In this episode of Quality Talks, NCQA President Peggy O’Kane speaks with Dr. Farzad Mostashari, Co-founder and CEO of Aledade. Farzad brings decades of experience in health IT, policy and primary care transformation to a candid and energizing conversation about what’s holding back US health care and how we can move it forward.

Farzad and Peggy explore the structural flaws in our system, from fragmented care and fee-for-service incentives to the undervaluing of primary care. They discuss how ACOs, Medicare Advantage and data-driven models can help shift the system toward better outcomes and lower costs.

Peggy and Farzad explore:

• The Issue of Incentives: Farzad argues that while good care happens daily, it often occurs despite the system—not because of it. Misaligned financial incentives and lack of structural support hinder progress.
• The Key to Accountable Care: Access, point-of-care intelligence, care transitions and targeted wraparound services form the core of Farzad’s actionable framework for improving outcomes.
• Medicare Advantage and ACOs: A nuanced discussion of how MA and ACOs compare, what each gets right, and how to align incentives across Medicare.
• What Works? A call for smarter learning networks that identify and spread what’s truly effective in improving care and reducing cost.

This conversation offers a timely and practical roadmap for advancing value-based care. Farzad’s clarity, humor and strategic insight make complex topics accessible—and energizing. Whether you’re a policymaker, provider or health system leader, this episode delivers ideas worth implementing. 

Key Quote:

The most expensive thing in health care is the thing that no one wants. It isn't the fancy doctor's office or the upgraded scan. It's the hospitalization.

Hospitalizations are ridiculously expensive and the cost has been going up. There's classic charts that show inflation and TVs are down 98% in cost, and hospitalizations are up. Like, the thing in the American economy that has had the most inflation over the past two decades is hospitalization. And no one wants that. No one wants to be hospitalized. 

And, look, if you need to be hospitalized, you're gonna be hospitalized. That's where we can break apart that concept of not needing a hospitalization is the highest quality hospitalization. What's the highest quality hospitalization? The one you didn't have!

-- Farzad Mostashari, MD

Time Stamps:

• (01:20) Distinguishing Incentives in Health Care
• (06:25) Unlocking the Potential of Primary Care
• (09:31) Thinking Holistically About Accountability 
• (15:22) Measurement, Medicare, ACOs and More
• (26:07) The Doctor’s Role in the Era of AI
• (33:04) Peggy’s Reflections

Links:
Connect with Farzad Mostashari