Bringing Advance Care Planning To A National Scale
By Mandy Cohen, CEO of Aledade Care Solutions and Steve Wardle, SVP of Aledade Care Solutions and former CEO of Iris Healthcare
A lot has happened in a year! In less than 12 months, Aledade acquired Iris Healthcare and successfully integrated and scaled up their proven, patient-facing solution across Aledade’s national network of 1,500 practices in 45 states. We are also pleased to announce that we exceeded the goals we set for delivering Iris’ comprehensive advance care planning (CACP) service to patients with serious illness across Aledade’s nationwide network of primary care practices.
Back in January of 2022, Aledade was in the process of establishing Aledade Care Solutions and acquiring Iris Healthcare, a leading advance care planning company. We launched Aledade Care Solutions with the vision of connecting high-cost, high-need patients to care services that support practices in Aledade ACOs by improving patient outcomes and reducing health care costs. Focusing on patients with serious illness was a natural place to start, and a successful randomized control trial with practices in Aledade’s nationwide network of ACOs gave us confidence that Iris’ model was highly impactful and ready for scale.
We set big goals for our first year together. We aimed to have Iris scale up its model of CACP services to Aledade member practices all across the country, allowing Iris to enroll 8,000 of the highest need patients in the program by the end of the year, essentially doubling the volume of patients served in FY ‘21.
This was not going to be easy. Integrating an existing company and employees into Aledade while simultaneously forming a new company and also scaling up rapidly was going to be a huge challenge. But the team stepped up to the plate — and hit it out of the park.
We spent several months integrating our technology platforms, aligning our operations and performing an initial launch of the service with a small number of our innovative markets. By mid-year, we significantly accelerated our pace. We tripled the size of our patient-facing teams and quadrupled our monthly volume of patient enrollments in just four months, all while maintaining the highest level of quality and driving impactful initiatives throughout a year of exponential growth.
We built a streamlined and data-driven operation. Our predictive algorithm was developed by a team of best-in-class experts in AI and machine learning at Curia.ai, which helped us identify patients who could benefit the most from this service in the next two years. We made sure that this service was free of charge to the practices and free of charge to patients, building on Aledade’s model of alignment between patients, practices and society, and bringing high-quality care at low cost. And, at the end, official legal documentation of a patient’s detailed, personalized care preference would be in patients’ hands and embedded in their medical records to guide care teams and families through a variety of critical care scenarios that might arise as their serious illness progressed or during a medical crisis.
In the end, the support for the CACP program from our Aledade partner practices exceeded our expectations, and allowed us to exceed our enrollment goal of 8,000 patients having received a CACP facilitation. We saw patient satisfaction scores for these services at 98.5%. And we heard from so many patients who benefited from a CACP. One patient told us:
"This is how I wanted it. And they’re all my decisions! You’ve removed my stress because now I have a plan. It’s very helpful to know that my doctors and my family will all know my wishes."
We know that many people avoid these conversations. Another CACP patient shared how pleasantly surprised they were with the experience:
"To tell you the truth, this [CACP] was something that I dreaded and procrastinated for a long time. The Iris person I worked with was so compassionate and kind that she actually made the experience.... enjoyable. I never thought I would think or say that."
The service is also highly beneficial to the patient’s family and loved ones. As one family member told us:
"I just want to say I appreciate this service being extended to mom; it was very helpful. It's not something people necessarily want to talk about, but you guys helped get that started and that's a good thing."
It’s a good thing for patients, and the family members who care about them. It’s also a good thing for our health care system, because it proves there’s a new way forward.
The process Aledade went through with this effort is the Aledade Care Solutions playbook that we intend to repeat with additional focused-care interventions. First, identify mission-aligned companies delivering focused-care solutions to patients that connect them with high-quality care and keep them out of high-cost settings. Then test how those solutions perform through a rigorous evaluation in coordination with Aledade member practices. And for those care interventions that are successful at improving health and reducing health care cost, we will scale and integrate those programs across the entire Aledade network to achieve greater scale and impact.
This year, we proved we can scale high-impact, high-quality care solutions across the largest network of independent primary care practices in the country. The Aledade model is built, fundamentally, on alignment. Our mission is that we are committed to building a health care system that does what is good for patients, good for practices and good for society. We have proven over the past eight years that this model is sound, which has allowed us to consistently grow at more than 40% a year. And what we have proven this past year is that we can successfully design, execute and scale innovations on top of that proven model.
Here’s the best part: we’re just getting started. We plan to use the lessons learned from this past year to scale Kidney Care Management services to Aledade’s network nationwide and we are currently incubating additional care services focused on Medicare Advantage success and overall cost savings.
We look forward to continuing to grow Aledade Care Solutions and connecting patients to high-impact care services that extend the reach of the Aledade platform and member practices - keeping patients healthy and out of the hospital.