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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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