By Gregg A. Masters, MPH
On July 8th 2011 I penned a blog post titled: Waiting for ACOcor? pondering the question of whether this time will be different in the managed competition positioning dynamics we’re likely to witness post roll-out of the Affordable Care Act. Afterall, the ‘chassis’ on which to graft if not build an ACO can be found in iterations of prior physician led vehicles including IPAs, medical group Medicare Advantage contractors and even PHOs (Physician Hospital Organizations) where the ‘institutional partner’ (ie, the ‘H’ hospital) serves as a limited partner to the medical group or IPA which operated the PHO as ‘the general’.
Today we learned that the former Director of the Office of the National Coordinator for Health Information Technology, Farzard Mostashari, MD has launched – with an infusion of $4.5 of investment capital from Venrock and Bob Kocher, MD taking the lead – an ‘ACOcor’ of sorts tagged ‘Aledade‘.
Mostahari outlines his rationale and reasoning pathway to this ACO consulting and turnkey management company as follows:
Today, I’m launching a new company, called Aledade.
Aledade partners with independent primary care physicians to make it easy and inexpensive for them to form and join Accountable Care Organizations (ACO) in which doctors are paid to deliver the best care, not the most care.
This is good for patients who will find that their trusted primary care doctors are more available and better informed than ever before. It’s good for doctors who want to practice the best medicine possible, the way they always wanted to. It’s good for businesses and health plans looking for healthcare partners that deliver the highest possible value and outcomes. And it’s good for the country as higher quality, lower cost care will help lessen the strain on our budget and our economy.
The world of start-ups may not be the usual path for those leaving a senior federal post, but it’s the right decision.
For me, Health IT was never the “ends,” but a “means” to better health and better care, and I continue to believe that better data and technology is the key to a successful transformation of health care. And it is why the attempts to do so now can succeed, where they have failed before.
Empowering doctors on the frontlines of medicine with cutting edge technology that helps them understand and improve the health of all their patients- that is the mission of our new company, and one that has animated my entire career.
During the seven years I spent working for Tom Frieden and Mike Bloomberg in NYC, it was exhilarating to be able to push the frontier in what was possible — to innovate at the edge.
Working with my team, we were able to: invent new statistical methods for outbreak detection , develop new data visualization methods, create visibility into population health down to the neighborhood level, bring decision support and rapid diagnostics to the point of care, automate electronic quality measurement, and implement novel financial incentives and hands-on technical assistance to support care transformation in small independent primary care practices. It was exhilarating.
When I moved to HHS in 2009, the transition to federal service also meant a change in perspective.
As the National Coordinator for Health IT, my key responsibility was now to ensure a minimum national “floor.” We had to push the country as a whole towards a common core set of data and capabilities. We applied creativity and grit to do what needed to be done, using the best tools available to us: encouraging the private sector; organizing and scaling state and local efforts like the inspiring work of the regional extension centers; and — yes — through the blunt instrument of regulations too.
I’m extremely proud of the work we did, and the foundation we put in place. The country is in a massively different place, and the age of data has finally come to healthcare. But in that role, I was also acutely aware of the compromises and incremental half-steps that have to be taken when the goal is to move an entire nation. I was inspired by those that pursued improvement not “compliance” and did not mistake the floor for a ceiling.
I’ve had the good fortune for the past nine months to be ensconced among some truly great thinkers at the Brookings Institution, and to go on a “walkabout” – talking to and visiting with leading practitioners throughout healthcare. I have come away with a rare stereoscopic view of the changes sweeping through health care — the anxiety of those with “one foot on their old business model’s grave and the other foot on their new business model’s banana peel”, mingled with the excitement of those who would disrupt the status quo.
And during this process, I have also found my cause.
It’s to help independent primary care doctors re-design their practices, and re-imagine their future. It’s to put primary care back in control of health care, with 21st century data analytics and technology tools. It’s to support them with people who will stand beside them, with no interests other than theirs in mind. It’s to promote new partnerships built on mutual respect, and business arrangements that will truly reward them for the value that they uniquely can bring- in better care coordination, management of chronic diseases, and preventing disease and suffering. It’s to achieve lower cost through better care and better health.
I believe in this. And this is the mission of our new company. And to realize it, we will be back at the vanguard, helping to lead this transformation in health care that has been underway for years but is quickening and coming faster than ever before.
This is clearly an idea who’s time has come – in fact, it’s been here a while. Yet the white water of health[care] ecosystem reform remains, witness: Universal American: A Sign of Things to Come? The key strategic question is: can Aledade build upon and leverage the collective experience and insights of the past in the development of independent physician networks (IPAs) or their management companies (MSOs) to put physicians back in control via risk assumption at the population health level? In other words, can they succeed in tapping if not channeling the vital community physician leadership to deliver on the culture as well as the mission critical objectives (i.e., the triple aim) of the ACA levied principally on the ACO community writ large?
Clearly Mostashari’s work in building out the HealthIT infrastructure and population health connectivity that enables the vision if not spine of any ACO or accountable care initiative (better care, better outcomes & lower per capita costs) is mission critical insight. Improvements in healthIT and reach of REC’s (Regional Extension Centers) is one big difference since the ambitious if not technologically ‘pre-mature’ launch of Healtheon and the associated rise and collapse of the PPMC (physician practice management company) industry. [Editor's Note: For additional PPMC context, see 'The ‘Medical Aggregators’: Are We Entering Round Deux?']
This one is worth watching very closely!