Success in value-based care starts with physicians: How Aledade’s Clinical Engagement Team is delivering change through real-world expertise
Aledade’s vision of a health care system that is good for patients, good for doctors and good for society as a whole is led in large part by our Clinical Engagement Team (CET). This group of senior and regional medical directors strives each day to bring real-world expertise and insider perspectives for primary care practices and community health centers (CHCs) in our Accountable Care Organizations (ACOs).
In order to bring change, this team assists ACOs and supports practices and CHCs by engaging physicians in their value-based care journey. These talented physicians have been at the forefront of health care for more than two decades and keep their sights focused on helping primary care organizations guide patients to better health through the lens of our proprietary Core 4 model of care — access and quality; risk stratification; care transitions; and care compass.
Becoming trusted guides
The CET includes five senior medical directors and 14 regional medical directors, all under the leadership of Dr. Jen Brull, vice president of clinical engagement.
“We talk with our practices and health centers every month and leverage our relationships, data and our connections on the field teams to help drive change in the space of value-based care,” Brull says. “If you are a physician who owns a practice and signs up to be a part of an ACO, it does not generate less work, it creates more — but it is better work. That’s where my team steps in. Our job description is to help the Core 4 happen. That’s our biggest responsibility.”
Members of the field teams are working with front line staff — those who are doing the work in the Aledade App — a workflow tool to support ACO work in practices and CHCs. This application combines several robust patient data sources and creates valuable insights, which helps more effectively manage patient populations.
The CET leverages their relationships with physicians so they more readily agree to do things like review the daily huddle, approve new workflows and determine priorities, Brull says.
“There are other things that we do as well, including lending a voice around new clinical work that is happening. When we roll out initiatives to the members of our ACOs we ask them their thoughts and if there is anything we can do within that initiative that would make their connection with the patient stronger, or make their work easier,” she says. “We are able to then bring that feedback to Aledade and be an advocate for practices and CHCs by detailing the issues they see in the initiative.”
What makes this team so successful, Brull says, is their ability to take ACO members who are not performing as well as they could and elevate them so they can help move the whole ACO forward.
Brull recalls one such accomplishment during her time as a regional medical director.
“One of the successes I was most proud of concerned a very large practice that had six sites and around 100 physicians. Because of their size, it was difficult to engage all of the clinicians,” she says. “I had an amazing field team crew, and we brought their ACO medical director onto our team and connected the sites so we could offer our services at each location. We began to share more data within the ACO so the big clinic could see how their performance was holding back the ACO.
“It was that combination of how to leverage each part of the equation to strategize and create an environment where the ACO could really flourish,” Brull says. “Now, they are one of the leading practices in that ACO, all the sites are engaged, the medical director is plugged into the whole ACO, not just his practice, and serves as a local medical director to other practices in the ACO. That was a big victory, and we were able to make a huge difference in that ACO — it was a real team effort.”
Changing hearts and minds
Victories like that are the bread and butter of what this team does, which is to change hearts and minds, says Dr. Emily Maxson, chief medical officer for Aledade.
Maxson is proud of the team and their many accomplishments, including their dedication to bringing comprehensive advance care planning (CACP) to patients.
“I am proud of the team for helping pave the way for CACP for our patients in need and those who are at high risk of passing in the next 12 months. It is really important that we understand and heed their wishes at the end of life, whatever they might be,” she says.
The success of this initiative exemplifies the CET’s ability to really understand practices and CHCs, including what drives them and the barriers they face, then thinking critically of how to overcome them with empathy, Maxson says.
How to grow successfully
The Clinical Engagement Team creates more trust-based relationships with clinicians each year and helps express our desire for medicine that is good for patients, good for practices and good for society. Explore the expertise and experience our CET members bring to Aledade and ACO members.
If you're a member of an Aledade ACO, you have unlimited access to additional clinical resources reviewed and approved by the CET.
If you're not yet a member of an Aledade ACO, getting started is easy. Schedule a personalized consultation to discover the benefits of Aledade ACO membership for your organization.