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Aspire Health CEO Brad Smith on the Importance of Advanced Illness Care

Brad Smith is the Co-Founder and Chief Executive Officer of Aspire Health, the nation’s largest provider of community-based palliative care services for patients facing a serious illness. Aspire currently operates in 25 states and 67 cities in partnership with many of the nation’s largest health plans. Since launching in 2013, Aspire has served over 40,000 patients and currently provides over 250,000 home visits per year.

We recently sat down with Brad for a discussion on why this work is important, C-TAC’s payment model and his upcoming remarks at HLTH.

First off, what is Aspire Health and what led you to start it?

Aspire Health is a specialized, interdisciplinary physician practice focused on caring for patients facing a serious illness.  We serve these patients through interdisciplinary teams of physicians, nurse practitioners, nurses, social workers and chaplains who visit patients in their homes.  Today, Aspire is the nation’s largest advanced illness care provider, currently operating in 25 states and 67 cities.  Since 2013, Aspire has served more than 45,000 patients through its partnerships with over 20 health plans. I started Aspire with our Board Chairman and former U.S. Senate Majority Leader Bill Frist because we believed there had to be a better way to care for patients facing a serious illness.

Did you always want to start a healthcare company?

No, not really. I have also been interested in non-profit work and public policy, but I never really saw myself starting a healthcare company.  However, that changed about six years ago when my grandmother passed away in a cycle that included multiple hospitalizations, a nursing home stay, and lots of discomfort for my grandmother as well as my dad, my brother and I. Ironically, my brother was training at the time to become a palliative care physician in Boston working on research under Dr. Susan Block and Dr. Atul Gawande.  Through my experience with my grandmother as well as conversations with my brother, I became very passionate about the space, feeling there was so much opportunity to make it better.  After about 12 months of gathering data on the leading advanced illness care models across the country, I took the idea to Senator Frist who then partnered with me to launch Aspire in the summer of 2013.

With healthcare touching all of us at some point, why is this population so important?

Living with a serious illness is a very challenging time for patients and their families. Their care can be fragmented, confusing and all too often does not align with their personal goals and values. In addition, patients with a serious illness represent some of the most expensive patients in the country who often end up going to the hospital when it is either unnecessary or unwanted. Yet we know – and programs across the country have proven – that care can be much better for these patients.  Over the past five to ten years, a number of studies have repeatedly demonstrated how advanced illness programs can consistently provide high patient and family satisfaction, reduce hospitalization by nearly 50%, and decrease costs in the last year of life by 20% to 25%.  Advanced illness care is truly one of the areas in healthcare where you can meet all three aspects of the triple aim.

In your mind, what could you be doing more of to make a greater impact in healthcare and what’s stopping you from accomplishing it?

We need to make home-based advanced illness care available to all the patients who need it. Aspire has developed a scalable model in which Aspire contracts directly with health plans using a risk-based reimbursement model. This model has provided sustainable financing but is limited to Medicare Advantage, Managed Medicaid, and commercial health plan members as well as ACOs, IPAs and MSOs.  Today, Aspire does not serve any traditional, Medicare fee-for-service patients.  We are hopeful that as CMS sees the success of Aspire and other advanced illness care programs across the country, it will consider expanding access to advanced illness care to traditional Medicare patients.

You were on the team that developed C-TAC’s payment model. Why was this project so important to you and your work?

Over the past five years as Aspire has served over 45,000 individuals, we have seen the difference our services can make in the lives of our patients and families.  Not only that, but we are significantly reducing costs for our health plan partners.  With the baby boomers aging and over 25% of all Medicare costs occurring in the last year of life, there is clearly a tremendous need to expand access to these services for traditional Medicare members.  C-TAC’s payment model leverages the lessons we and other advanced illness care providers across the country have learned into a thoughtful payment model that could expand access to home-based advanced illness care to millions of seriously ill Americans.

What does this model mean for a smaller provider group in Boulder, CO or a larger practice in San Francisco, CA?

Patients with serious illness exist in all parts of the country – urban and rural – and we set out to create a payment model that could provide access to advanced illness care to patients regardless of where they lived.  As a result, the Advanced Care Model (ACM) is designed to be flexible by allowing a range of providers to participate in the model no matter their size or geographic location.  Specifically, the ACM model would allow physician groups, ACOs, hospitals, hospices, home health agencies and other provider organizations to provide advanced illness services. The ACM would also allow consortiums of small practices to join together to participate in the model as a single entity in order to achieve the necessary patient volume to measure the program’s success.  Together, we believe these provisions would allow the model to serve patients across the country in both urban and rural areas.

What does it mean for people and their families?

The ACM model is designed to care for patients with a broad range of advanced illnesses, including cancer, organ failure, dementia and other serious illnesses, in what is a very challenging time of life for patients and their families.  The ACM is designed to provide the services that research shows patients care most about when facing a serious illness. This includes creating an individualized care plan to proactively address each patient’s symptoms and disease, coordinating care across all of a patient’s providers, ensuring patients and their families have 24/7 support, facilitating shared-decision making among patients, families and their physicians about a patient’s goals of care, and most importantly ensuring the care a patient receives is actually aligned with their goals and values.

You’re speaking at the upcoming HLTH conference in Las Vegas. As a ‘health disruptor’ what do you want to convey to the audience by the time you’re done speaking?

I am excited to share Aspire’s journey and the lessons learned along the way. In a field that is evolving quickly like advanced illness care, continuously innovating is critical to providing the best care to patients. For example, Aspire is continually improving its proprietary patient identification algorithms through our partnership with Google Ventures. In addition, we are leveraging the lessons we have learned from the 45,000 patients we have served over the past five years to develop automated workflows that better target specific interventions to individual patients based on their unique needs. It is critical that we all continue to innovate and share our learnings so that we can deliver services that best meet the needs of our unique patient population.

What are you hoping to learn from some of your peers in other parts of healthcare at this event?

I am excited to learn how others are using technology to care for seniors.  Whether its tele-video visits or organizing rides to the physician via Uber, we think there are a number of ways that technology can be used to improve the convenience of care for our patients and families while at the same time reducing the cost of delivering our care.  Aspire has run several pilots using technology in innovative ways to care for our patients, and we are very excited to learn more about what others are doing.

If you weren’t leading Aspire, what would you be doing right now instead?

That’s a great question – I just wish I had more time to think about it!  I am really excited about leading Aspire’s growth over the next few years, but if there was another big problem I was going to tackle it would be how to address social determinants of health for high cost, managed Medicaid patients.  I am not sure if I would do this through a non-profit, public policy, or another healthcare company, but I think it’s one of the big challenges our country is facing and would love the opportunity to work on it.

At the end of the day, how do you personally judge your success and the success of Aspire?

At the end of the day, I think it’s about the number of patients and families we – or other organizations like us – serve and, more importantly, the quality of the services we provide to those patients.  I just want to make sure as many people as possible have a very different experience than my family had with my grandmom.  Whether those patients are being served by Aspire or another provider doesn’t really matter to me, but making sure these services are provided in a high-quality and sustainable way is what drives me every day.

What’s the one thing outside of your world that you think is really innovative and cutting edge in healthcare?

I am really interested in how technology can be used to deliver lower cost care to expensive patient populations.  I think nothing can replace face-to-face interactions, but I think there are some really interesting ways you can deliver care to complex patients via phones and tablets.  Most of the telehealth work across the country to date has been focused on less seriously ill patient populations, but I think the next area of exploration will be around how to deploy technology to serve more complex patient populations.

Finally, this work can be hard and draining some days, what’s the one thing everyone supporting this community should always keep in the front of their minds?

In our work, we deal every day with patients who are likely to pass away in the next year.  And when we hear those patients’ stories and the things they care about, it is almost never how much money they made or the titles they had – it is almost always about relationships and how they were able to love the people around them.  My favorite thing about this work is how it constantly reminds you to think about the things that really matter in life and to look every day for ways you can positively impact the lives of those around you and leave the world just a little bit better than you found it.

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