Four years ago, I wrote a blog post to celebrate the second birthday of this new, little company we had started, called Aledade.
I made a pretty bold claim for such a scrappy and small team: “our success will be a marker and a model for whether it’s possible to return control of healthcare to doctors over corporations if quality can triumph over size, and whether less spending can come from better care not less care.”
This fall, with the public release of data from the 2019 Medicare Shared Savings Program and data from our contracts with commercial and other payers (like today’s announcement of our work with Blue Cross and Blue Shield of Kansas), we finally have answers:
Yes. Yes. And resoundingly yes.
In 2019, Aledade ACO practices provided better care for more than 800,000 patients across 27 states - and by better care, I mean more primary care and prevention - more follow-ups when a patient left the hospital, more patient engagement, more coordinated care especially for patients with chronic conditions like high blood pressure and diabetes.
All of this more yielded a lot less. 10,000 fewer hospitalizations. Fewer unnecessary visits to the emergency room. Fewer days spent in a nursing home.
Including our work with commercial health plans, Aledade ACOs have saved the health care system more than $400 million over the past five years by rewarding physicians for delivering care the right way.
Take a moment to appreciate the scale of that. When we first started in 2014, we operated just two ACOs. We helped coordinate the care for just a few thousand patients. Today, more than half the states in the country are home to primary care practices in an Aledade ACO - and we’re growing every year. And every year, we’re helping save hundreds of millions of dollars in health care so it can be spent on helping people stay healthy, not waiting until they get sick.
More than 7,000 independent physicians work with Aledade to care for patients in urban neighborhoods and rural communities stretching from the East Coast to the West Coast. They’re providing care to patient populations in the Mississippi Delta, in the rural communities of Kansas, in the boroughs of New York City, and in the mountains of Utah. They live and work in wildly different and diverse places, but they are all achieving the same thing: results.
Simply put, the model we started in 2014 works -- for patients and doctors. For their work in 2019, just with Medicare Shared Savings Program, our network of independent primary care practices earned $55 million - on top of their traditional Medicare revenue. While it varies by the size of the practice, that comes out to roughly a quarter of their annual Medicare fee-for-service revenue. For some practices, it was as much as half their FFS revenue. That’s not even counting the savings checks from our contracts with commercial payers, Medicare Advantage, or Medicaid. In 2019, every single one of our Medicare Advantage value-based contracts achieved savings.
If you work in an independent primary care practice today, no matter where you live, whether you work with patients covered by Medicare or Medicaid or private health plans or Medicare Advantage, chances are the Aledade model has succeeded in a practice just like yours.
This couldn’t be a more important time to help primary care practices move into value-based care. Fee-for-service has failed. It’s not good for doctors. It’s not good for patients. And as the COVID-19 pandemic proves without a doubt, it’s not good for society.
That doesn’t mean the alternative will get here automatically or instantly. It takes some work.
In 2016, our Senior Vice President of Policy and Economics Travis Broome sat down with me to reflect on our first full performance year for our very first ACOs for the American Journal of Managed Care. How did we do? What did we learn?
The short answer was that we were confused. When we looked at the data, we did everything right. In our Delaware ACO, for example, we reduced hospitalizations. We reduced unnecessary emergency room visits. We reduced readmissions to the hospital. We increased preventive care like blood pressure screening, tobacco cessation, and vaccinations for pneumonia. But by the end of the year, costs overall had actually gone up, and we didn’t earn any savings.
We had a lot to learn, and a lot of hard work to do. We had to learn what interventions worked. Like the Annual Wellness Visit. Our data showed that patients who received an initial AWV from their primary care provider (with support from an ACO) saw total healthcare costs of 5.7 percent over eleven months, and clearer results for higher-risk patients. Our data also showed that the AWV was a gateway to better primary care. Specifically, patients who received an AWV had a 70 percent higher screening rate for fall risk and depression than those who did not. AWVs led to higher rates of A1C control, breast cancer screening, colorectal cancer screening, and tobacco use screening and cessation intervention.
We knew these visits worked, we just had to help more practices do them. And it was hard work! Many of the practices we work with have been caring for their communities for generations, and all of a sudden, here we were, explaining that we had to do more of these visits. It required new data, new workflows, and a new approach to care - instead of focusing on who just came in the door, finding the high-risk people who weren’t even coming in. These practices started seeing results, and started sharing the stories of how the work was done.
In our first year, practices in Aledade ACOs conducted AWVs on about half of their patients. By 2019, that was up to more than two-thirds. Between just 2018 and 2019, Aledade ACO practices increased the primary care services with a PCP by 7.5 percent, that meant 90,000 more visits between patients and their primary care provider in 2019.
This year, as the results from their 4th performance year came back, the same Delaware ACO that didn’t earn savings in that first year earned a quality score over 92% including particularly high marks for helping patients control their blood pressure, and earned $12 million dollars in savings - which means they will be receiving a shared savings check from Medicare that is equivalent to more than half of their annual Medicare fee-for-service revenue. In fact, all of our ACOs in their fourth year earned savings. And 95 percent of ACOs in their third year did, too.
What happened? To put it simply: it takes time, and a lot of hard work in the bank. We’ve been road-tested and put through our paces. We’ve learned what is important, and what isn’t. We’ve collected best practices and lessons learned. We’ve built the muscles to do this work the right way and get rewarded for it.
Value-based care done the Aledade way is tough work, but it’s honest work. It isn’t instantaneous, but it’s lasting. And it’s proven that we can give control of health care back to doctors over corporations, that quality wins over size, and our entire health care system can spend hundreds of millions of dollars less on health care by helping doctors provide better care - by turning this health care system into one that finally treats every patient with the dignity and care that they deserve.