Three Things I Wish I Knew: Dawn Alley

Former CMS Innovation Center Strategy Officer draws on her CMS model experience to share lessons learned

Advice from Dawn Alley, PhD, head of scale at IMPaCT Care, a digital platform for Community Health Workers.

First, keep it simple. No one can improve on 10+ measures at a time. Focus on a small group of measures that matter and align care around those. One of the most successful models that I worked on, Million Hearts, was designed around a single important but powerful measure: cardiovascular risk. Moving the needle on that measure resulted in reductions in all-cause mortality – we literally saved lives through payment change.

Second, design for dysfunction. Health care is tremendously fragmented, and without multi-payer regional alignment, that’s very hard to change. The Accountable Health Communities Model was able to achieve a percentage of total cost of care savings through navigation. We weren’t able to fully fix the broken system, but we made a huge dent on unnecessary utilization by going straight to the people we serve.

Third, align incentives where you can. The Vermont All-Payer Accountable Care Organization (ACO) Model achieved six percent total cost of care savings in Medicare by aligning closely with Medicaid.

Additionally, there is no value-based care without patient engagement. Often, it’s the people without a primary care provider who most need value-based care, so we need to innovate to reach those populations. One of the most rewarding parts of my career has been engaging people that others had given up on. We did this at CareBridge health, where we hired Russian and Mandarin speakers to reach out to Medicaid beneficiaries in their preferred language. We do this at IMPaCT Care, where Community Health Workers draw on their shared lived experience to engage individuals with co-occurring medical, behavioral, and social needs. I’ve been so impressed in working with Medicaid Health Home providers, who accept geographic attribution for underserved patients, with Community Health Workers helping to engage individuals who have been disconnected from care. This work is doable with the right care models and incentives. Let’s get to work!

More about Alley's experience:

Please explain your current role and your previous role at CMS.

I held multiple roles at the CMS Innovation Center, directing the State and Population Health Group and serving as Chief Strategy Officer. That experience led me to my current role, because I saw the challenges of scaling what works, especially cost-effective, community-based interventions. At IMPaCT Care, we expand access to evidence-based community health worker programs through proven, scalable infrastructure. 

How long have you been participating in value-based care? What was your first experience?

I started working in population health and health services research in 2008. I came to CMS in 2015 because it seemed like the best opportunity to “go where the money is” and change incentives. When I first started, I was privileged to shadow ACO leaders to gain on-the-ground insights into how value-based care organizations make decisions and implement care transformation.

What was your initial interest or reason for practicing value-based care?

I grew up as a Medicaid beneficiary, and I’m passionate about getting what works to the people who need it most. We know that it’s possible to deliver high-value care that is person centered and prevention oriented, but too often, we see a system that is failing to do that. I saw value-based care as a way to incentivize cost-effective, community-based care.

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