201. The North Carolina State Health Plan Preferred Provider Strategy with Treasurer Brad Briner

Brad Briner, North Carolina state treasurer, and Alex Mullineaux, Aledade regional market president, join Josh Israel, MD, and Sean Cavanaugh to discuss the state health plan’s new preferred provider strategy. The goal of this approach is to improve patient health outcomes and reduce costs by connecting patients with clinicians that have a proven record of  high-quality, cost-effective care. Treasurer Briner and Alex share how this strategy came about, the benefits for patients and how North Carolina hopes to scale the plan in the future. In phase one, the state health plan approved partnerships with three networks to support this initiative, including Aledade.

Paul Offit, MD, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, joins Josh Israel, MD, and Sean Cavanaugh to discuss the recent decision by the Centers for Disease Control and Prevention (CDC) to move several vaccines (including rotavirus, influenza and COVID-19) from a universal recommendation to shared clinical decision-making. While shared clinical decision making has always been an option for physicians and patients, Offit provides practical tips for clinicians navigating these conversations, advising physicians to be empathetic to patient fears, but also to be passionate in explaining the severe risks of vaccine-preventable diseases.

Amelia Knopp and her father, Ryan Knopp, MD, from Stone Creek Family Physicians in Manhattan, Kansas, join Josh Israel, MD, and Sean Cavanaugh to discuss Amelia’s experience with the health care system following a shocking leukemia diagnosis. They share how this diagnosis set Amelia and their family on a journey that they describe as “health care at its best.” Amelia emphasizes the importance of trust in the physician-patient relationship, and how advocating for patients and providing clear communication helps build a better patient experience. Ryan notes how his daughter’s experience underscores the importance of value-based care in ensuring that physicians are invested in the relationship with their patients and providing high-quality, accountable care.

Catherine Olexa-Meadors, head of growth and partnerships at Town Hall Ventures, joins Josh Israel, MD, and Sean Cavanaugh to discuss the recently announced ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model from the Center for Medicare and Medicaid Innovation (CMMI), also known as the CMS Innovation Center. They explain the new payment system, which includes outcome-aligned payments tied to demonstrating improved patient outcomes, and how advances in technology, specifically in digital patient engagement, could help this model succeed. They also explore challenges, including the delay in the announcement of payment rates and the concern that patients not in an accountable care organization (ACO) may not have someone monitoring the total cost of care.   Watch the full episode on YouTube   Listen to Episode 193: Breaking down CMMI's new strategy with Abe Sutton, director of CMMI, and Farzad Mostashari, MD

Shawn Martin, executive vice president and CEO of the American Academy of Family Physicians (AAFP), joins Josh Israel, MD, and Sean Cavanaugh to discuss challenges with the future of primary care, particularly independent primary care practices. Martin believes that value-based care has helped sustain rural health care practices and that the Medicare Shared Savings Program (MSSP) will serve as the foundation for value-based care moving forward. Martin stresses the benefits of partnering with support organizations, like accountable care organizations (ACOs), in succeeding in value-based care and outlines opportunities for the AAFP to partner with ACOs to support physician independence, provide value-based care training and advocate for rural health care funding.

Margaret E. O’Kane, CEO, president and founder of the National Committee for Quality Assurance (NCQA), joins Joshua Israel, MD and Sean Cavanaugh to discuss how the organization has helped transform quality measurement in the American health care system. Over the past 35 years, O'Kane and the NCQA have developed quality measurement standards for clinicians while striving to minimize the administrative workload that comes with an expanding array of quality metrics. O’Kane advocates for a future where quality measures are better integrated into health care technology systems, emphasizing that systemic changes are crucial for improving quality, rather than solely focusing on individual physicians. Watch the full video episode

Join Josh Israel, MD, and Sean Cavanaugh, along with Brittney Anderson, MD, family physician and podcaster (“Physicians Hanging a Shingle”) and Dan Bowles, general manager of practice health at Aledade, to discuss Anderson’s journey to owning her own private practice, and how she supports other physicians seeking independence. Both Anderson and Bowles believe value-based care is crucial for independent primary care practices, and that greater exposure to independent practice models is essential to provide physicians with more employment options. As Bowles explains, this is the driving force behind Aledade’s effort to support physicians looking for information and a path to their own independent practice. Connect with us at [email protected] or visit the Aledade Newsroom

Join Josh Israel, MD and Sean Cavanaugh in their video debut as they discuss the Medicare Shared Savings Program (MSSP) results for 2024 released by CMS with Aledade CEO Farzad Mostashari, MD They explore how Aledade Accountable Care Organizations (ACOs) earned more than $1 billion in total savings and continue to improve performance year over year, including substantially reducing hospitalizations. We also sit down with Sandeep Mann, MD, primary care physician and Aledade partner since 2015, to explore how his practice has thrived in value-based care. Watch the full episode Connect with us at [email protected] or visit the Aledade Newsroom

Abe Sutton, director of the Center for Medicare and Medicaid Innovation (CMMI), sits down with Aledade CEO Farzad Mostashari, M.D., and Sean Cavanaugh to unpack the new strategic framework for CMMI models. Sutton explores CMMI’s focus on three pillars: promoting evidence-based prevention, improving patient access to their health data and driving choice and competition in health care markets. He discusses the recently announced WISeR (Wasteful and Inappropriate Service Reduction) Model, which aims to leverage artificial intelligence (AI) in reviewing prior-authorization requests to prevent harmful or unnecessary services. He also talks about the Ambulatory Specialty Model (ASM), which would reward specialists for improving health outcomes in Medicare patients with lower back pain or heart failure and CMS efforts to improve risk adjustment through permanent programs and testing new ideas on a smaller scale through the Innovation Center. Connect with us at [email protected] or visit the Aledade Newsroom

Join Josh Israel and Sean Cavanaugh for part two of their most recent road trip visiting primary care practices from Los Angeles to Washington D.C. First, they visited Dr. Arvinder Bir and Dr. Seema Bir, Aledade partners in California, to discuss how Aledade has helped enable their practice to reduce patient hospitalizations and remain independent. Next, they visited Varesh Chaurasia, CEO of HealthyU Clinics, and Dr. Lauren Havard, CMO, in Phoenix, Arizona to discuss what they are looking for in an accountable care organization (ACO) partner, emphasizing hands-on experience in local markets. Finally, they met with Dr. Salil Trehan in Amarillo, Texas, whose practice has previously partnered with multiple ACO enablers, to gain insights into what sets great ACO partners apart. Connect with us at [email protected] or visit the Aledade Newsroom