The Power of a Value-Based Care Family

By Miranda Morris, Aledade Executive Director for Arkansas

Primary care is really about family. By virtue of the longstanding relationships primary care providers develop with their patients these medical professionals become part of our families.

We rely on the judgment and commitment of our primary care physicians to help us navigate the fragmented US healthcare system. The men and women who fill these roles give selflessly of themselves throughout their careers to proactively manage our overall health needs.

They answer calls on Saturdays for emergency advice about spider bites (spoiler alert: it’s probably not a spider bite). They field emergency requests for refills, make critical referrals, and hold last-minute add-on visits. They dedicate time and emotional energy into counseling us about things far beyond our organic bodily functions. For many of us, our primary care providers are the objective voices of reason as we navigate the aging process.

As an Aledade ACO administrator, I am honored to support 109 primary care clinical sites around the state of Arkansas. I’m continually amazed at how much of the work that is part of every primary care clinic’s daily reality doesn’t get recognized and isn’t compensated under our current payment systems.

Last Spring, during the height of the initial impact of the COVID-19 virus, among some of the most stressful uncertainty the Arkansas primary care community has ever faced, I noticed a Facebook post from one of our ACO partner clinics. It brought tears to my eyes. The Administrator at the Winston Clinic in Sheridan, AR had shared a sweet post from the Zini Clinic from Mountain View, and she accompanied it with the comment, “We love our Aledade family and brother/sister clinics!”

This comment perfectly sets the tone for the triumph of helping deliver nearly a million dollars in Shared Savings checks from the Medicare Shared Savings Program (MSSP) to the Winston Clinic, the Zini Clinic, and 11 of their “brother and sister clinics” around the state for their work in 2019.

These 13 primary care clinics represent a broad cross-section of Arkansas. They include small, rural, single-physician practices, and they include large, complex, urban sites. Some care for patients in rural areas where cellular service and broadband remain largely unavailable. Others provide critical proactive primary care services in downtown Little Rock to both the vulnerable and the affluent.

Between them, these clinics employ 78 physicians and advanced practice partners—and several hundred more nurses, techs, administrators, and other staff. Despite their different patient populations, the distance between them, and their different sizes, I’ve invariably heard the providers and staff members in these clinics talk about their patients and each other like they talk about family. That’s the power of a network like Aledade’s.

As a profession, primary care is still very tough going. Primary care physicians have some of the lowest salaries in the medical profession, and they have to manage high overhead costs if they want to remain independent. Their communities rely on them, so vacations are difficult, and personal time is rare. It can feel like lonely and isolating work at times.

Over more than a decade, each of these Arkansas clinics has been working in various programs to make the transition to value-based care. Insurance companies and public payers create programs to help compensate these clinics for all the costs and complications that they prevent through proactive care, work that can’t be directly billed to a patient. This includes things like keeping their patients healthy and identifying illnesses or diseases as early as possible to alleviate downstream suffering. Usually, this work comes with significant documentation, reporting, and administrative requirements and, as we’ve found in Arkansas, it usually requires a group of practices to come together to share their best practices and work on improving the quality and efficiency in their clinics. Value-based care requires teamwork.

For a group of independent primary care clinics to achieve Shared Savings through this Medicare program, they must be practicing at the top of their game, and they must have strong team support. These generalizations are spot-on for the 13 clinics in the Aledade AR ACO that we fondly refer to as our “OG ACO.” We call them that because some of these practices have been working with Aledade in Arkansas for more than five years now. Unfortunately, because the initial MSSP program wasn’t well-aligned with the CPC+ program that has seen such wide uptake and achieved such a valuable impact in our state, those clinics faced a long wait to get paid for several years of upfront investment to better serve their patients and their communities.

Their years of effort will finally pay off next month when the 13 clinics will split just under a million dollars to go toward their practices and their continued support of their communities.

In the course of achieving this goal, these clinics have improved processes and increased their efficiency and responsiveness to serve families in communities around the state, and they have done this with ingenuity and compassion. And along the way, they have become connected to each other. They have become family.

Staff from Dr. Randy Walker’s clinic in DeQueen have huddled with staff from Dr. Derek Lewis’s office in Little Rock to share tips with each other on using a new electronic health record. As an early adopter of value-based care and team-based clinical service models, the CEO at SAMA Healthcare Services in El Dorado has coached and mentored administrative staff members at other ACO practices. Dr. Shawn Purifoy, Local Medical Director and physician owner of Malvern Family Medical Clinic, has provided hundreds of hours of infinitely patient clinical leadership to the entire group. 

There are countless other examples of these clinics sharing resources and insights that have made each of them stronger and more committed to the care they provide for their communities. These newest MSSP results represent compensation for years of hard work and dedication. I am honored and humbled to be able to share a small part of their story, and I look forward to many more years of continuing to serve these practices as they serve our state.