Primary Care, Medicare and a New Vision of Accountability
Dr. Farzad Mostashari, CEO of Aledade, Inc., joins NCQA’s Peggy O’Kane to unpack why US health care struggles to improve and how we can fix it. From Medicare reform to AI in care delivery, Farzad shares bold ideas and his “Core 4” framework for better primary care and accountability. Insightful, candid and surprisingly fun.
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Our Guest
Farzad Mostashari, MD Chief Executive Officer, Aledade
Farzad Mostashari has spent his career at the forefront of health care policy and health information technology. Dr. Mostashari is the former National Coordinator for Health IT at the Department of Health and Human Services, and served as a distinguished expert at the Brookings Institute’s Engelberg Center for HealthCare Reform. Prior to his work at the Office of the National Coordinator, he founded the NYC Primary Care Information Project, which equipped 1,500 physicians in underserved communities with electronic health records.
Dr. Mostashari is the chair of the board of directors for Resolve to Save Lives, a global health organization that aims to save millions of lives from cardiovascular disease and infectious disease epidemics. He is also Co-Chair of the Health Evolution Summit. He has spoken and written extensively on issues affecting health IT, ACOs, and health care policy and delivery. He has been published in the New York Times, the Journal of American Medical Association, and Health Affairs, among others.
Dr. Mostashari received his MD from Yale University School of Medicine and his Masters in Population Health from Harvard T.H. Chan School of Public Health.
Episode Description
In this episode of Quality Talks, NCQA President Peggy O’Kane speaks with Dr. Farzad Mostashari, Co-founder and CEO of Aledade. Farzad brings decades of experience in health IT, policy and primary care transformation to a candid and energizing conversation about what’s holding back US health care and how we can move it forward.
Farzad and Peggy explore the structural flaws in our system, from fragmented care and fee-for-service incentives to the undervaluing of primary care. They discuss how ACOs, Medicare Advantage and data-driven models can help shift the system toward better outcomes and lower costs.
Peggy and Farzad explore:
- The Issue of Incentives: Farzad argues that while good care happens daily, it often occurs despite the system—not because of it. Misaligned financial incentives and lack of structural support hinder progress.
- The Key to Accountable Care: Access, point-of-care intelligence, care transitions and targeted wraparound services form the core of Farzad’s actionable framework for improving outcomes.
- Medicare Advantage and ACOs: A nuanced discussion of how MA and ACOs compare, what each gets right, and how to align incentives across Medicare.
- What Works? A call for smarter learning networks that identify and spread what’s truly effective in improving care and reducing cost.
This conversation offers a timely and practical roadmap for advancing value-based care. Farzad’s clarity, humor and strategic insight make complex topics accessible—and energizing. Whether you’re a policymaker, provider or health system leader, this episode delivers ideas worth implementing.
And, look, if you need to be hospitalized, you’re gonna be hospitalized. That’s where we can break apart that concept of not needing a hospitalization is the highest quality hospitalization. What’s the highest quality hospitalization? The one you didn’t have!
Dive Deeper
Timestamps
(01:20) Distinguishing Incentives in Health Care
(06:25) Unlocking the Potential of Primary Care
(09:31) Thinking Holistically About Accountability
(15:22) Measurement, Medicare, ACOs and More
(26:07) The Doctor’s Role in the Era of AI
(33:04) Peggy’s Reflections
