Keeping Physicians Independent: Dr Patricia Salber Interviews Dr Farzad Mostashari

In a recent episode of the American Journal of Managed Care’s Managed Care Cast podcast, Dr. Patricia Salber, MD, MBA, of The Doctor Weighs In interviewed Aledade Co-founder and CEO Farzad Mostashari, MD, about how his company is keeping physicians independent through value-based care.

Value-based care, Mostashari said, is different from the standard fee-for-service model in that a practice’s success as a business is not tied to how many people they can see in a short amount of time. Rather, it is tied to outcomes for patients such as keeping people out of the emergency room by ensuring they have regular visits to manage any conditions.

How did Mostashari build Aledade? “We built the company on incorporating lessons that my cofounders and I learned over decades of trying to get behavior change but only addressing one of the pieces,” he said.

“We successfully got 143,000 primary care docs from paper to electronic, but they weren’t really focused on population health or prevention. What I realized was that through regulatory and compliance programs you can have them check the boxes, but unless you fundamentally change their economic model, you don’t get behavior change,” Mostashari said. “In order to get sustained behavior change, you need to have all three pieces in place: the technology, the coaching, and the changed economic models.”

Salber asked Mostashari if Aledade can be compared with organizations like Kaiser Permanente or Geisinger. “We certainly don’t have the same degree of ‘systemness’ that larger organizations have, but it is part of the larger vision,” Mostashari said. “There is a place where Aledade practices can surpass them, though, and that’s in the degree of ‘touch’ we have with providers.”

Aledade currently has 550 practices in 28 states, with $8.5 billion under management. There are about 3560,000 Medicare patients, and those Aledade ACOs cared for in those contracts, they saved 10,000 hospitalizations, adding up to $180M in savings. Medicare got to keep about half of those savings, which left about $90M, and of that, $55M went back to practices. “We don’t take our share out before the doctors get theirs, so Aledade and the docs are on the same side of the table—it comes out of Aledade’s share of savings—about $150,000 per practice,” Mostashari said. “Particularly in the times of COVID, this model has kept many of our practices afloat.”

“[Our ACOs are] at 94% on the Medicare quality index. We live by ‘good for patients, good for doctors, good for society.’ We and other ACOs have delivered on that. What we need to do now is scale it,” Mostashari said.

Aledade is doing its part; the company has added 200 practices to its accountable care organization network so far in 2020.

As to where Aledade is going from here: “More, better,” Mostashari said. “More practices and continuing to serve all kinds of independent practices from the solo docs to the multi-specialty practices to federally funded community health centers. We’re also expanding into Medicaid and [working] with private insurers. And we want to do more. We’ve built a platform and we’ve built that trust relationship with practices.”

Listen to the full podcast here.