We Got This! ACO Success in Year 4 and Beyond

November 10, 2020

By Ryan Knopp, MD – Local Medical Director, KS 2016 and Access ACO

(The following blog post was adapted from a message from Dr. Knopp to his fellow colleagues in Aledade ACOs in Kansas.)

It was late fall of 2017, at an Aledade all-staff retreat, where I first recall Dr. Farzad Mostashari alluding to year 4. 

“Year 4,” he told us, “is when the magic happens. An ACO develops into full maturity, starts achieving major goals, and ultimately reaps major rewards.”  

No truer words have been spoken. As I sit and reflect on our Aledade Kansas/Access journey with over four full years of value-based care under our belts, I cannot help but feel a swell of pride and accomplishment at the work we have done.  I also see the early momentum and success the Midwest/Opportunity ACO achieved in just two short years and marvel.  

The outcomes speak for themselves. According to its recent press release, CMS reported a $2.6 billion savings by the Medicare Shared Savings Program with physician-led ACOs saving Medicare nearly twice that of hospital-led ACOs. In addition, Aledade showed a 25% savings beyond other physician-led ACOs. No surprise that Aledade is growing rapidly from coast to coast. Our work pays off, both literally and figuratively.  


Good for patients, good for doctors, good for society. It is more than just a motto. Those words have truly come to life as value-based care proves itself to be both the present and the future of our healthcare system.

But complacency holds no place in the plans for our ACO. Our rallying cry is, “Good to great.”  What is the roadmap to success in the year ahead, and what barriers or roadblocks do we face?

First, hello, pandemic. We now face a new set of challenges in 2020. New workflows.  Testing/PPE challenges. Telehealth.  Delayed routine healthcare  Mental health crises.  Challenges around the development, socialization, and education of our children. Socioeconomic concerns. Food insecurity. Domestic violence. Health disparities.  

A daunting list, to be sure.  And all this beyond the usual, non-pandemic challenge of trying to avoid resting on our laurels or seeing a drop in our performance.

But here is what I know: Our Aledade family in Kansas and throughout the Midwest, our tight-knit group of clinics and providers, will look out for each other, our patients, and our communities. We have seen that special bond and cohesive approach pay dividends from the beginning. 

I know that we are well-positioned to manage the ripple effects of this pandemic beyond our response to COVID itself. 
Mental/behavioral health? Check. We know this to be one of the great public health crises of this generation, and we began prioritizing our ACO response to behavioral health concerns far before the pandemic.  

Delayed routine healthcare or patients simply not coming in to see their doctor?  Check.  Can you say gap lists?!  How about outreach worklists?  Attribution lists anyone?  We know how population health management works.  

New workflows and telehealth? Check. Old news, and we are pros at this point.  

Socioeconomic challenges and health disparities?  Check.  We are in tune with the impact that social determinants have on our patients’ well-being.  Understanding health disparities and working to achieve health equity is, in fact, the focus of October’s clinical call as well as Aledade Rounds (if you didn’t catch Farzad’s presentation on Aledade Rounds in the last couple of weeks, please check it out on the Aledade Learning Center).  

Value-based care positioning practices to survive and thrive despite a pandemic that throws fee-for-service out the window at times? Check. Commercial and MSSP contracts have become more than a bonus. They’re a financial lifeline for us at this point.

All this is to say – we got this! 

Thank you for your partnership, engagement, and efforts thus far. But now, let me offer a challenge. We are all indelibly accountable to one another at this point in the journey.  And it is time for our year-end Q4 push. Each provider and each clinic must continue to not only carry their weight but to constantly strive for improvement. I know it’s not easy. We are all being pulled in a hundred different directions. And in a pandemic year we could ask for grace in falling short on our percentage of Annual Wellness Visits, high-priority transitional care management percentage, Emergency Department visit follow-up, risk coding, and other metrics. 

The challenge, though, is to resist that urge and aim for excellence against all odds. I have a strong suspicion we are up to the challenge… year 4 and beyond.