Farzad Mostashari Profile picture
Sep 14, 2020 10 tweets 5 min read Read on X
1/ Value-based care works. MSSP saved $2.6 billion dollars with $1.2 billion in net savings to Medicare, matching CBO’s savings expectations for 2019

Physician-led ACOs again out-performed hospital ACOs. What we need now is to help more practices participate in these models
2/ @AledadeACO is proud to be the largest, most successful nationwide enabler of physician-led ACOs, delivering better care at lower cost for >340,000 Medicare beneficiaries, saving Medicare and American taxpayers nearly $180 million in unnecessary health care spending last year!
3/ Here's the list of the physician-led ACOs we are supporting, and our performance data.

* It doesn't matter if you're urban, rural, suburban, or in which state

* It gets better. The longer you work, the more the chances of success

* More risk = Higher rewards
4/ Last year was also the first year of the new Pathways to Success program. Every single one of Aledade’s MSSP ACOs who switched to Pathways to Success (higher risk/ higher reward) achieved savings. Every single one!

aledade.com/what-medicare-…
5/ Every Aledade ACO achieved an average quality score of 90% or higher for the year.

Our practices in MA earned ⭐️⭐️⭐️⭐️ in 2019, w many improving their rating by over a full ⭐️ since joining Aledade

As @SeemaCMS said- lower cost AND HIGHER QUALITY than Fee For Service
6/ Getting rid of hospital ACO squatters has not hurt the program savings, and has improved the numbers for the remaining "high revenue" ACOs.

But no matter where you look, legacy tracks or Pathways, one-sided, or two-sided, "low revenue" physician-led ACOs save TWICE as much
7/ What's not great is that there are too few physician practices participating.

In California- land of capitation, >90% of small practices w fewer than 500 Medicare ACO lives, are not in an ACO model

We and @CMAdocs are working together to change that!
prnewswire.com/news-releases/…
8/ "The trauma of the pandemic has underscored the need for a resilient health care system where reimbursement is not tied to volume of services provided, but rather to value-based incentives to keep patients healthy"

(We @AledadeACO are growing like crazy in the midst of COVID)
9/ We can least afford to lose practices in rural areas that are often the only source of primary care, and supporting them is a particular source of pride for us.

Giving advanced payments WORKED (AIM funding eval) innovation.cms.gov/data-and-repor…

CHART is putting more $ into them
10/ But the best way to support rural physician-led ACOs is to be FAIR to them.

As it stands now, their lives are included in regional trends, which dilutes their true performance.

This "rural glitch" may account for virtually all of this discrepancy.

THIS HAS TO BE FIXED

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More from @Farzad_MD

Apr 30
1/ When Walmart enters any business you can expect that they will leverage their massive scale to get better economics, create value for customers- and drive out local mom and pop competitors

Thats what many assumed would happen w primary care clinics

but it didn't

why not?
2/ The first thing I have to acknowledge is to rule out "execution"

They aren't perfect (their Athena and Epic EMR travails show that) but Walmart knows how to execute, and they won't scale something until they've figured out how to make it profitable.

They couldn't
3/ To their credit, they tried a lot of permutations over the past 10 years, and strictly as an operator, you have to give them respect that they could be a force

- Third party vendor
- Walmart Health clinics
-Oak St Health
- Own clinics + telehealth

Read 16 tweets
Nov 2, 2023
1/ Final rule for Physician Fee Schedule is out.

let's see how the Medicare Shared Savings Program provisions played out compared to the proposed rule.

(tl;dr mostly as proposed- incremental improvements to the nation's most mature, and most successful value based program)
2/ risk adjustment should be updated to the new "v28" approach for performance and benchmark years.



my only complaint is that it's only applied moving forward- if it's good policy why not allow existing contracts to update?

3/ Fixing the glitch where ACO risk scores and regional risk scores weren't treated equally (ACO gets a cap, now region does too)



(again, why not have a simple single approach for all contracts instead of only applying it moving forward?)

Read 12 tweets
Sep 11, 2023
1/ What are the factors driving the mysterious slowdown in Medicare cost growth?

It's been a longstanding dinner conversation among health policy folks, and I have one idea to add to the mix that I haven't seen discussed yet.. Image
2/ There were lots of theories batted around in the article and the followup from @sangerkatz

My fav: "Talk Therapy Actually Works" (@ZekeEmanuel)

Policymakers setting expectations of cost control inhibit investments and behaviors that drive cost growth
nytimes.com/2023/09/09/ups…
We saw similar unexplained slowdown in healthcare costs during the *ultimately unsuccessful* Clinton health reform efforts.

The slowdown happened almost immediately in 1992, even though nothing had happened yet, other than campaign talk

(@jrovner can prob give history on that) Image
Read 8 tweets
Dec 24, 2022
1/ Warning!

nerdy Medicare payment deep dive

OMNIBUS EDITION

You've read the headlines ("Medicare pay cuts partially averted") but to understand what led us here--and what's to come-- we need to go deeper

Also, some cool tangents on effective/ineffective financial incentives
2/ let's walk through the weeds of

"a temporary patch on an expiring pandemic patch for the unintended consequences of a good-will effort to fix pay imbalance between primary care & specialists, made worse by a failure to predict future inflation, w a sop to value-based pay"
3/ The "failure to predict medical inflation"

remember the annual "doc fix" scramble? it was because the "sustainable growth rate" was indexed to inflation, which was near zero for years. So Congress had to constantly step in to reverse its own past efforts to control costs. 😧
Read 27 tweets
Dec 22, 2022
1/ Medical Debt- a holiday story

A few years ago, I found myself poring over a printout of ED frequent fliers with a PCP in Mississippi.

The office manager knew why they were going to the ED.

“They’re not going to show their faces here. They all owe us money.”
2/ Because of the Emergency Medical Treatment & Labor Act, the ED would see them even if they owed money

But thousands more dollars would have been added on top of the prior debts

His bills will climb. His credit score will drop. Collection agencies will start hounding him
3/ When I was in college I got dehydrated at a crew meet and an ambulance took me to the ER. A couple of liters of fluid later I was fine

But I couldn't figure out what to do when the bills started coming

For years I carried the stress and shame of being sent to debt collection
Read 17 tweets
Nov 1, 2022
1/ Let's flip through the Physician Fee Schedule Final Rule just out, w shared savings focus

Here's a little trick to get past all the pesky comments (that people spent 1000's of hours developing and submitting), and right to the meat of the matter:

CTRL-F "we are finalizing"
2/ First up: we want to increase participation!

strong evidence for providing upfront capital, especially to rural, underserved, low income ACOs (see AIM)

Good idea to expand it 👍

Lots of comments about eligibility criteria, repayment, etc etc.

"finalized as proposed"
3/ We want to increase participation!

Let's allow folks to stay in one sided risk for longer, especially lower income (no hospital) ACOs

Makes sense 👍

Lots of comments about who, how, when, etc etc

"finalized as proposed without modification"
Read 23 tweets

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