as maybe wonder about their sustainability.
Mostashari recently spoke with Healthcare Informatics Managing Editor Rajiv Leventhal on a myriad of healthcare IT issues, including information blocking and drilling down on the results of ACOs to date. Below are excerpts of that interview, edited for formatting purposes.
What’s new with Aledade? What are you working on these days?
You know that whole technology infrastructure we put in place and the whole volume to value shift? We’re basically [trying] to connect those. You have new payment models, so let’s help smaller and independent practices with those value-based contracts. And you have the technology infrastructure, meaning EHRs [electronic health records] and HIEs [health information exchanges], so how can we put those together and create workflows that can help smaller practices succeed in these value-based contracts using the technology, the information, and the business process redesign, which is maybe the hardest piece of this all. You need to rewire the workflows around the patient and his or her needs even if the patient is not in the office today. Aledade is in 11 states going on 15, and is working with 500 primary care physicians, going on 1,000, across the U.S. We are partnering with them and bringing them together on saying, “Enough with compliance; compliance with pay-for-performance, compliance with meaningful use, compliance with patient-centered medical home [PCMH] requirements.” Let’s keep people healthy and out of the hospitals and share in the affordability in healthcare that we help create.
Farzad Mostashari, M.D.
You recently published an in-depth report on Aledade’s ACOs in the field. At a high level, what did you learn most from that?
The first takeaway is that these things take time and people get better over time. This is not an overnight thing; you cannot transform healthcare overnight. But on the other hand, you can do a lot in a short period of time. Just within a year, in our “freshman experience,” we were able to cut ER visits by 5 to 6 percent and reduce 30-day all cause readmissions by 14 to 16 percent, relative to national trends. That’s huge—if there was a drug that cut readmissions by 14 percent, that would be a blockbuster drug! We reduced acute hospitalizations by 4 percent and 11 percent against national trends. So those are big things you can change in a short amount of time, even in these small practices. We’re very proud of the hard work our practices did and the technology that helps them succeed.
What are the key strategies and IT elements of these ACOs?
Some of it is high-touch and low-tech, so changing what the primary care practice does in terms of things like same day scheduling, so putting up posters, and smiling when a patient calls on a Friday at 4 p.m. and says he or she isn’t feeling well. Instead of saying “go to the ER,” say “come on in, we’ll see you.” So some of it is relationship based, but there are also things that [these ACOs do] that they couldn’t do before.