Written by Aaron McKethan
Last week, I joined Aledade, where I’ll help launch new ventures to improve health care. With Aledade’s same founding mission and innovative spirit, we are envisioning new ways to strengthen and grow primary care all across the country. In this blog, I share what led me here.
First, some background: My wife and I both grew up in Boone, a small scenic town in the mountains of western North Carolina. Every time we go back home, we note changes since our last visit: the population is growing, traffic is increasing, and the local university is adding new students and bigger buildings. We also note how the local economy is changing.
New local businesses launch every year, bringing fresh energy to the community. A new independent bookstore in Boone recently received a surprising shoutout from actor Tom Hanks on late-night television. New local entrepreneurs join a fabric of independent business owners committed to knowing their customers and their families, often going back for generations. Local business owners hire local people. Their initiative, imagination, and risk-taking put food on the table of local people, send children to college, and contribute to local charities. They communicate with customers directly, not through customer service hotlines or “remote chat specialists.” And their profits remain local, multiplying benefits within the community.
While there are always new businesses to celebrate, we have also witnessed the closure of many small companies struggling to compete against the growing presence of national corporations and franchises. While economic change is complex, there are important, hidden costs when small businesses close. With increasing reliance on larger corporations headquartered elsewhere, there is a tangible loss of connection, memory, and the capacity for local action. Residents of a local community can start to see themselves as isolated consumers rather than as members of a local ecosystem. Communities with historical distinctions gradually start to converge toward the homogeneous look and feel of all others.
The health care industry is not immune from the same market pressures favoring consolidation and increasing scale. Nationally, many physicians have been acquired by large health systems or corporations. While efficiency is the stated rationale of such acquisitions, higher costs for patients, employers, and taxpayers is the common result. These changes also influence physician joy and burnout. Many physicians who join large corporations trying to escape the real stresses of independent ownership find that their new work often involves meeting corporate productivity targets, patient referral expectations, and onerous documentation requirements. Hence, the act of selling a practice to refocus on the joys of patient care can result in replacing one kind of headache for another.
How will these trends affect patient care, the health of local communities, and the people who live there? Growing up, I saw firsthand how medical professionals as small business owners know the people they serve and are committed to the long term flourishing of the community. The couple that owns and operates our town’s local pharmacy (where I ran the cash register in high school) also led my church’s youth group. While my wife’s grandfather operated his own dental practice, he also served as an elected county commissioner to spearhead development of a new public library. When my parents’ primary care practice told us that Dad had terminal cancer, they provided excellent, compassionate care. They also activated a network of personal relationships to help our family in Dad’s last year of life.
All of this brings me back to Aledade and my new role. Aledade continually strives to answer a simple question: “How can we best serve physician practices to maintain and strengthen patient relationships in an increasingly complex, corporatized health care economy?” Underlying this question is a conviction that physician independence - which can take many forms - confers clinical autonomy for doctors to enter into healing relationships free to do what they believe is best for their patients and neighbors.
In its first seven years, Aledade has offered tools, technologies, and training to strengthen the healing work of partner physicians. Now that the core Aledade model has shown repeatable success, we are compelled to deepen partnerships with physician practices, launch new organizational and financing models, integrate new clinical services and capabilities, and make it easier to start new practices on the road to value-based care. There is much hard work ahead, but it’s work that’s worth doing.
I join Aledade with the conviction that every community is stronger with successful, resilient physician practices who are invested in their patients and neighbors, have the tools and capabilities to succeed, and are true stakeholders in helping their local communities flourish. Supporting these goals is why I’m proud to help Aledade chart its next course