Farzad Mostashari, MD, is Co-Founder & CEO of Aledade, a physician-led public benefit corporation and national leader in value‑based care. Aledade helps primary care organizations deliver better patient outcomes and thrive financially by keeping people healthy.

As healthcare systems continue to grapple with rising costs and worsening chronic disease burden, Aledade partners with primary care organizations – including independent practices, clinics, community health centers and systems – to help them succeed in value-based contracts by improving outcomes, reducing unnecessary utilization, and strengthening primary care’s role in the healthcare system. Today, Aledade works with more than 3,000 primary care organizations and supports over 3 million patients in value-based care arrangements.

Dr. Mostashari has spent his career at the forefront of healthcare policy and health information technology. He 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 Health Care Reform. Dr. Mostashari received his MD from Yale University School of Medicine and his Masters in Population Health from The Harvard T.H. Chan School of Public Health, and he has spoken and written extensively on issues affecting health IT, ACOs, and healthcare policy and delivery.

Farzad Mostashari, Co-Founder and CEO of Aledade

The Pulse: Could you tell us about your professional journey to date, and how that has informed your view on healthcare policy in the United States?

Farzad Mostashari:I’m happy to, and I’m happy to be talking to a group of folks who I genuinely think are going to make a difference in healthcare. One of the most important things I’ve learned over my career is the ability to recognize the healthcare system for what it actually is – a system – and to understand what really drives behavior inside it.

I’ve spent my whole career at the edges of medicine, public health, and public policy, and even as a kind of insider–outsider, it took me a long time to really internalize how powerful financial incentives are in shaping care. I started out in public health, working on things like banning smoking in bars and restaurants and raising cigarette taxes in New York City. Those were structural interventions – they changed the environment in which people made decisions – and they worked.

We thought technology would function the same way in healthcare. We believed electronic medical records would become the operating system for medical practices, embedding quality, prevention, access, decision support, and population health directly into care delivery. I spent a decade working toward that, including serving as U.S. National Coordinator for Health IT, overseeing certification, interoperability, meaningful use, and a major federal investment to digitize American healthcare.

In many ways, that effort succeeded. We digitized healthcare. But what the technology mostly became was better billing and coding tools. In hindsight, that shouldn’t have been surprising. If your operating model is fee-for-service, that’s how technology is going to get used – and you can see the same question playing out today with AI.

What was most frustrating to me is that we made essentially no progress on the outcome I cared about most: preventing heart attacks and strokes through better blood pressure control. We were at about 65% control before, and about 65% afterward. That experience pushed me to look for places in American healthcare where preventing strokes is actually more profitable than treating them — and that realization has guided everything I’ve done since.

The Pulse: You were part of the Office of the National Coordinator for Health Information Technology during a time when electronic medical records were becoming rapidly adopted. What are your greatest learnings from this experience, and how can you apply them to today’s technology landscape?

FM: I’ll start by saying that electronic medical records didn’t suddenly take off because the technology got better. They had been around for a decade or more with very slow adoption. What changed was federal policy. The HITECH Act created a strong incentive structure, support organizations, and a sense of inevitability. We funded Regional Health IT Extension Centers and put trained coaches at the elbow of practices – especially primary care practices – to help them actually change how they worked. While we didn’t achieve all the clinical outcomes we wanted, it was a very successful implementation of massive behavior change across American healthcare.

One of the key lessons was being unambiguous about the competition. We said clearly: paper is bad. Documenting care on dead trees is unsafe. And I think we’re starting to see that same clarity emerge now around unmanaged fee-for-service – that it has bad incentives and leads to bad outcomes for patients and society. Another lesson is that adoption doesn’t happen without help. You can’t just tell people to change. You have to make it simple, script the moves, and support them as they adapt those changes to their environment. That’s very much the approach we take at Aledade in helping practices move into value-based care.

The Pulse: Now we would love to hear more about Aledade. Can you share a bit about how it has grown over the past decade, and the unique aspects of its business model that have enabled its success?

FM: Today, Aledade is the largest physician-led value-based care enabler in the country. We partner with over 3,000 practices and support more than 3 million patients in value-based contracts, with millions more in those same practices who aren’t yet in value-based arrangements. We’re also the largest participant in the Medicare Shared Savings Program, which is the flagship permanent value-based program for traditional Medicare. Almost 20% of all patient lives that are in that program are in practices partnered with Aledade, which we’re very proud of — but it also means there’s still a lot of work to do.

Our growth really comes down to a few key decisions. First, we chose not to build or buy primary care clinics. Instead, we partner with existing practices, which allows us to scale quickly. We added more than 500 practices in 2025, and we added more than 700 practices in 2026. You can’t build 700 new practices in America in a year – no one can. Second, we decided to be agnostic to practice type and EHR, rather than limiting ourselves to one model or platform. And third, we started in the Medicare Shared Savings Program, which meant we had to actually generate savings through better care. You can’t increase revenue through accurate diagnosis coding alone in that program. All three required a tech-forward approach. The investments we’ve made now allow us to grow faster, work across multiple EHRs, and achieve real outcomes at scale.

The Pulse: Thinking back to the state of healthcare ten years ago and where it is now, what upcoming initiatives are you most excited about for Aledade to tackle? How do you see the company evolving in the near future?

FM: What strikes me is how much continuity there’s been. When I look back at our Series A pitch deck, we’re basically doing exactly what we said we would do. While many large healthcare organizations have changed leadership and strategy multiple times, we’ve stayed focused. What excites me about the next decade is being able to do this work better, faster, and on a much bigger scale. The advances in AI are real, and while we’re thoughtful about how to use them, they create meaningful opportunities to accelerate what we’re already doing.

The Pulse: This year’s conference theme is Healthcare 2030: Preparing Systems, Policy, and People for the Next Decade. How do you see the future of healthcare policy evolving, and what do you think are the biggest priorities for ensuring success over the next ten years?

FM: My simple takeaway from my time as a federal policymaker is that good policy aligns private profit with public good. The first step is identifying incentives that drive bad outcomes and fixing them. In recent CMS payment rules, there’s been real movement on some of the most damaging distortions – like site-of-care payment differences that drive consolidation and long-standing imbalances that favor procedural specialties over primary care.

But it’s not just about prices. No one really wants to answer the question, “What’s the right price for a stroke that could have been prevented?” The real issue is how we create incentives for prevention, chronic disease management, and access to primary care. What we know works is giving primary care accountability for total cost of care and supporting practices in succeeding under that responsibility. The opportunity now is figuring out how to bring more practices in and help them generate more savings once they’re there.

The Pulse: What advice would you give to those looking to work at the intersection of healthcare policy and business and innovate on care delivery and payment models?

FM: My first piece of advice is not to kid yourself about the business model. Forget the marketing language and look honestly at how the organization actually gets paid. Incentives matter, whether you’re for-profit or not-for-profit. If your revenue comes from fee-for-service billing, your incentives will push you toward more volume and more coding. Choosing a business where it’s more profitable to prevent strokes than to treat them simplifies a lot of the moral hazard and aligns incentives with outcomes. From where I sit, that alignment makes all the difference.