Farzad Mostashari, M.D., is back near the frontlines of medicine.
After spending a chunk of his career creating policy in Washington, D.C., Mostashari is now running Aledade, the company he co-founded in 2014 to help independent physician practices transition to value-based models.
It’s work he believes in. And it’s not so much being a physician that helps him understand what practices face.
“To me, it’s more our spirit of service of going and seeing that the primary care doctors in rural Arkansas are just doing God’s work," he said. "They know their patients. They are so connected to their communities. It’s just humbling to be able to support them. I think that’s the key thing—having the spirit of humility and service rather than a [medical] degree."
Aledade is helping practices stay independent by bringing them together into accountable care organizations (ACOs). Mostashari thinks it’s a model that can help solve some of the healthcare system’s biggest problems by improving the quality of patient care and reducing costs.
Here’s more of what Mostashari had to say about Aledade, healthcare and what lies ahead:
FierceHealthcare: You had a big job as the national coordinator for health information technology at the U.S. Department of Health and Human Services. What made you walk away from the policy world?
Farzad Mostashari: It was an amazing privilege to be able to really serve the entire country from Alabama to Alaska and be part of a big movement like that. The reason I went into government was, at the time, I felt the big thing we needed to improve health was the right policies. After a certain point, I felt we had the policies, but I wasn’t seeing the implementation in the field. It was so frustrating. I wanted to take the policies and turn them into concrete examples or models for others to potentially follow.
More about Farzad Mostashari, M.D.
FH: I read that Aledade’s founding stemmed in part from your nine-month healthcare “walkabout,” when—as part of your Brookings Institution fellowship—you went around and talked with health plans, hospitals and independent physicians. What was the big takeaway for you?
FM: I spent nine months at the Brookings Institute and I started a learning network for physician-led ACOs and we published a tool kit on how to succeed in accountable care. But the "aha" moment was what we called the paradox of primary care leadership. The paradox was independent primary care practices are best situated to lead the value-based revolution and they have the least resources and, frankly, less confidence they can do it on their own.
FH: What are the big challenges for physicians and other providers who want to move to value-based care?
FM: I think the first challenge is just that many times practices are too small to be able to take on that sort of risk. You need to come together, you need to create a vessel where multiple practices that trust each other and trust you, can come together, join together and say we want to be in a boat together and we are going take on this challenge together. You need the right team in the boat. The second challenge is the resources needed: to hire the medical director, to direct the legal process, the regulations, the policy, the coaching, and the technology. It just takes money. It takes time and expertise.
FH: Aledade is still a pretty new venture since you started in 2014. How has it gone and how has the company grown?
FM: We’re a young company but we’re growing pretty quickly. We are now in 24 states. We have over 300,000 Medicare lives that we are responsible for and another 130,000 commercial lives. Overall, we have about $4 billion a year in total costs of care we are managing. That’s a heady responsibility. We just signed a one-of-a-kind partnership with Blue Cross/Blue Shield of North Carolina.
FH: You got good news last fall with the release of CMS’ results from its Medicare Shared Savings Program (MSSP) ACOs. How did Aledade stack up?
FM: We had eight out of nine of our ACOs—who were sophomores, juniors and seniors who had been doing this for more than two years—got paid shared savings distribution either from the Medicare program (six of them) or by their Blue Cross contract (two of them). That’s pretty good. I call that a good start ... The hospital ACOs on average had no decrease in cost beyond what they were paid by Medicare. That’s the big picture. It’s not so much Aledade as this concept of a physician leading accountable care.
FH: CMS’s release of its final rule on MSSP ACO participation was met with mixed reviews. What was your take on it, and do you worry it could result in a significant decrease in program participation?
FM: I thought it was a good thing. I thought some of those concerns were overblown. The big picture was that they set the path forward, they clarified the uncertainty and they approved the program. We know what the rules are now and we can move ahead.
FH: Why the name Aledade?
FM: I wanted to go back to, why are we doing this in the first place? What’s the North Star? Not focusing on box-checking but focusing on the outcomes is what I wanted this company to be all about. The aledade is the part of the astrolabe [the instrument that travelers used in celestial navigation] that points to the North Star. I thought that was neat.
FH: What are you looking forward to in 2019 and beyond?
FM: I want us to keep plugging away. I want us to keep growing and keep serving. I want us to keep helping patients to leave the hospital and keep growing the model with more doctors and more types of payers. So, we can go to practices and help them with all their patients, not just their Medicare patients or their Blue Cross patients.
FH: Are there still some doubters out there in terms of whether this model can really work?
FM: I think there are some people who haven’t looked at the evidence for a couple of years. They are still standing by their old convictions but haven’t really updated their viewpoint. I think the evidence now is pretty strong that this is the track that is the most promising program that exists for Medicare for lowering costs and improving quality at the same time.
FH: Any other thoughts about where healthcare is heading?
FM: I think we are going to the heart of the problems with healthcare. I think that was really important to me if I’m going to do this. I wanted us to tackle the big issue, the heart of the dysfunction of fragmented healthcare and people like my Mom not getting the best care possible. That was the perverse incentive, as well as the lack of information. We’re doing something really hard but if we can make this work than it really provides a blueprint for others to follow. We’re putting a lot of pressure on ourselves. It’s not an easy thing to do but I think we’re able to attract incredibly mission-oriented people.
FH: What has happened with your mother’s healthcare experience?
FM: She has been the recipient of what is so common for the elderly in America, which is no one is in charge of her healthcare. And so, it’s me from hundreds of miles—or sometimes thousands of miles—away trying to figure out and coordinate her care. She’s had complications and hospital stays. She’s resilient but she’s suffered a lot. So, anyone who has had a loved one in the grips of the system, where everyone is doing their part, but no one is in charge of the whole patient, I think that will resonate with them.
FH: So, what’s with those bowties?
FM: Well, I started wearing them when I was in medical school because some professors who I really respected, who were clearly establishment, but also quirky. That shaped my image of myself—being an insider and an outsider at the same time.
FH: So, it’s kind of tied up with your image now?
FM: It’s tied up, as you say.