Redesigning Aledade around the daily work of preventive care

Value-based care pays practices for keeping patients healthy, meeting quality benchmarks, and lowering the cost of care. Aledade’s app turned payer requirements into daily work for small primary-care teams. The app had grown into separate worklists and disconnected views, so staff searched patient records, hospital alerts, risk data, and spreadsheets to decide who needed attention and when.

I led the redesign of the core app after research I conducted with product partners and Aledade’s practice transformation specialists, who worked directly with clinics on patient care, daily workflows, and the move to value-based care. A final 8-week study with 32 participants across 6 states helped refine the work. I combined separate task lists into one prioritized view of each patient’s open needs and deadlines. Staff could handle several care tasks during one call and record each outcome. That made repeat calls less likely for patients who were often elderly or managing serious health problems.

Daily Huddle gave staff and physicians the same view of the day’s patients. Staff reviewed each suggestion before the visit, then physicians used the relevant information while the patient was in the room.

The app I redesigned was the day-to-day tool that helped practices meet accountable-care requirements: staff identified patients who needed timely outreach, prepared physicians for visits, and documented the preventive care required for shared-savings payments. Aledade’s internal analytics found that clinicians who used Daily Huddle were 10x more likely to discuss a suggested diagnosis while the patient was in the room. In 2022, Aledade’s network saved Medicare $572M and prevented more than 46K hospitalizations.