Aledade’s Chief Policy Officer on Advocacy for Alternative Payment Models
As Healthcare Innovation reported earlier this month, “On Jan. 16, the leaders of the Bethesda, Md.-based Aledade, a national physician enablement company, announced the creation of a policy institute, called the Aledade Policy Institute. A press release posted to the organization’s website began thus: ‘To strengthen primary care and advance value-based care in the United States, Aledade, the nation’s largest network of independent primary care, announced its launch today of the Aledade Policy Institute’ The Aledade leaders noted that ‘The Aledade Policy Institute builds on the company’s success fostering collaboration and dialogue with regulators, legislators and stakeholders on value-based care. As a Public Benefit Corporation, Aledade prioritizes efforts that advance social good, and not just business objectives, as part of its mission. The Institute will play an important role in this effort by sharing insights to enrich health care policy discussions at a pivotal time for state and federal leaders.’”
The press release quoted a statement by Farzad Mostashari, M.D., co-founder and CEO of Aledade, that “The Aledade Policy Institute will be a powerful voice for advancing primary care and value-based care at this important time in our nation’s history. Sensible policy can materially improve the health outcomes of individuals and communities and the clinicians that serve them. Through this Institute, we are committed to supporting the needs and lifting up the voices of primary care practitioners and advancing policies that encourage even more widespread adoption of value-based care.”
The press release also noted that the Policy Institute “will focus on advancing policies across four key areas:
• Strengthening value-based care models to improve outcomes and reduce costs.
• Enhancing payment and regulatory systems to ensure sustainable primary care, including reducing the administrative burden these practices and health centers face.
• Promoting choice and competition to foster innovation in the U.S. health system.
• Driving interoperability to unlock the potential of health data.”
Shortly after the announcement, Healthcare Innovation Editor-in-Chief Mark Hagland interviewed Sean Cavanaugh, Aledade’s chief policy officer, regarding the announcement, and about the policy landscape around accountable care organizations (ACOs) and alternative payment models (APMs). Below are excerpts from that interview.
Why did you and your colleagues at Aledade feel you should create a policy arm?
There are a couple of reasons why we’re doing this. Not long ago, Aledade became a public benefit corporation. And our mission is to do good things for our society, as well as running a good business. And I run the policy shop; and there’s a group of us who run policy and advocacy. And we try to do good things. But we’re not perfect, and maybe we can bring some people in to help us discuss what we’re doing on a policy level. And are we living up to our public-benefit mission? And with a new Congress and new administration, the timing seemed good around this as well.
There are already a number of other organizations involved in policy advocacy in this space, including NAACOS (National Association of ACOs), APG (America’s Physician Groups), MGMA (Medical Group Management Association), and AMGA (American Medical Group Association): do you feel anything’s missing?
We’re big fans of those organizations, and I’m on the board of NAACOS and the National Transformation Task Force. They’re great, and we’re big fans. But we like to inform their work as well. And we have such a large network, and we’ve been at this for ten, eleven years now, and we our work can inform theirs. And a lot of focus has been on federal advocacy; but we also do state-level advocacy in 13 states, soon to be 14 states. And in those states, we work through a lot of our primary care doctors. A lot of them are interested in policy, and we coach them. For example, there’s a big issue around supporting the existence of primary care, whether it’s mandating spend on PC. So we’ve moved forward. For example, the state of Delaware mandated greater reimbursement to primary care doctors; and we were a driving force in that legislation. There’s a similar movement taking place in Arkansas. So we think we have something to contribute on our own, both on a state and federal level, not to their exclusion, but through augmenting their work. We have policy know-how and also a lot of on-the-ground experience, so we can inform and augment their work.
Benchmarks over time have emerged as a real issue for provider leaders. Do you and your colleagues at Aledade also see the appropriateness of the calibration of benchmarks as an issue?
Absolutely: for these models to work over time, they have to provide sustainability for our physician practices. So yes, we’ve been working with federal policymakers to help them understand that. And two years ago, CMS made a statement saying that they did understand this. MedPAC has acknowledged it several times, Congress is starting to get it. Now, we need to get real solutions embedded into programs, so that is one part of what that bullet point in the press release.
What are you anticipating will be the hardest thing to accomplish in advocacy?
One of the unappreciated facts is that the MSSP [Medicare Shared Savings Program] has worked; people at times have described the results as disappointing. But this is unprecedented for one-third of Medicare beneficiaries to be cared for under this program, improving the quality of care and reducing costs. So trying to deliver the message that this program has been successful. So if you think of the 68 million roughly Medicare beneficiaries, one-half are in MA. So you’re talking about 30-something remaining, it’s about 11 million in the MSSP. The important thing is that it’s very sizeable; it’s not like some small experiment that worked in Peoria; this is working across the country. And we should all figure out how to bring the success forward to more.
Do you see success and participation expanding in the near future?
Every administration so far has been committed to growing the program. So I’m optimistic from that perspective that we are aligned in terms of the goal; we just need to get the details aligned.
So you feel pretty optimistic overall, then?
I do, yes. We’re going to try to do some good work going forward.