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Seeing the Potential in Physician-Led ACOs, Dr. Mostashari Makes a Shift

September 26, 2014
by Mark Hagland
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Farzad Mostashari, M.D., the former National Coordinator for Health IT, after a brief stopoff at the Brookings Institution, launches a new company to facilitate physician-governed ACOs

When he left his position as National Coordinator for Health Information Technology in October 2013, after two years and seven months in the federal healthcare IT czar position, no one doubted that he would continue to make his presence known in some way in the U.S. healthcare world.

First. Dr. Mostashari left the Office of the National Coordinator for Health IT (ONC) to join the Washington, D.C.-based think tank The Brookings Institution, as a Visiting Fellow “focused on healthcare payment reform and helping independent practices with care transformation,” according to his LinkedIn profile. But he was only at Brookings nine months before he announced that he had become founder and CEO of a new consulting and technology services firm, Aledade, Inc. (Bethesda, Md.). According to its website, under its “What We Do” tab, it says that “Aledade makes it easy and inexpensive for Primary Care Physicians to form Accountable Care Organizations. We offer primary care doctors a complete package of resources, services, and technology needed to establish the ACO with no upfront costs.”

Meanwhile, on Sept. 23, Dr. Mostashari collaborated with a colleague, Bob Kocher, M.D., who had served as special assistant to President Obama for healthcare and economic policy on the National Economic Council from 2009 to 2010 (Dr. Kocher is now a partner at the Palo Alto, Calif.-based Venrock, the venture capital firm helping to fund Aledade’s launch), to pen an op-ed article for The New York Times regarding lessons learned in the creation of the Rio Grande Valley Accountable Care Organization Health Providers in McAllen, Texas, a participant in the Medicare Shared Savings Program (MSSP) for ACOs. Drs. Kocher and Mostashari noted that, in a famous June 1, 2009 New Yorker article entitled “The Cost Conundrum,” Atul Gawande, M.D. had cited the small Texas border city of McAllen, Texas, as the most expensive place for healthcare charges in the United States at the time. Yet with the creation of the Rio Grande Valley ACO, Mostashari and Kocher noted, physicians who saw the future were able to come together to successfully move forward to reduce costs and improve clinical outcomes.

The key point that Drs. Kocher and Mostashari made in their Sep. 23 Times op-ed was that when physicians create and lead ACOs, they prove the success of the model. And now, in co-creating Aledade with a several other colleagues, Dr. Mostashari is betting that facilitating ACO creation and development will help move the industry forward to significantly expand the comment. Dr. Mostashari spoke with HCI Editor-in-Chief Mark Hagland on Sep. 25 regarding all these subjects. Below are excerpts from that interview.

After just nine months after joining The Brookings Institution, what made you decide to change jobs again, so shortly after your departure from ONC?

While I was at Brookings, studying ACOs, I was getting so excited not only about ACOs, which Brookings helped put on the map, I got excited especially about physician-led ACOs. And I found, much to the surprise of many people, though it was not surprising to me, was that it was the independent, physician-led groups doing so well. 18 PCPs in Rio Grande Valley, 80 physicians in South Florida. They were really doing a great job, knocking it out of the park. And I thought to myself, gosh, I wish there were more groups out there—the physicians who have been under-resourced, they’re doing things that are good for their patients, their communities, and themselves, and I thought to myself, gee, I want to help crank that window open more! And I’ve been wanting to get to population health through technology and other things—but it’s just awesome where there’s a clear business case for ACOs and for leveraging technology not just for its own sake, but for something important like this.

Farzad Mostashari, M.D.

What does the company’s name mean?

Remember [as National Coordinator], we used to talk about keeping our eye on the prize, the North Star, feet on the ground? So I took that and said, when we’re navigating, and it’s like a very turbulent time, like being in a ship in a storm, and it turns out that an aledade [more commonly spelled alidade ] is the instrument that helps you locate true north.

What are you seeing happening out in the industry in terms of physician-led ACOs like the Rio Grande Valley ACO? What’s making them successful?

Number one, they go through the practice, they don’t go around the practice. So how are we going to care better for our sickest patients who need the help? We’re going to go through the primary care doctors, not around them. A lot of people think it’s too hard to go through the doctors, that the doctors are too busy, that they can only understand fee-for-service medicine. So they’re trying to keep paying the doctors fee-for-service, while trying at the same time to capture the value of population health by putting in nurse case managers, and social workers, and technology, and whatever, instead of leveraging the power of physician engagement in the concept.

Implicitly, you’re saying that doctors can adapt to profound change in healthcare?