103. 150 Years of Obamacare

Dr. Caroline Fife and Dr. Christopher Apostol join us to explore the rising cost of skin substitutes in wound care, which Aledade data suggests is a tenfold increase in the last three years. Dr. Fife explains that rising costs are due to an increase in both cost of the product and increased usage and she addresses the real concerns such as the way many skin substitutes are exempt from FDA review, offer rebates or discounts to clinicians and how some Medicare payment models incentivize the use of more expensive treatments. Dr. Apostol also notes how wound care has evolved through the lens of primary care, including an increase in specialist utilization and mobile wound care teams. Connect with us at [email protected] or visit the Aledade Newsroom

Dr. Amelia Bond and Dr. Dhruv Khullar join us to discuss the long-term savings of accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). Their recent study in JAMA found that ACOs generate increasing savings over time, with physician-led ACOs demonstrating more significant savings. Learn about their study’s methodology, policy implications for The Centers of Medicare & Medicaid Services (CMS) and where Dr. Bond and Dr. Khullar will focus their research next. Connect with us at [email protected] or visit the Aledade Newsroom

Natalie Davis, CEO of United States of Care, joins us to talk about the challenges of discussing value-based care with patients and policymakers. Through extensive research with over 30,000 individuals, Davis shares that the term "value-based care" often evokes negative connotations of low-quality care. When presented with the benefits of value-based care without using the term itself, people were most interested in spending more time with their doctors and receiving personalized, quality care. Join us to learn more about effectively communicating with patients and policymakers about value-based care. Connect with us at [email protected] or visit the Aledade Newsroom

A majority of those with behavioral health challenges lack access to high-quality care. Gabe Diop, co-founder of Rula, a behavioral health physician group, joins the ACO Show to discuss how Rula is making behavioral health care more accessible by partnering with primary care practices to connect patients with the care they need. Dr. Samantha Cotler, family medicine physician in Wall, N.J., explains how her partnership with Rula has improved patient outcomes and made it easier to connect patients with in-network physicians. Connect with us at [email protected] or visit the Aledade Newsroom.

The U.S. faces a significant shortage of primary care physicians, particularly in rural and under-resourced communities. Join Eli Greenspan, policy advisor at Foley Hoag LLP, and Dan Bowles, general manager of Practice Health Solutions at Aledade, to highlight the role that international medical graduates play in addressing this shortage. They explain the complex process that international medical graduates must complete to practice in the U.S., and how the physician shortage is connected to immigration policy. This includes the Conrad 30 Waiver Program, which incentivizes graduates to practice in under-resourced areas. While this program is valuable, it’s also limited in scope, so our guests explore additional legislative efforts to improve and expand these programs. Connect with us at [email protected] or visit the Aledade Newsroom.

Aledade CEO, Dr. Farzad Mostashari, and best-selling author Geoffrey Moore explore how the concepts in Moore’s influential book, “Crossing the Chasm” can be applied to accelerate adoption of value-based care. In order to move to mainstream adoption, it’s crucial to focus on the niche market of “pragmatists in pain” who have an urgent need that the current system isn’t solving. Our co-host Sean Cavanaugh, chief policy officer at Aledade, points out that oftentimes in the traditional fee-for-service model, the pragmatists in pain are independent primary care clinicians. Moore and Dr. Mostashari also share insights and recommendations for the new administration from their recent article, including focusing on primary care, defining the competition and paving the way for simplifiers who can help clinicians navigate the complexities of value-based care. Using this framework, the Center for Medicare & Medicaid Services (CMS) could accelerate expansion of value-based care to the majority of the nation’s primary care clinicians as well as their patients. Connect with us at [email protected] or visit the Aledade Newsroom.

Join us this episode as our guests from Aledade, Dennis Liubyvyi, Director of Artificial Intelligence (AI) Research, and Jette Henderson, Staff AI Researcher, explain the world of AI and machine learning and its potentially transformative impact on health care. Dennis shares how AI models at Aledade are reshaping patient care by analyzing vast amounts of patient data to predict critical health events such as kidney disease progression and congestive heart failure. The goal is to provide more timely, targeted interventions to patients who need them most. Jette also notes the challenges that exist in these predictive models, particularly regarding biases within data sets, which can lead to inaccurate predictions and how Aledade is developing tools to help identify and mitigate these biases. Connect with us at [email protected] or visit the Aledade Newsroom

Dr. Sameer Sheth, President and Co-Founder of Chamber Cardio, joins Josh and Sean to discuss the opportunities and challenges for specialists, particularly cardiologists, in transitioning to value-based care. Dr. Sheth notes that cardiologists have traditionally been slower to adopt value-based care because of a lack of financial incentives, but an increasing drive to remain independent is pushing more cardiologists towards value-based models. Dr. Sheth shares how he and Chamber Cardio are working to create a network of cardiologists, health plans, and tools to better incentivize their transition to value-based care. Connect with us at [email protected] or visit the Aledade Newsroom

Join Melanie Phelps, Senior Advocacy Advisor for Health System Transformation at the American Heart Association (AHA), to discuss her recent research which explores the impact of ACO-driven value-based care from the patient and caregiver perspectives. Melanie explores the overwhelmingly positive results of the study, which found that patients and their caregivers experienced better care, better support, and better patient outcomes as a result of their clinicians’ participation in an ACO. Dr. Julie Prosseda, Family Medicine Physician in Wilmington, DE and a participant in the AHA study, joins us to explore the reasoning behind these benefits of value-based care for patients, which is largely due to better relationships with their primary care physicians, as well as access to timely support and resources from an expanded care team. This more wholistic, patient-centered value-based care leads to enhanced patient engagement and a more trusting clinician-patient relationship. While it’s clear that patients should be demanding broader access to value-based care, Melanie and Dr. Prosseda also explore the challenges of expansion, including increasing educational opportunities and more alignment among payment models. Learn more about the American Heart Association’s research: Understanding Patient, Family Caregiver and Health Care Team Member ACO Experiences Connect with us at [email protected] or visit the Aledade Newsroom

Value-based care is a team effort, and nurses play a crucial role in coordinating care to achieve better and more efficient patient outcomes. Jacqueline Nikpour, Assistant Professor at the Emory University School of Nursing, and Kathy Samhammer, LPN at Cedar Ridge Family Medicine, join us to discuss the role of nurses in primary care, and how practices can maximize nurses’ contributions in the shift towards value-based care. Kathy’s role includes managing chronic conditions and preventing hospital readmissions, and she discusses the importance of ongoing, personalized communication with patients, especially after ER visits. This approach has led to better patient engagement and satisfaction, which is crucial for improving health outcomes. As Kathy demonstrates, expanding the role of nurses in value-based care is critical, but Jacqueline also notes the challenges in this expansion, including payment and recognition of nurses’ value. By addressing these challenges and better integrating nurses in patient care teams, we can ensure better care coordination and a more patient-centered health care system. Read Jacqueline’s article in Health Affairs: To Improve Outcomes Under CMS’ ‘Making Care Primary’, Focus On Registered Nurses Connect with us at [email protected] or visit the Aledade Newsroom