CEO Farzad Mostashari: How early failure at Aledade helped the company evolve

There are plenty of lessons to be learned in failure, but it's rare for a company and its top brass to offer a peak behind the curtain into those takeaways.

But that's exactly what Aledade, which supports primary care practices in the shift to value-based care, did shortly after its launch. The team was confident in its performance in the first year and was already seeing early progress in reducing hospitalizations, CEO Farzad Mostashari, M.D., said during a keynote presentation at the Fierce Health Payer Summit earlier this month.

However, the savings results came back. And it ended up being a huge wake-up call to the team, he said.

"We let ourselves really, really hope," Mostashari said. "And then the results came back, and we did really well on quality and we got no savings check. And it was devastating."

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Mostashari joined Fierce Healthcare Senior Editor Heather Landi for the conversation at the conference in Austin, Texas. He said that rather than wallowing in the disappointing performance, the team decided to take a deep dive into what went wrong to determine what they could improve.

And they released a paper that detailed those lessons. Mostashari said his initial suggested title for the report was "Anatomy of a Failure."

Since then, Aledade's trajectory has been trending steadily upward. In 2022, 98% of the company's Medicare Shared Savings Program (MSSP) accountable care organizations earned savings.

Aledade also represented five of the 10 highest-performing ACOs in the program, despite representing just 7% of covered lives in MSSP. It generated more than $572 million in savings for 2022 alone, according to data from the Centers for Medicare & Medicaid Services.

"It comes with time," Mostashari said. "But you can't get better if you can't honestly look at where things aren't working."

However, while value-based care has grow slowly but steadily in Medicare, there's still plenty of work to be done in helping other insurance segments catch up to what Medicare Advantage (MA) and the traditional program have accomplished.

Mostashari said part of the problem is that the contracting models that work well in MA and traditional Medicare don't necessarily translate as well when you're applying it to a self-insured employer plan. More innovative development in contracting will be critical to making a dent there, he said.

Medicaid is more adaptable to what works in Medicare, Mostashari said, but the churn in that population makes it far more difficult for value-based care to stick.

Those challenges, however, don't mean that Aledade is resting on its laurels.

"We're not one of those folks who say, 'Oh, awesome care model, but it only works for MA,'" he said. "This care model works for commercially insured patients, too."