Being Able to Focus on the Future: Our Practice’s Experience in Value-based Care with Aledade and Anthem

October 18, 2023

By Dr. Richard Cole, Patrick County Family Practice

I like to tell people that our town was once so small that it was a one stoplight town, and that one was on our driver’s ed course.

Today, we have a few more stoplights. But it’s not just the traffic that has changed. Health care has changed, too. When I went into medicine, the goal was to care for people and keep them healthy. But over the years, the practice of medicine became too focused on making money and “delivering services.” 

That’s why I’ve been so thankful to be part of an accountable care organization, working together with companies like Aledade and Anthem Blue Cross and Blue Shield in Virginia. Now we can focus again on preventive care, and keeping people healthy. We can spend our time on the type of health care that America needs more of right now.

Our practice started in 1991. Six years later, we became a rural health clinic, now serving a population of more than 35,000 patients in and around our county in southwest Virginia. There used to be more health care access in this area, but in 2017 our local hospital closed. That meant, suddenly, our patients had no local access to an emergency department or an X-ray machine. Patrick County Family Practice became the only medical provider in the county. So we did what our community needed – we expanded hours, hired a few more clinicians, opened urgent care, even installed an X-ray machine of our own. It was hard work and significant investments, especially since we were making them in the old fee-for-service system.

Then we joined an ACO. Right out of the gate, it gave us the ability to expand access and offer more preventive care. 

Now we can reach more patients. We can offer telehealth for homebound patients who can’t get into the office. We serve a rural community that has poor cell and internet service, and even just a phone call can make the difference between whether a patient winds up in the hospital or not. We’ve been able to expand our phone hours, offering help over the phone on nights and weekends.

And when we get a patient into the office, we can make the most of that visit. Now, if I find out through Aledade’s Daily Huddle that the patient in front of me hasn’t had their annual wellness visit yet, I can do that while they’re there. We can check our quality measures to make sure we’re making steady progress. We can get data from outside our EHR, like making sure we know when a patient has gotten a mammogram.

It’s not that we couldn’t do all of this before, but joining value-based care meant we didn’t have to choose between keeping our practice running and delivering the type of care our patients needed. Joining an ACO made it worthwhile to go the extra mile.

It’s been essential to also have a payer that works with us in all of these efforts. Anthem has given our practice easier and more straightforward reimbursement for claims. They keep our practice revenue flowing without throwing a bunch of denials and red tape my way. And thanks to their work on value-based care, I’m able to give even more of my patients – including patients who are commercially insured or covered through the Health Insurance Marketplace – the same kind of value-based care my patients on Medicare get.

What this all means is that, more and more, we’re able to focus exclusively on better health outcomes for our patients. More and more, I’m able to think about the future.

A lot of independent practices don’t get to do that these days. Too many independent practices have gotten bought out, and I’ve been hoping that trend can be reversed in our country. I want to show young doctors who care about primary care – who care about supporting their community – that they can still be entrepreneurs. They can still own and run their own practice.

Value-based care like the kind Aledade and Anthem have brought to our practice is the path to staying independent. Thanks to the shared savings I’ve earned in value-based care, I’m able to put our small business on a more solid financial footing. We’re able to retire debt. We’re able to pay our staff fair salaries to reward them for the tireless work they do and keep them close in a tight labor market. We can even fix one of the biggest problems that has hit my community and rural communities across the country: hiring more doctors. Thanks to our shared savings revenue, I’m considering hiring another physician in our practice and growing the health care expertise in our community, instead of just watching it shrink. 

My wife always reminds me of an old saying: “People don’t care how much you know until they know how much you care.” I’m grateful to our partnership with Aledade and Anthem, because it’s helping us show this community, our neighbors and friends, how much we care for their health and well-being. It’s helping us see a brighter and healthier future together.