The ACO Show

Shawn Martin, executive vice president and CEO of the American Academy of Family Physicians (AAFP), joins Josh Israel, MD, and Sean Cavanaugh to discuss challenges with the future of primary care, particularly independent primary care practices. Martin believes that value-based care has helped sustain rural health care practices and that the Medicare Shared Savings Program (MSSP) will serve as the foundation for value-based care moving forward. Martin stresses the benefits of partnering with support organizations, like accountable care organizations (ACOs), in succeeding in value-based care and outlines opportunities for the AAFP to partner with ACOs to support physician independence, provide value-based care training and advocate for rural health care funding.

Margaret E. O’Kane, CEO, president and founder of the National Committee for Quality Assurance (NCQA), joins Joshua Israel, MD and Sean Cavanaugh to discuss how the organization has helped transform quality measurement in the American health care system. Over the past 35 years, O'Kane and the NCQA have developed quality measurement standards for clinicians while striving to minimize the administrative workload that comes with an expanding array of quality metrics. O’Kane advocates for a future where quality measures are better integrated into health care technology systems, emphasizing that systemic changes are crucial for improving quality, rather than solely focusing on individual physicians. Watch the full video episode

Join Josh Israel, MD, and Sean Cavanaugh, along with Brittney Anderson, MD, family physician and podcaster (“Physicians Hanging a Shingle”) and Dan Bowles, general manager of practice health at Aledade, to discuss Anderson’s journey to owning her own private practice, and how she supports other physicians seeking independence. Both Anderson and Bowles believe value-based care is crucial for independent primary care practices, and that greater exposure to independent practice models is essential to provide physicians with more employment options. As Bowles explains, this is the driving force behind Aledade’s effort to support physicians looking for information and a path to their own independent practice. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Join Josh Israel, MD and Sean Cavanaugh in their video debut as they discuss the Medicare Shared Savings Program (MSSP) results for 2024 released by CMS with Aledade CEO Farzad Mostashari, MD They explore how Aledade Accountable Care Organizations (ACOs) earned more than $1 billion in total savings and continue to improve performance year over year, including substantially reducing hospitalizations. We also sit down with Sandeep Mann, MD, primary care physician and Aledade partner since 2015, to explore how his practice has thrived in value-based care. Watch the full episode Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Abe Sutton, director of the Center for Medicare and Medicaid Innovation (CMMI), sits down with Aledade CEO Farzad Mostashari, M.D., and Sean Cavanaugh to unpack the new strategic framework for CMMI models. Sutton explores CMMI’s focus on three pillars: promoting evidence-based prevention, improving patient access to their health data and driving choice and competition in health care markets. He discusses the recently announced WISeR (Wasteful and Inappropriate Service Reduction) Model, which aims to leverage artificial intelligence (AI) in reviewing prior-authorization requests to prevent harmful or unnecessary services. He also talks about the Ambulatory Specialty Model (ASM), which would reward specialists for improving health outcomes in Medicare patients with lower back pain or heart failure and CMS efforts to improve risk adjustment through permanent programs and testing new ideas on a smaller scale through the Innovation Center. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Join Josh Israel and Sean Cavanaugh for part two of their most recent road trip visiting primary care practices from Los Angeles to Washington D.C. First, they visited Dr. Arvinder Bir and Dr. Seema Bir, Aledade partners in California, to discuss how Aledade has helped enable their practice to reduce patient hospitalizations and remain independent. Next, they visited Varesh Chaurasia, CEO of HealthyU Clinics, and Dr. Lauren Havard, CMO, in Phoenix, Arizona to discuss what they are looking for in an accountable care organization (ACO) partner, emphasizing hands-on experience in local markets. Finally, they met with Dr. Salil Trehan in Amarillo, Texas, whose practice has previously partnered with multiple ACO enablers, to gain insights into what sets great ACO partners apart. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Aledade CEO Farzad Mostashari, M.D., and Mat Kendall, president, join Josh Israel and Sean Cavanaugh to share insights from their recent road trip to primary care practices from Los Angeles to Washington D.C. They reflect how conversations about value-based care have evolved over the past 11 years — and what organizations are trying to learn when deciding whether to join an accountable care organization and who to partner with on that journey. Join us to learn why Aledade stands out in this ever-evolving landscape. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Dr. Caroline Fife and Dr. Christopher Apostol join us to explore the rising cost of skin substitutes in wound care, which Aledade data suggests is a tenfold increase in the last three years. Dr. Fife explains that rising costs are due to an increase in both cost of the product and increased usage and she addresses the real concerns such as the way many skin substitutes are exempt from FDA review, offer rebates or discounts to clinicians and how some Medicare payment models incentivize the use of more expensive treatments. Dr. Apostol also notes how wound care has evolved through the lens of primary care, including an increase in specialist utilization and mobile wound care teams. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Dr. Amelia Bond and Dr. Dhruv Khullar join us to discuss the long-term savings of accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). Their recent study in JAMA found that ACOs generate increasing savings over time, with physician-led ACOs demonstrating more significant savings. Learn about their study’s methodology, policy implications for The Centers of Medicare & Medicaid Services (CMS) and where Dr. Bond and Dr. Khullar will focus their research next. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Natalie Davis, CEO of United States of Care, joins us to talk about the challenges of discussing value-based care with patients and policymakers. Through extensive research with over 30,000 individuals, Davis shares that the term "value-based care" often evokes negative connotations of low-quality care. When presented with the benefits of value-based care without using the term itself, people were most interested in spending more time with their doctors and receiving personalized, quality care. Join us to learn more about effectively communicating with patients and policymakers about value-based care. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

A majority of those with behavioral health challenges lack access to high-quality care. Gabe Diop, co-founder of Rula, a behavioral health physician group, joins the ACO Show to discuss how Rula is making behavioral health care more accessible by partnering with primary care practices to connect patients with the care they need. Dr. Samantha Cotler, family medicine physician in Wall, N.J., explains how her partnership with Rula has improved patient outcomes and made it easier to connect patients with in-network physicians. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom.

The U.S. faces a significant shortage of primary care physicians, particularly in rural and under-resourced communities. Join Eli Greenspan, policy advisor at Foley Hoag LLP, and Dan Bowles, general manager of Practice Health Solutions at Aledade, to highlight the role that international medical graduates play in addressing this shortage. They explain the complex process that international medical graduates must complete to practice in the U.S., and how the physician shortage is connected to immigration policy. This includes the Conrad 30 Waiver Program, which incentivizes graduates to practice in under-resourced areas. While this program is valuable, it’s also limited in scope, so our guests explore additional legislative efforts to improve and expand these programs. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom.

Aledade CEO, Dr. Farzad Mostashari, and best-selling author Geoffrey Moore explore how the concepts in Moore’s influential book, “Crossing the Chasm” can be applied to accelerate adoption of value-based care. In order to move to mainstream adoption, it’s crucial to focus on the niche market of “pragmatists in pain” who have an urgent need that the current system isn’t solving. Our co-host Sean Cavanaugh, chief policy officer at Aledade, points out that oftentimes in the traditional fee-for-service model, the pragmatists in pain are independent primary care clinicians. Moore and Dr. Mostashari also share insights and recommendations for the new administration from their recent article, including focusing on primary care, defining the competition and paving the way for simplifiers who can help clinicians navigate the complexities of value-based care. Using this framework, the Center for Medicare & Medicaid Services (CMS) could accelerate expansion of value-based care to the majority of the nation’s primary care clinicians as well as their patients. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom.

Join us this episode as our guests from Aledade, Dennis Liubyvyi, Director of Artificial Intelligence (AI) Research, and Jette Henderson, Staff AI Researcher, explain the world of AI and machine learning and its potentially transformative impact on health care. Dennis shares how AI models at Aledade are reshaping patient care by analyzing vast amounts of patient data to predict critical health events such as kidney disease progression and congestive heart failure. The goal is to provide more timely, targeted interventions to patients who need them most. Jette also notes the challenges that exist in these predictive models, particularly regarding biases within data sets, which can lead to inaccurate predictions and how Aledade is developing tools to help identify and mitigate these biases. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Dr. Sameer Sheth, President and Co-Founder of Chamber Cardio, joins Josh and Sean to discuss the opportunities and challenges for specialists, particularly cardiologists, in transitioning to value-based care. Dr. Sheth notes that cardiologists have traditionally been slower to adopt value-based care because of a lack of financial incentives, but an increasing drive to remain independent is pushing more cardiologists towards value-based models. Dr. Sheth shares how he and Chamber Cardio are working to create a network of cardiologists, health plans, and tools to better incentivize their transition to value-based care. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Join Melanie Phelps, Senior Advocacy Advisor for Health System Transformation at the American Heart Association (AHA), to discuss her recent research which explores the impact of ACO-driven value-based care from the patient and caregiver perspectives. Melanie explores the overwhelmingly positive results of the study, which found that patients and their caregivers experienced better care, better support, and better patient outcomes as a result of their clinicians’ participation in an ACO. Dr. Julie Prosseda, Family Medicine Physician in Wilmington, DE and a participant in the AHA study, joins us to explore the reasoning behind these benefits of value-based care for patients, which is largely due to better relationships with their primary care physicians, as well as access to timely support and resources from an expanded care team. This more wholistic, patient-centered value-based care leads to enhanced patient engagement and a more trusting clinician-patient relationship. While it’s clear that patients should be demanding broader access to value-based care, Melanie and Dr. Prosseda also explore the challenges of expansion, including increasing educational opportunities and more alignment among payment models. Learn more about the American Heart Association’s research: Understanding Patient, Family Caregiver and Health Care Team Member ACO Experiences Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Value-based care is a team effort, and nurses play a crucial role in coordinating care to achieve better and more efficient patient outcomes. Jacqueline Nikpour, Assistant Professor at the Emory University School of Nursing, and Kathy Samhammer, LPN at Cedar Ridge Family Medicine, join us to discuss the role of nurses in primary care, and how practices can maximize nurses’ contributions in the shift towards value-based care. Kathy’s role includes managing chronic conditions and preventing hospital readmissions, and she discusses the importance of ongoing, personalized communication with patients, especially after ER visits. This approach has led to better patient engagement and satisfaction, which is crucial for improving health outcomes. As Kathy demonstrates, expanding the role of nurses in value-based care is critical, but Jacqueline also notes the challenges in this expansion, including payment and recognition of nurses’ value. By addressing these challenges and better integrating nurses in patient care teams, we can ensure better care coordination and a more patient-centered health care system. Read Jacqueline’s article in Health Affairs: To Improve Outcomes Under CMS’ ‘Making Care Primary’, Focus On Registered Nurses Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Comprehensive Advance Care Planning (CACP) supports individuals in understanding and sharing their values and goals for medical care at the end of life. Kerri Petrin, Vice President and Head of Operations at Aledade Plus, joins us to explore how the CACP program allows patients and their loved ones to have guided, personalized conversations with clinical facilitators and generate legal documents so that patients and their care teams can make health care decisions that align with the patients’ values. We are also joined by Marissa McNichols, who shares insights into her role as a CACP facilitator, especially the importance of having open-ended conversations that include family members, allowing everyone the opportunity to ask questions and make decisions outside of a crisis moment. Tune in to learn more about how CACP is transforming end-of-life care planning, ensuring alignment with patient values and reducing unwanted, unnecessary care. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

Graduates of the Aledade FIRST Program, Dr. Boone Marois and Dr. Breanna Heard-Pinho, reflect on their experiences in the program and how it helped prepare them to practice value-based medicine. Dr. Heard-Pinho, Family Medicine Physician in Vicksburg, Mississippi, shares how Aledade FIRST taught valuable practice management skills, as well as held in-depth discussions of value-based care not taught in traditional residency programs. While Dr. Marois, Family Medicine Physician in Asheville, North Carolina, reflects on the importance of taking a preventative approach with each patient. Listen as they share unexpected joys and challenges of practicing value-based care in their communities. Connect with us at acoshow@aledade.com or visit the Aledade Newsroom

In this episode, Sean Cavanaugh and Josh Israel discuss the complexities of caring for patients who are dually eligible for Medicare and Medicaid. They are joined first by Melanie Bella, whose prior roles include former Director of Indiana Medicaid, Director of the CMS Medicare-Medicaid Coordination Office and EVP at Cityblock, and are then joined by Aledade’s Mohamed Arif, and Lahila Pitts. They explore the unique challenges these patients face, including fragmented care and high social needs. They also highlight how value-based care and data-driven solutions are improving outcomes for this underserved group. Tune in for insights into better care coordination for dual-eligible beneficiaries.