Aledade, an independent primary care network focused on value-based care, on Thursday established a 10-year partnership with insurer Humana. Under the collaboration, Humana’s Medicare Advantage members will receive primary care from Aledade physicians using value-based arrangements.
Bethesda, Maryland-based Aledade partners with independent primary care practices across 45 states and Washington, D.C. More than 65% of the practices that are in Aledade’s network are located in areas that have been federally designated as having a shortage of primary care health professionals.
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Last week, the company announced that it had added more than 450 primary care practices to its network for 2023. Aledade now has more than 1,500 independent primary care practices and health centers in its network — up from 1,000 last year.
“Aledade’s business model is 100% based on working with primary care practices to improve care for their patients so they can be paid not for how many visits they can cram into shorter and shorter times, but rather be paid and rewarded on the basis of keeping their patients healthy and out of the hospital,” Aledade CEO Farzad Mostashari said in a recent interview.
The company’s network has more than 5,000 physicians and 15,000 clinicians operating under value-based payment arrangements. Aledade works with a variety of payers, including Medicare, Medicaid, Medicare Advantage and commercial insurance companies.
Aledade’s relationship with Humana began in 2019 when the two companies started working together in a limited number of markets. By the end of last year, more than 100,000 patients in Humana’s network received value-based care from one of Aledade’s physician practices.
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Under their new 10-year collaboration, the partners will phase in current and new state-wide agreements for value-based care for Humana’s Medicare Advantage members. Their partnership will continue to grow as new practices and markets are integrated into Aledade’s network, Mostashari declared.
The partners’ agreements include a pathway to full risk, meaning meaning care would be provided on a payment model in which Humana transfers all financial risk to Aledade.
He pointed out that many insurance companies buy or establish their own primary care practices, as well as steer patients to online or virtual care. Some of these insurers view these efforts as a substitute for working with existing community primary care practices, Mostashari lamented.
“But Humana’s view is quite clear. Even though they do have their own primary care clinics, mostly in Florida, they view success as a partnership model with community primary care practices and are willing to share risk with community primary care. [Aledade] is willing to work with all health plans, but not all health plans have that willingness. I’m not going to name names, but not all health plans are as good at partnership-based thinking as Humana,” Mostashari said.
To assess the success of this partnership, Aledade will track three key metrics: increased utilization of primary care services, decreased emergency department visits and reduced hospitalizations. Mostashari said these factors are the best indicators to determine how well value-based care arrangements reduce the cost of care and improve the health of patients.
Photo: metamorworks, Getty Images
