Running Through Walls: Data Driven Healthcare

Is it possible to make changes to the American healthcare system that will benefit patients, doctors, and society? It’s what Farzad Mostashari is aiming at with Aledade, the company he founded in 2014. As Mostashari explained to Venrock partner Bob Kocher during an episode of Running Through Walls, this goal rests on helping primary doctors with their own practices stay independent, instead of being forced to join hospital groups.

Bringing about real change in healthcare, Mostashari believes, starts by asking the right questions — something he’s championed since early in his career after leaving medical school and completing his residency. After a stint at the Centers for Disease Control and Prevention, Mostashari became an assistant commissioner for the New York City Department of Health, and was responsible for wrangling storehouses of data and unearthing insights from them.

“We often thought that if we got more data, it would give us better signal,” Mostashari recalls of his time spent analyzing data on the impact of cigarette taxes, and links between school absenteeism and spikes in asthma. But the reality was that simply accumulating data didn’t provide answers. “You need the appropriate analysis for the question,” Mostashari says — which means knowing which questions to ask before you start analyzing information.

After moving on to the U.S. Department of Health and Human Services, the Brookings Institution, and then Aledade, Mostashari maintained the focus on refining the questions before digging for answers. In his work for the government, Mostashari helped oversee the implementation of electronic health records (EHRs).

“We tried to make every practice with EHRs able to do population health,” says Mostashari. “We worked backwards from those goals and said, if you want to prevent heart attacks and strokes, then you need to better control people with high blood pressure — for example, identify the people with high blood pressure who are not on a diuretic.” However, figuring out which 10 patients out of 10,000 might fall into this category requires more than EHRs, he adds — it needs an efficient medical practice.

At Aledale, Mostashari and his team want to help doctors build and lead Accountable Care Organizations (ACOs), which can allow them to stay independent. But to do so, Mostashari argues, doctors must be able to improve patient health while lowering costs — and they need the right questions paired with the right answers to do so.

“When physicians come together, they can work like gangbusters when they don’t have to worry about demand destruction” — that is, watching their revenue disappear if healthcare costs are reduced. If doctors can figure out how to offer better primary care and reduce expensive hospital admissions and specialist consultations, Mostashari says, “they can make more money on the way from volume to value. The problem is that they need to get the governance and technology together, and get their practices redesigned.”