Why Value-Based Care adoption plateaued in the U.S.

My old boss, Farzad Mostashari, M.D., CEO of Aledade, just dropped an article in the New England Journal of Medicine (NEJM) arguing that Value-Based Care (VBC) adoption has hit a bit of a plateau in the U.S.. I couldn't agree more. One of his key recommendations - CMS should actively support enablers and simplifiers—organizations that streamline the complexity of VBC work for providers. How is it that after more than a decade of experience, tens of billions of dollars in shared savings distributed, and over 1000 Accountable Care Organizations (ACOs) across MSSP and REACH, this work is still so freaking complicated? Is it really possible that 1 in 3 ACOs got ZERO shared savings last year?   This may be controversial, but after nine years of running ACOs and building the Business Intelligence team at Aledade team - I don’t think the work is actually that complicated. ACOs excelling in VBC aren't running NASA-level algorithms — they're just consistently nailing the basics: they have much higher Annual Wellness Visit (AWV) and Transitional Care Management (TCM) rates, they accurately capture chronic-conditions year-over-year, and they make sure patients know when they should come into the clinic vs. going to the emergency department. Almost all of the data necessary to do these things is already within reach of the average provider without any complex analytics. So what’s the problem? It’s not impossible to look up the last time a Medicare patient had an AWV in Athena. But integrating these data-driven workflows into already exhausting daily FFS workflows is extremely challenging. Instead of running at this workflow challenge head on, too many new ACOs (and enablers) over-invest in data-only strategies, assuming that if they can just get the data into the hands of a provider, that the workflows will sort themselves out. Everyone learns eventually: the gap between data insights and operational execution isn’t just a step in the process—it's the whole game! Far fewer resources are dedicated to listening and responding to practice feedback, tailoring workflows to unique practice situations, and putting in place clear change-management plans. Why? Because: 1️⃣ change-management just isn’t as sexy as machine-learning, and 2️⃣ it’s highly customized difficult-to-scale work and the only tools on the market that manage qualitative feedback from customers were built to manage a straight forward sales function, not a highly variable operational change management program across thousands of individual practices. For the last nine years I’ve dreamt of building an operating system for VBC that seamlessly knits together the data analytics required to succeed in VBC contracts with the performance and change management tools required to turn that data into action at the practice level. I’m pleased to say that Evan Gogel, and I are about to bring that dream to life. More to come very soon!