Thread by @Farzad_MD

1/ My new followers may not know that on the side of being an epidemiology explainer on twitter, I'm also lucky to run an amazing company, @AledadeACO

We just announced a Series C growth round (what you do when you've proven your business model)

aledade.com/aledade-raises…

2/ It's been surreal doing a fund-raise in the middle of COVID madness, and the crash in the public markets

[Will post an explainer on why public market drop would shake venture/ private growth investors- naively might ask- wouldn't you want more private if public is down?]

3/ But - as @rtnarch has pointed out, down markets are when you learn a lot about investors. You want the ones who don't flinch, who can take the long view.

In the long view, fundamental ability to create value, and being seen as trustworthy is worth more than this year's IRR

4/ These investors are rare. Someone should make a list of them (@BRobertsVC)

We were so fortunate to have OMERS Growth Equity (Teresa Lee) step up

They help Ontario city workers, school boards, librarians, police and fire responders retire with confidence of guaranteed income

5/ They don't need to make the numbers look good on one fund so they can raise money for their next fund. They can just focus on finding companies that will do well over the long term..and will do good also.

Environmental, social and governance (ESG) factors matter to them ♥️🌎

6/ We LOVED that about them.

We were also blessed to have strategic partners like @HealthEcho and @BlueShieldCA and @CMAdocs who believe in our mission to help doctors thrive under outcome-based payment models.

And existing investors like @GVteam and @MeritechCapital

🙏

but-

7/ These are also incredibly smart investors who want to make good for the pensioners and universities and families who have entrusted them with their money.

The reason they invested was because Aledade is a great business, and incredibly resilient once the flywheel is spinning

8/ This is how we and the practices we team up with get paid (actual slide-saving you the click-bait "see how buzzy startup Aledade raised $64M" article)

We reduce total cost of care for the system, while improving quality

Good for patients, Good for society, Good for docs

9/ Independent primary car practices are treated like Pawns in a fee-for-service system that rewards brute size, market power, negotiating leverage over health plans

But they are Kings & Queens if the game is keeping people healthy and out of the hospital

Whether in MA, or ACOs

10/ If the question is "How to get better health at lower cost?"

Primary Care Is The Answer

We spend 6% of the $3.7 Trillion a year on primary care, and we believe that spending more on primary care is the key to reducing spending-on the failures of primary care

that's our bet

11/ But most independent primary care practices don't have the scale to take risk contracts, downside capital reserves, time to vet software platforms, negotiate data interfaces, follow the details of policy and regulations (and details matter!), figure out the playbook

We do

12/ This is what I'm most proud of
@AledadeACO

That we have been able to recruit amazing people who are the best at each of these- technology, practice change, policy-and who love to serve others

who put practices first

(we're always looking for more)
aledade.com/careers

13/ We were told that it would be helpful to make a quick-cut video for the investing round to explain what exactly we do for our independent practices, but the round closed before we had a chance to show it to any of them.

Here's my chance to show it :)

14/ So does it work?

If you bring together primary care practices and arm them with new incentives, new technology, new workflows

Give patients more informed, more accessible, more engaged primary care- but also just MORE PRIMARY CARE

Does it actually reduce bad events? yeah

15/ What's even more important perhaps than the results over three years (and it does take a few years to get the flywheel spinning!) is that we were able to do it in incredibly different healthcare markets: KS, LA, MS, FL, WV

(2019 results are even better, BTW)

Tech=scale

16/ This. is. not. normal.

There have been lots of amazing primary care practices that have successfully taken risk for years, generated incredible results in their home turf, but efforts to "put it in a box" have failed- spectacularly for HeathCare Partners/Davita Medical Group

17/ And as a business, our success is fundamentally tied to the need to turn 3 dials simultaneously. And that means we have 3 levers, not just one

What will we use the investment for?

help more practices-
more payer contracts
more savings
more risk (higher risk, higher reward)

18/ A big question has been what impact this pandemic will have on our business.

It's incredible, but while fee-for-service has received a $100B bailout already (and another $75B to come), value-based models are pretty much fine as-is.

benchmarks float

aledade.com/how-mssp-progr…

19/ Doing well in a total cost of care contract from Medicare means doing better than the regional trends, given whatever is going on in region.

And if what's going on is COVID, we need to help our primary care practices cope with it better than they otherwise would have..

eg:

20/ Shipments of COVID-19 support packages of personal protective equipment to over 500 practices

282,000 surgical masks;
119,000 KN95 respirators;
348,000 medical gloves;
101,000 disposable gowns;
29,000 face shields;
4,000 bottles of hand sanitizer

aledade.com/responding-unp…

21/ expert guidance on what's happening with COVID epidemiology, practice finances and operations, regulations, billing, and so much more

aledade.com/covid-19

22/ Telehealth

23/ Policy and Regulatory/ Advocacy

modernhealthcare.com/opinion-editor…