Aesara Partners 

At Aesara Partners, our mission is simple: enable you to be the best version of yourself. We offer a range of focused services that unlock the potential of people, teams and cultures to maximise business performance. 

Collectively our Partners and Associates have decades of experience both in executive coaching and as board level leaders themselves working in multiple sectors across global markets.

Partner & Executive Coach

Doshisha University

Professor of Strategic Management, Global MBA Program

The CFO Coach K.K.

The CFO Coach K.K. is a boutique executive coaching firm specializing in developing High-Performance​ Financial Leaders and Teams.

Founder & Executive Coach

Kansai Gaidai University

•	Awarded President's Global Education Award (Teacher of the Year).

Professor of Leadership & Management

Benesse Holdings, Inc. (USD 4.5B; Tokyo Stock Exchange Code: 9783)

•	Member of the Board of Directors for Berlitz Corporation; Benesse Corporation; and Benesse Style Care.  Chairman of Audit Committee for Berlitz Corporation. Member of Benesse Holdings Pension Committee.
•	Global CFO covering all 40+ Benesse group companies
•	Championed and supported multiple cash generation initiatives including a CFO led "Save to Grow" initiative to improve Company Financial performance and to identify significant savings for business reinvestment
•	Enhanced Finance bench strength and hired a high potential team to start financial business consulting
•	Implemented several process and capability best practices to move group companies towards global standards

Global Chief Financial Officer & Corporate Senior Vice President

McCann Worldgroup Holdings

• Overall Responsibility for Operations (Finance, IT, Legal, and Administration - 10 legal entities) 
• Successfully turned around long term loss making lead agency by delivering double digit margin improvements within two years
• Delivered double digit margin improvements for all six MWG Group companies 
• Built a new Finance team and moved from Scorekeeping to Business Partnership and improved business performance
• Major projects within last two years include: 
  - Shared Service center creation/migration
  - New Financial System Migration
  - Acquisition & Divestiture
  - Business Turnaround
  - Retirement Plan consolidation/change
  - Office relocation/rent reductions

Group Chief Financial Officer, Executive Vice President, and Member of The Board

Becton, Dickinson and Company

• Led Finance, Procurement, General Affairs, and Rebates teams (43 staff) to deliver multi-million dollar cash and profit performance improvement for first year and beyond. Exceeded all budget expectations.
• Engaged Japan Management Team and Global Finance Leadership Team on company objectives to deliver best outcome (Finance Transformation initiative, Sales effectiveness improvement, Key Account Management, Business Continuity plan, and strategy/selection of backup distribution center).  Led process for 2012-16 Business Plan development
• Developed and executed Finance department strategy and vision to move from scorekeeping to business partnership. Implemented job rotation program and hired several high potential employees to improve bench strength.
• Championed multiple Finance and Procurement initiatives including definition and implementation of new 401k Retirement Plan; divestiture of non-core business; change of primary banks (reduced bank fees by over 30%); vendor reduction process, and new travel expense management system 
• Taught New Manager Essentials program and selected as leadership trainer for PEPFAR program in South Africa to teach Leadership and Change Management to African Health Ministry officials

Finance and Administration Director

Avon Products Inc.

•	Implementation project leader for Avon Sales Leadership Framework (ASLF) – Highest priority project for the Company to adapt to a new Sales Model.  Completed project implementation in record timing.  Awarded regional award as part of ASLF Team. Only person in Asia recognized for both Top-line and Bottom-line contributions in the same year.
•	Defined and executed new vision and mission and led Sales Support department to complete over 40 initiatives (within a six-month period) as part of Team’s new journey towards field motivational excellence. Incorporated new processes to deliver high impact incentives, and to create Sales energy and momentum for sales turn-around.    
•	Achieved highest employee engagement scores with Sales Support Department significantly exceeding country results in over 95% of categories.  Previously had also led Finance department to highest employee engagement scores.
•	Global Project leader for a high potential, multi-functional, multi-national team to study and recommend actions to improve Global Sales Incentive management/spending process.
•	Oversaw execution of a variety of Company and Public/Media events ranging from Sales Conferences to Philanthropic events including Annual Awards to Women, and Pink Ribbon Campaign support.

Executive Director and Member of the Board

•	Responsible for Financial policy making/implementation and reporting for Avon Japan as a public company (including statutory/public, and Board Meetings). All year-end financial documents audited with no comments/exceptions.
•	Defined and executed new department Vision and Mission, and recruited, trained and developed a completely new Finance team (80% new hires within a six month period) to move from scorekeeping to business partnership. Finance team formed core of country high potential list.
•	Consistently over achieved profit performance commitment under adverse conditions of sales decline by aggressively managing strategic business needs with cost cutting; Delivered zero overhead growth during all years; Japan winner of regional awards for best cost management performance, and for boldest transformation strategy.
•	Provided leadership and support for critical decisions and strategy development as Japan Leadership Team Member.  Actively led change management process within company.
•	Consistently achieved best internal control results in Asia-Pacific/Avon over a period of eight audits.  Japan one of only two countries with highest audit rating. Outstanding performance generated support to remove Japan from list of High Coverage countries.
• Co-developed strategic/financial business case, and obtained approval for number of campaign reduction in 2006 making Avon Japan only country ever in Avon to undergo campaign reduction. 
• Independently analyzed and provided strategic direction for Plant study which challenged and reversed previous recommendation by outside consultants on plant closure.
• Provided leadership in several restructuring initiatives by providing an achievable plan to achieve 12% people related cost reduction.  Played lead role in this study representing Finance, Supply Chain and HR 
• Consistently achieved highest performance rating and nominations to several high potential programs
• Elected (and re-elected) to Board of Directors

Executive Director, CFO and Member of the Board of Directors

Delphi

• Prepared Asia-Pacific regional messages / presentations for Delphi Strategy Board, and for Delphi Board of Directors.
• Supported development and implementation of critical Asia-Pacific strategies.  Performed competitive intelligence and other special studies to identify risks / competitive threats and outlined regional / corporate response.
• Provided Miller Heiman strategic selling process training to Asia-Pacific personnel to improve value propositions and increase sales effectiveness.

Director Asia-Pacific Planning

• Management responsibilities for Finance, HR, General Affairs, and Six-Sigma.
• Active member of the Japan Strategy Board and Japan management team.  
• Six-Sigma Deployment Champion for Delphi Japan.

Delphi Japan – CFO & Administration Director

Country Responsibilities:
• Managed all finance functions including accounting, budgeting / forecasting and treasury.
• Lead development of cross-functional and cross-divisional Internal Control Review Board.
• Lead and supported strategic initiatives including venture development support, site enhancement, competitive analysis, transfer pricing, and cost reduction studies.
• Represented Japan in Asia-Pacific Financial Task Team.

Regional Responsibilities:
• Coached country CFO and staff to implement common financial reporting processes.
• Supervised and provided training for engineering / commercial / plant / site analysts.  Coordinated regional financial training programs for the sector in the Asia-Pacific region.
• Coordinated the regional budget, business plan, and capital management process.
• Supported development of common financial practices among ventures including:  Loan monitoring, F/X and cash management, compliance with accounting principles, report submission, etc. Provided regional oversight of venture risk exposure.

Asia-Pacific Senior Finance Mgr.

Executive Coach | MBA Professor | Ex-Global CFO

I help senior leaders master complexity, elevate strategic impact, and lead with authentic authority.

I bring over 25 years of C-level and boardroom experience as a former Global CFO for a $5B publicly traded company, combined with a deep commitment to human-centered leadership development.

Today, I coach global executives, CEOs, and leadership teams — specializing in executive transitions, strategic leadership, high-performance teams, and Asian leadership development.

I am also an MBA Professor of Leadership and Strategic Management, blending research-driven frameworks with boardroom-tested insights to develop transformational leaders.

Based in Kyoto, fluent in English, Urdu, and Japanese.

Connect with me: arif@thecfocoach.jp

Website: www.thecfocoach.jp (please sign up on my mailing list to receive future announcements and newsletters)

Arif Iqball

MedFlow

Chief Executive Officer

MedFlow transforms healthcare quality and cost—we help providers get paid more for delivering better care, while reducing costs.

Co-Founder

Frontier Psychiatry

Currently providing specialized dementia care and clinical support as a neuropsychiatrist while guiding the company's strategic direction through its next growth phase as a board member.

Board Member, Neuropsychiatrist

Co-founded and bootstrapped Frontier Psychiatry, architecting the technology infrastructure that enabled rapid scaling to 75 staff serving 5,000 monthly patients. Developed innovative care delivery models integrating digital health tools and value based care to improve access to specialized psychiatric services in underserved communities.

Co-Founder, COO

BrainCheck

Led clinical R&D team while supporting sales, marketing and other functions from seed stage through Series B funding. Guided product development to enhance cognitive assessment technology for neurodegeneration detection and improved clinical workflows.

Chief Medical Officer

EvergreenHealth

Served as the memory and behavior expert at EvergreenHealth's Neuroscience Institute and for the geriatric clinic. providing specialized clinical neuropsychiatry expertise for comprehensive workup and diagnosis of dementia and related conditions. Applied innovative digital biomarkers and assessment technologies to enhance diagnostic accuracy while developing technology-enabled care models for this vulnerable patient population. Collaborated with an outstanding multidisciplinary team to deliver cutting-edge care.

Neuropsychiatrist

NeuroLex Labs

Led research and development of pioneering digital biomarkers for neuropsychiatric conditions and neurodegeneration. Directed innovative voice diagnostics pilot studies across academic, private, and non-profit partnerships nationwide, advancing clinical assessment technology for early disease detection. Provided healthcare leadership to a team of over 30 research assistants and graduate/undergraduate fellows, driving technology-enabled care models that transformed traditional neuropsychiatric evaluation approaches.

University of Washington - School of Medicine

Practiced neuropsychiatry across multiple sites in Washington state including Harborview Medical Center, and the Seattle Veterans Administration Medical Center. Specialized in dementia and movement disorders.

Senior Fellow, Neurology - Movement Disorders

Veterans Administation

Parkinson's Disease Research, Education and Clinical Center (PADRECC) Advanced Fellowship

Advanced Fellow, Neurology, Movement Disorders

Brainstorm: Stanford Laboratory for Behavioral Health Innovation and Entrepreneurship

Director of Partnerships and Strategy at the world's first academic laboratory for behavioral health entrepreneurship.

Founding Partner

University of Washington Medical Center

Practiced psychiatry across multiple sites in Washington state including University of Washington Medical Center, Harborview Medical Center, and the Seattle Veterans Administration Medical Center.

Resident Physician

King County, WA

Board Member - King County Behavioral Health Advisory Board

My path:
Age 12: I built my first computer
Age 15: I started a small business making first websites for local orgs with HTML and JavaScript
Age 16: I learned C++ and made some primitive games
Age 22: I graduated from RPI with a degree in computer and electrical engineering and took a job that seemed cool working on designing and building a US Navy destroyer
Age 23: Finished chemo and hit remission from Hodgkin's Disease and took a hard look in the mirror
Age 25: Finished a masters in biomedical engineering at Hopkins, focusing on AI and machine learning for medical imaging 
Age 26: Had my first big win in engineering & medicine – invented a modular MRI-compatible exercise device for muscle testing and digital biomarkers
Age 27: Got into UMass medical school on my 3rd try, pursuing neuropsychiatry
Age 30: Built an electronic health record (EHR) while in medical school for a Boston-based company, my first foray into healthcare entrepreneurship and technology-enabled care models
Age 34: Built my first health-tech company, NeuroLex, using voice as a digital biomarker to detect neurodegeneration and disease earlier
Age 36: Finished residency and fellowship at University of Washington and founded a specialized dementia clinic for EvergreenHealth, applying clinical neuropsychiatry expertise
Age 37: Sold NeuroLex and helped build BrainCheck, a digital cognitive assessment technology company pioneering digital biomarkers for dementia assessment
Age 38: Founded and bootstrapped Frontier Psychiatry and grew it to 75 staff and 5k patients/month diving into innovative technology-enabled care models and healthcare leadership
Age 40: Raised a series A and transitioned to scaling mode, implementing value-based care approaches and quality improvement methodologies
Age 41: Handed off Frontier Psychiatry and Founded MedFlow, a workflow automation company for healthcare transformation and optimized care delivery systems

It's been a journey. 

My goal here is to share what I've learned in clinical neuropsychiatry, digital biomarkers, healthcare entrepreneurship, and healthcare leadership to move the needle on outcomes in healthcare, especially dementia care. Healthcare needs absolutely everyone's help to change the status quo. We need to demand better from our systems through technology-enabled care models and organizational change management.

For more information please follow me here and visit rezahg.com

Reza Hosseini Ghomi, MD, MSE

Forward Health: $660 million raised, shut down overnight.

Olive AI: $850 million raised, sold for parts.

Babylon Health: $4 billion valuation, collapsed.

Pear Therapeutics: FDA-approved digital therapeutics, bankrupt.

The pattern is obvious. Healthcare tech keeps failing spectacularly.

And I keep watching them make the same mistakes.

I've built healthcare companies for 15 years. Here's what they don't understand:

1. Healthcare is not a tech problem
↳ It's a trust problem wrapped in regulation
↳ Lives are at stake, not just convenience
↳ Patients want proven solutions, not beta tests
↳ Doctors need extensive validation before adoption

2. The integration trap kills everything
↳ Forward's CarePods were technologically impressive
↳ But they couldn't integrate with existing health systems
↳ No EMR connection means no real utility
↳ Workflow disruption kills adoption faster than poor features

3. Why consumer tech playbooks fail
↳ Healthcare data is dirty, siloed, and inconsistent
↳ 80% of critical data is unstructured
↳ Interoperability isn't a feature, it's the foundation
↳ You can't "move fast and break things" with patient care

4. The reimbursement reality nobody talks about
↳ Olive automated tasks but couldn't prove ROI
↳ No CPT code means no sustainable business
↳ Insurance coverage drives provider adoption
↳ Free trials don't create lasting change

5. What actually works in healthcare tech
↳ Solve one painful problem extremely well
↳ Integrate seamlessly into existing workflows
↳ Get clinical champions who see immediate benefit
↳ Build for the system that exists, not the one you wish existed

Forward shut down with zero transition plan for patients.

Canceled appointments overnight. App went dark immediately.

This is what happens when you optimize for TechCrunch headlines instead of patient care.

When you design for Silicon Valley investors instead of 65-year-old physicians.

When you prioritize disruption over integration.

Healthcare doesn't need revolutionary technology.

It needs evolutionary technology that works within existing systems.

Simple beats brilliant. Integration beats innovation. Reliability beats features.

I've seen billion-dollar failures and million-dollar successes.

The difference? The successful ones understood healthcare is different.

The failures thought they could brute force it with money and engineers.
They were wrong.

💬 What health tech product promised everything and delivered nothing?
♻️ Repost if you believe healthcare needs humble innovation, not disruption
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for realistic takes on what actually works in healthcare technology

Neuropsychiatrist | Engineer | 4x Health Tech Founder | Cancer Graduate - Follow to share what I’ve learned along the way.

AARP just released a state-by-state ranking of dementia risk factors.

The results surprised me.

Here's what they found:
For years, we've talked about dementia prevention in general terms. Exercise helps. Mediterranean diet helps. Social engagement helps.

But which factors matter most? In America specifically? By state?

We didn't know.

AARP partnered with the University of Washington (where I trained) and analyzed data from millions of Americans.

They ranked all 12 modifiable dementia risk factors.

The top 3 account for the largest share of preventable cases:

1. High blood sugar (diabetes and prediabetes)
↳ The single biggest preventable cause
↳ Affects 37 million Americans with diabetes
↳ Another 96 million with prediabetes
↳ Many don't know they have it

2. Hearing loss
↳ Affects 48 million Americans
↳ Even mild untreated hearing loss increases risk
↳ Doubles dementia risk when moderate
↳ Only 20% of people who need hearing aids use them

3. Lower education levels
↳ Less than high school completion
↳ Linked to reduced cognitive reserve
↳ This one requires societal changes, not individual action
↳ Shows why dementia prevention must be more than personal responsibility

The other 9 factors on the list:
High blood pressure
Obesity
Physical inactivity
Smoking
Depression
Social isolation
Excessive alcohol
Air pollution
Traumatic brain injury

What makes this research different:
Previous studies lumped all these factors together and said "45% of dementia is preventable."

True. But not actionable.

This study shows which factors drive the most cases. Where to focus first. 

The findings vary by state.

Some states have higher rates of diabetes. Others have more untreated hearing loss. Prevention strategies need to match local risk patterns.

Here's what this means practically:
If you have diabetes or prediabetes, treat it aggressively. Target HbA1c below 7%. 

Get your hearing tested. If you need hearing aids, use them. The stigma isn't worth your brain health.

We've known for decades that cardiovascular disease deaths have dropped since 2000.

Down significantly because we addressed risk factors. Smoking cessation. Blood pressure control. Statin use.

During that same time, Alzheimer's deaths surged 140%.

We haven't applied the same prevention mindset to brain health that we applied to heart health.

Your blood sugar matters more than brain training apps.

Your hearing matters more than crossword puzzles.

💬 Have you had your blood sugar or hearing checked recently?
♻️ Repost if prevention beats treatment
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for evidence-based dementia prevention strategies

Citations: AARP. The Dementia Risk Reduction Project: Identification of Major Modifiable Dementia Risk Factors in the U.S. AARP. 2025.

Walking 3,000 steps per day slows Alzheimer's by 3 years.

7,500 steps? You delay cognitive decline by 7 years.

New research from Mass General just reinforces what we suspected.

I've been telling patients to exercise for brain health for 15 years. But I couldn't tell them exactly how much mattered or how much it would help.

Now we have some data.

The Harvard Aging Brain Study tracked 296 older adults for years. They measured step counts, brain scans for amyloid and tau proteins, and cognitive function.

Here's what they found:
People who walked 3,000-5,000 steps daily had cognitive decline delayed by 3 years on average compared to sedentary people.

People who walked 5,000-7,500 steps daily had cognitive decline delayed by 7 years.
The mechanism:

Walking slows the buildup of tau proteins in your brain. Tau is the protein that actually kills brain cells in Alzheimer's disease.

Amyloid plaques show up first. Then tau spreads and destroys neurons. Walking doesn't reduce amyloid much. But it dramatically slows tau accumulation.

Three reasons this matters more than any drug:
1. Alzheimer's medications cost $26,000 yearly and slow decline by maybe 4-6 months
2. Walking costs zero dollars and delays decline by years
3. You can start today without a prescription or insurance approval

The study only tracked people who already had elevated amyloid in their brains. These were people on the Alzheimer's path. Walking still protected them.

What 5,000 steps looks like:
- 40 minutes of walking at moderate pace
- 2-3 short walks throughout the day
- Doesn't need to be intense or complicated

This isn't about running marathons or joining a gym. It's about consistent moderate movement.

I tell my patients: if you do one thing to protect your brain, make it moderate movement. Be a bit out of breath. More effective than any supplement. Cheaper than any medication. Available right now. (If you can't walk, then bike, or swim, or row...you get the idea).

45% of dementia cases are potentially preventable through lifestyle factors. Walking is the single most accessible intervention we have.

⁉️ How many steps are you averaging per day?
♻️ Repost if you think prevention beats treatment
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for evidence-based brain health

Citations: Yau WY et al. Physical activity as a modifiable risk factor in preclinical Alzheimer's disease. Nature Medicine. 2025.

Your eye doctor might diagnose Alzheimer's before your neurologist does.
And the test takes 5 minutes.

New research shows retinal imaging detects early Alzheimer's with 93.5% accuracy.

That's better than most brain scans. From a routine eye exam.

Think about that: the same equipment checking for glaucoma could spot dementia 10 years early.

Here's the science that could change things:
1. Your retina is literally brain tissue
↳ Same embryological origin as your brain
↳ Only place we can see living neurons directly
↳ Shares blood-brain barrier properties
↳ Changes mirror brain degeneration in real-time

2. What Alzheimer's looks like in your eye
↳ Thinning of specific retinal nerve fiber layers
↳ Reduced blood vessel density in the macula
↳ Altered vessel branching patterns
↳ Microhemorrhages you can't see or feel

3. The accuracy is remarkable
↳ 93.5% for early-onset Alzheimer's detection
↳ 86.3% for mild cognitive impairment
↳ AI analyzes patterns humans miss
↳ Non-invasive, no radiation, results in minutes

4. Why this beats traditional testing
↳ Brain MRI costs $3,000+ and takes hours
↳ PET scans require radioactive tracers
↳ Lumbar puncture is invasive and expensive
↳ Retinal imaging costs less than an oil change

5. The implementation gap
↳ Technology exists right now
↳ Equipment already in most eye clinics
↳ We're just not using it for dementia screening
↳ Insurance doesn't cover it yet for this purpose

I do a basic retinal exam as part of my neurology visits but my eye can't catch these kinds of changes accurately enough.

Just like we have eye screening tools in every pediatrics office, these devices would be lightweight and cheap enough to be in every PCP office.

I've diagnosed over 1,000 dementia cases in 15 years.

Most come too late. After years of decline. When interventions are less effective.

This technology could flip that entirely.

Your annual eye exam becomes dementia screening.

Accessible. Affordable. Already available.

The tools exist. We're just not using them.

Imagine catching Alzheimer's when lifestyle changes, medications, and interventions actually work.

Not after 50-70% of brain function is already lost.

That's the future retinal imaging may offer.

💬 When was your last comprehensive eye exam?
♻️ Repost if you believe accessible early detection saves lives
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for breakthroughs in early diagnosis that are practical

Citation: Hao, J., et al. (2024). Early detection of dementia through retinal imaging and trustworthy AI. npj Digital Medicine.

The Alzheimer's Association just spent $50 million to answer one question:
Can lifestyle changes actually prevent dementia?

The answer: Yes. And it's not even close.

The POINTER study tracked 2,100 people in their 60s and 70s for two years.

Half got intensive lifestyle intervention. Half got standard advice.

The results made the intervention group's brains 1-2 years younger.

Here's what they did:
1. The intervention wasn't complicated
↳ Mediterranean-style diet
↳ Regular aerobic and strength exercise
↳ Brain training and cognitive challenges
↳ Vascular risk monitoring and management

2. The results were measurable
↳ Improved cognitive function scores
↳ Reduced "brain age" on objective tests
↳ Benefits persisted throughout the study
↳ Changed people's cognitive trajectories

3. Why this study matters differently
↳ Largest rigorous lifestyle intervention ever
↳ Used objective brain measurements, not just surveys
↳ Proved you can reverse cognitive aging
↳ Showed combination therapy works better than single interventions

4. The translation problem
↳ This worked in a controlled research setting
↳ How do we deliver this in the real world?
↳ Insurance doesn't cover lifestyle prescriptions
↳ Doctors aren't trained to prescribe diet and exercise like drugs

5. What's coming next
↳ $40 million to implement POINTER in communities
↳ Brain scans and blood tests being analyzed
↳ Will show if cognitive improvements match brain changes
↳ Could transform how we think about prevention

Here's what frustrates me:
We prove lifestyle interventions work.

Then we act like they're optional.

Meanwhile, we celebrate $50,000 drugs that slow decline by a few months.

And ignore the free interventions that actually reverse it.

The healthcare system will pay $50,000 for monthly infusions.

But won't pay for nutrition counseling or exercise programs.

We have the evidence. We know what works.

Diet. Exercise. Cognitive engagement. Social connection. Vascular risk management.

Not one thing. All of them together.

The question isn't whether lifestyle changes work.

It's whether our healthcare system will ever prescribe them like medicine.
Up to 45% of dementia risk is modifiable.

We know how to modify it.

We just don't.

💬 Would you commit to a 2-year intensive lifestyle program if it could prevent Alzheimer's?
♻️ Repost if you believe prevention deserves the same investment as treatment
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for evidence-based approaches to preventing cognitive decline

Citations: Baker, L. D. et al. (2025). Structured vs self-guided multidomain lifestyle interventions for global cognitive function: The U.S. POINTER randomized clinical trial. JAMA.

Light drinking protects your brain.

Doctors have said this for decades. I've repeated it to patients.

A study at Oxford just added to the evidence convincing me we were probably wrong.

New study of 560,000 people: ANY amount of alcohol increases dementia risk.

There is no safe level. Zero.

The "benefits" of light drinking? An illusion caused by flawed research design.

Here's what the science actually shows:
1. The U-shaped curve was a mistake
↳ Previous studies compared drinkers to non-drinkers
↳ But "non-drinkers" included people who quit due to illness
↳ That made light drinkers look healthier by comparison
↳ Classic case of reverse causation fooling researchers

2. Genetic analysis tells the truth
↳ Can't fake your genes to look healthy
↳ 2.4 million people analyzed genetically
↳ Those genetically predisposed to drink more had higher dementia rates
↳ Dose-response: more alcohol, more dementia

3. Even moderate drinking damages the brain
↳ Brain scans show shrinkage at low levels
↳ Alcohol disrupts sleep quality every time
↳ Inflammation increases with each drink
↳ The "benefits" never existed

4. Why doctors believed the myth
↳ Observational studies showed correlation
↳ Wine drinkers seemed healthier than abstainers
↳ But wine drinkers also exercise more, eat better, have higher incomes
↳ We confused lifestyle with the wine itself

5. What this means for prevention
↳ Reducing alcohol may be as important as exercise
↳ No amount is "healthy" for your brain
↳ The less you drink, the better
↳ Complete abstinence is the lowest-risk choice

I've spent 15 years telling patients moderate drinking was probably fine.

I was wrong. The research was wrong.

The genetic evidence is clear: alcohol hurts brains at any dose.

Will I tell patients they can never drink? No.

But I'll stop pretending it's good for them.

The "heart healthy" glass of wine might be costing you brain cells.

There's no such thing as a brain-healthy drink. 

I've come to this conclusion now over the course of several years of accumulating evidence and reexamining my previous understanding.

💬 How does this change your thinking about alcohol and brain health?
♻️ Repost if this challenges what you thought you knew
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for evidence that changes clinical practice

Citations: Topiwala A, Levey, et al. Alcohol use and risk of dementia in diverse populations: evidence from cohort, case-control and Mendelian randomisation approaches. BMJ Evidence-Based Medicine. 2025.

Mr. Thompson's wife called me panicking.

"He's getting aggressive. He yells at me. He's not himself anymore."

She felt stuck, part of her wanted to put him in a memory care facility immediately and the other part couldn't bring herself to go down that path.

One question I asked changed things.

Mr. Thompson, 71, had been diagnosed with mild Alzheimer's 6 months earlier by his primary doctor. His memory was declining slowly. But so was his personality.

Aggression. Paranoia. Agitation.
His wife was exhausted and scared.

Here's the question I asked:
"Does he snore loudly at night?"

She looked confused. "Yes, he's always snored. What does that have to do with his aggression?"

More than you think.

I ordered a sleep study. Severe obstructive sleep apnea. Oxygen saturation dropping to 78% dozens of times per night.

His brain was being starved of oxygen for hours every night.

We started him on CPAP therapy. Within 3 weeks, the aggression improved. The paranoia reduced significantly. His wife got her husband back.

He still has Alzheimer's. His memory is still declining. But the personality changes that were destroying their marriage? Those were from untreated sleep apnea.

Sleep apnea causes or contributes to 30-40% of cognitive complaints in my practice.

It mimics dementia. It worsens real dementia. And it's completely treatable.

Three signs your cognitive decline might be sleep apnea:
1. Loud snoring with witnessed breathing pauses
2. Excessive daytime sleepiness
3. Personality changes or irritability that came on suddenly

The tragedy is how often this gets missed.

Patient has memory problems. Gets diagnosed with dementia. Nobody checks their sleep. Symptoms worsen. Family assumes it's just the disease progressing.

Meanwhile, treating their sleep apnea could have prevented years of unnecessary decline.

Emerging research shows sleep apnea might increase dementia risk long-term. We're still studying that connection.

But I know for certain that untreated sleep apnea makes everything worse. Cognition. Mood. Function. Quality of life.

I screen every single dementia patient for sleep problems now. About 1 in 3 has significant sleep apnea.

Mr. Thompson still comes to my clinic. His memory isn't improving. But his wife tells me she has her husband's personality back. That matters more than his score on a memory test.

Fix the sleep. Then see what cognitive problems remain.

⁉️ Have you seen sleep problems confused with dementia?
♻️ Repost if you screen for sleep apnea in cognitive patients
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for diagnostic insights that matter

I teach medical students one question that catches dementia earlier than most screening tests.

"What have you stopped doing that you used to enjoy?"

Not "how's your memory?" Not "what's today's date?"

This question reveals functional decline.

Here's why it works:
People with early dementia don't usually complain about memory loss. They know something's wrong, but they can't articulate it.

So they stop doing things. Quietly. Gradually.

They stop managing finances because it's "too stressful"

They stop cooking because they're "not hungry"

They stop driving to new places because they "prefer familiar routes"

They stop hosting friends because they're "too tired"

Each excuse seems reasonable. But together they paint a picture of someone avoiding tasks they can no longer handle.

I had a patient, Maria, who came in for annual checkup. Age 68. No memory complaints.

I asked my question: "What have you stopped doing?"

She paused. Then said "I used to love crossword puzzles. Haven't done one in months. They just frustrate me now."

That can be early cognitive decline. Not the puzzles themselves. The frustration when something that used to be easy becomes hard.

We did cognitive testing. Mild cognitive impairment. Early enough to intervene. Early enough to plan.

Three patterns that signal early dementia:
1. Withdrawal from complex tasks
2. Managing money, cooking elaborate meals, planning travel. These require executive function that declines first.
3. Reduced social engagement

Not because they're depressed. Because social situations demand cognitive effort they can no longer sustain.

Preference for routine
New situations require learning and adaptation. People with early dementia stick to routines because routines don't challenge their declining cognition.

Standard screening tests miss this.

The Mini-Mental State Exam asks "what's the date?" and "spell WORLD backwards." 

Patients with early functional decline can pass those tests easily.

But they can't manage their checkbook anymore. They've stopped organizing family gatherings. They've given up hobbies that require concentration.

That's dementia. Before the tests show it. Before families recognize it.

Why this matters:
Early intervention works better. Medications work better. Lifestyle changes work better. 
Families have time to plan.

But we miss the early window because we're asking the wrong questions.

A patient who scores 28/30 on cognitive tests but stopped managing their life? That's suspicious.

A patient who scores 24/30 but still runs their business? That might just be lifelong low cognition.

Context matters. Function matters. Pattern of decline matters.

⁉️ What question do you use to screen for early cognitive decline?
♻️ Repost if functional assessment beats screening tests
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for clinical diagnostic pearls

I teach residents to confidently diagnose dementia in 15 minutes.
No fancy tests. No referrals to specialists.

Just 3 assessments that primary care doctors can do in any clinic.

Most PCPs avoid dementia diagnosis because they think it requires neuropsychological testing or brain scans. But 60% of dementia goes undiagnosed, and specialists can't see that many patients.

Here's the system I developed after diagnosing over 1,000 cases:

Step 1: The pattern interview (5 minutes)
I ask the family these exact questions:
- What specific tasks can't they do anymore that they could do 2 years ago?
- Do they get lost in familiar places?
- Have they stopped managing their medications or finances?

The pattern tells you everything. Slow, steady decline over years? Likely Alzheimer's. Sudden changes with stepwise worsening? Vascular dementia.

Step 2: Computerized cognitive testing (8 minutes)
Digital tools give you:
- Objective scores across memory, attention, executive function
- Immediate results with normative data for age and education
- Reimbursable using CPT code 96132
- Can be administered by medical assistants

This replaces the 3+-hour neuropsych evaluation for most patients. Save the full testing for complex cases.

Step 3: Rule out reversible causes (2 minutes)
Check their chart for:
- Sleep apnea (causes 30-40% of cognitive complaints)
- B12 deficiency
- Thyroid disease
- Medication side effects

Fix these first. I've reversed maybe 5% of "dementia" diagnoses by treating sleep apnea alone.

What you don't need:
- Brain MRI unless atypical presentation
- Lumbar puncture unless suspecting rare dementia
- Referral to neurology for typical Alzheimer's or vascular dementia

What you do after diagnosis:
- Start acetylcholinesterase inhibitor if appropriate
- Create cognitive care plan (CPT 99483) - there are digital tools to automate this
- Connect to community resources
- Follow up in 3 months

The impact of early diagnosis is massive. Patients get years more of independence. Families have time to plan. Treatment works better.

And primary care doctors can provide this. The system makes it straightforward.

⁉️ What's stopping you from diagnosing dementia in your practice?
♻️ Repost if you think PCPs should lead dementia diagnosis
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for practical neurology systems

Scientists just reversed Alzheimer's in mice using nanoparticles.

Not by delivering drugs. The nanoparticles themselves were the treatment.

Here's what happened:
Researchers designed bioactive nanoparticles that target the blood-brain barrier. Instead of carrying medication, the nanoparticles directly triggered the brain's natural cleaning system.

The results:
Restored blood-brain barrier function
Cleared toxic amyloid-beta proteins naturally
Reversed memory loss in treated mice
No drug side effects

Why the blood-brain barrier matters:
Your brain has one billion capillaries. Each neuron has its own blood supply. This vascular network delivers 20% of your body's energy to your brain.

When this system breaks down, toxic proteins accumulate. The brain can't clean itself properly.

Traditional Alzheimer's drugs try to break through the barrier to deliver medication. This approach repairs the barrier instead.

The paradigm shift:
Instead of treating Alzheimer's as a protein problem, treat it as a vascular problem. Fix the blood vessels, and the brain can clean itself.

This aligns with what we're seeing clinically. Vascular health and dementia are deeply connected:
Hypertension increases dementia risk by 60%
Diabetes doubles Alzheimer's risk
Good cardiovascular health dramatically reduces dementia incidence

Three implications for the future:
- Nanotechnology could deliver treatments non-invasively
- Repairing vascular function may help multiple types of dementia
- Prevention focused on vascular health becomes even more critical

The timeline:
This is mouse research. Human trials are years away. But the concept is sound: repair the brain's infrastructure, don't just attack the proteins.

I've watched billions go into amyloid-targeting drugs with minimal success. Shifting focus to the vascular system makes biological sense.

Your brain's blood vessels matter as much as the neurons they feed.

⁉️ How much do you think about brain vascular health versus brain health?
♻️ Repost if this changes how you think about dementia prevention
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for breakthroughs in neuroscience

Citations: Chen J et al. Rapid amyloid-beta clearance through multivalent modulation of blood-brain barrier transport. Signal Transduction and Targeted Therapy. 2025.

60% of people with dementia never get diagnosed.

Not because we can't detect it. Because doctors don't have time to look. And data isn't always presented the right way for our brains to process.

Researchers just solved this with AI that requires zero physician time.
31% increase in new dementia diagnoses. Completely automated.

Here's how it works:
1. The AI reads medical records passively
↳ Analyzes physician notes from routine visits
↳ Looks for linguistic patterns in documentation
↳ Identifies cognitive concerns buried in charts
↳ Flags patients who need formal assessment

2. Combined with a 10-question patient survey
↳ Quick Dementia Rating System (QDRS)
↳ Completed by family members in waiting room
↳ Takes 2 minutes
↳ Captures functional decline doctors miss

3. Why this can change things
↳ No additional clinician time required
↳ No expensive testing needed for screening
↳ Works within existing electronic health records
↳ Open source - any health system can use it

4. The results from 5,000 patients
↳ 31% more dementia cases identified
↳ 41% increase in follow-up diagnostic testing
↳ Earlier detection means earlier intervention
↳ No false positives overwhelming the system

5. Why we've missed so many diagnoses
↳ 15-minute primary care visits
↳ Patients come in for other problems
↳ Cognitive screening feels like extra work
↳ Stigma prevents patients from volunteering concerns

I've seen this pattern for 15 years.

Families tell me "something's been wrong for 3 years" but the other providers they've seen don't have the time or training to address it.

This AI doesn't replace doctors. It gives them a heads-up.

"This patient's chart and family survey suggest cognitive decline. Consider formal assessment."

The tool is free. Developed at Regenstrief Institute over 10 years. Open source.

Any healthcare system with an EHR can implement it.

The technology to diagnose dementia early exists.

We're just not using it at scale.

This could change that.

💬 Would you want your doctor's EHR screening for dementia automatically?
♻️ Repost if you believe AI should augment diagnosis, not replace it
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for practical applications of health tech that actually help patients

Citation: Boustani MA, et al. Digital Detection of Dementia in Primary Care: A Randomized Clinical Trial. JAMA Netw Open. 2025.

Function Health just raised $298 million at a $2.5 billion valuation.

Celebrity-backed. Matt Damon. Magic Johnson. Pedro Pascal.

They've delivered 50 million lab tests since 2023.

And they still can't solve healthcare's fundamental problem.

What's missing:
Function charges $365 per year for 160+ lab tests. Full body MRI scans. Heart and lung CT. AI-powered analysis of your health data.

The technology is impressive. The execution is solid.

But patients pay 100% out of pocket.

No insurance coverage. No Medicare reimbursement. No pathway to the 80% of Americans who can't afford $365 annually for preventive care.

This is the pattern I've watched for 15 years building healthcare companies:
1. Amazing technology built for the wrong business model
↳ Direct-to-consumer works for wellness
↳ Fails for actual healthcare delivery
↳ Excludes everyone who needs it most
↳ Creates a two-tiered system

2. The innovation paradox
↳ 50 million tests completed is remarkable scale
↳ But it's the wealthy worried well
↳ Meanwhile, Medicaid patients can't access basic cognitive screening
↳ Innovation that doesn't reduce disparities isn't progress

3. Why insurance won't cover it
↳ No published outcomes data showing benefit
↳ No integration with treatment pathways
↳ Preventive screening without follow-up care
↳ Can't demonstrate cost savings to payers

4. The fundamental flaw
↳ They acquired Ezra for advanced imaging
↳ Launched "Medical Intelligence Lab" with AI
↳ Hired top talent from NYU and elsewhere
↳ Still selling to people who already have access to healthcare

Forward Health raised $660 million. Shut down and left patients stranded.

Function raised $350 million total.

Different approach. Same problem.

You can't disrupt healthcare by serving only people who don't need the system.

What I've seen:
The concierge medicine company that served executives but couldn't scale to regular employees.

The genetic testing startup that charged $3,000 per test when insurance would only pay $300.

The digital health platform that worked beautifully for tech workers but failed in rural clinics.

Function's technology could actually help people.

Their AI could identify early disease. Their screening could catch cancers early. 
Their data integration could improve outcomes.

But only if it's accessible.

The real test isn't whether celebrities invest.

It's whether Medicare covers it. Whether Medicaid patients can use it. Whether 
it works in community health centers serving uninsured populations.

Until then, it's expensive wellness for people who can afford to worry about optimization.

Not healthcare for people who need early detection.

We don't need better technology for the worried well.

We need accessible technology for the actually sick.

💬 Do you think enough people will pay out of pocket?
♻️ Repost if healthcare innovation should reduce disparities, not increase them
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for reality checks on healthcare technology hype

Your Fitbit says you slept 8 hours last night.
Your brain says otherwise.

I've seen this pattern in hundreds of dementia patients. They think they're sleeping fine because they're in bed for 8 hours.

But their brains are starving for the sleep that matters.

New research shows it's not how long you sleep.

It's how deeply you sleep.

Specifically: deep sleep and REM sleep protect against Alzheimer's.
Lack of these stages shrinks the exact brain region that Alzheimer's attacks first.

Here's what you need to know:
1. Sleep has stages for a reason
↳ Deep sleep clears toxic proteins from your brain
↳ REM sleep supports memory consolidation
↳ Both activate the brain's glymphatic cleaning system
↳ Light sleep doesn't do any of this

2. Midlife sleep quality predicts late-life dementia
↳ Poor deep sleep in your 40s-50s matters
↳ Brain shrinkage starts decades before symptoms
↳ By the time memory fails, it's often too late
↳ Sleep is when your brain takes out the trash

3. The Fitbit (and other consumer devices) lie
↳ sleep quality measurements are surprisingly inaccurate
↳ Sleep apnea destroys deep sleep
↳ Alcohol ruins REM sleep
↳ You can be in bed 9 hours and get 20 minutes of deep sleep

4. How to know if you're getting quality sleep
↳ Do you wake up refreshed or groggy?
↳ Do you need caffeine to function?
↳ Does your partner say you snore or stop breathing?
↳ Consider a sleep study if any answer concerns you

5. What destroys deep sleep and REM
↳ Sleep apnea (most common and most missed)
↳ Alcohol before bed
↳ Inconsistent sleep schedule
↳ Chronic stress and poor sleep hygiene

The cruel irony?

Most people with sleep apnea don't know they have it.

Their Fitbit says 8 hours. They think they're fine.

Meanwhile their brain is being bathed in toxic proteins all night.

I screen every dementia patient for sleep disorders.

At least 40% have undiagnosed sleep apnea.

Treating it doesn't cure their dementia. But it often slows the decline.

Your brain needs deep sleep and REM sleep to survive.

Not just sleep. Quality sleep.

Eight hours of garbage sleep is worse than 6 hours of quality sleep.

Stop tracking hours. Start tracking quality. Talk to your provider about a sleep study.

💬 Have you ever had a sleep study? What did you learn?
♻️ Repost if you believe sleep quality matters more than sleep quantity
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for brain health insights your doctor isn't telling you

Citations: Cho, G. et al. (2025). Lower slow‐wave sleep and rapid eye movement sleep are associated with brain atrophy of Alzheimer’s disease‐vulnerable regions. Journal of Clinical Sleep Medicine.

Mrs. Chen kept forgetting to turn off the stove.

Her daughter was convinced it was Alzheimer's disease.

It wasn't.

This case taught me why the type of memory problem matters more than the severity.

Mrs. Chen, 68, came to my memory clinic after her third kitchen incident. Her daughter was terrified she'd burn down the house.

The standard screening test showed mild cognitive impairment. Her primary doctor had already started her on donepezil.

But something didn't fit.

I asked her daughter to describe a typical day:
- She remembered to take all her medications perfectly
- She managed complex recipes without notes
- She could navigate anywhere in the city
- She balanced her checkbook accurately

But she forgot:
- To turn off the stove after cooking
- To close the garage door
- To lock the front door at night

This pattern told me everything.

Alzheimer's destroys memory formation. Patients can't create new memories. They forget conversations that happened 5 minutes ago.

Mrs. Chen's problem wasn't as much memory. It was more attention and executive function.

She could remember. She just couldn't track multiple steps in real-time tasks. And she was easily overwhelmed when too many things were going on at once.

This ended up being more frontal lobe dysfunction, less likely due to Alzheimer's disease (we do see executive predominant Alzheimer's regularly but this was a bit different).

The diagnosis: mild cognitive impairment with primary executive dysfunction. Likely early frontotemporal dementia.

Brain MRI in her case was supportive (more frontal pathology and fewer changes in the medial temporal lobes and medial parietal lobes). If it was executive predominant Alzheimer's I would have expected more pathology especially in the parietal lobe.

Why this matters:
Different dementias need different approaches

Alzheimer's medications don't always help frontotemporal dementia (and can make behavior worse)

Her prognosis and care plan completely changed

What we did:
- Stopped the donepezil (potentially contributing to more impulsive behavior)
- Set up automatic stove shut-off timer
- Created checklist system for daily routines
- Connected her with FTD support groups
- implemented full cognitive care plan

6 months later, she's doing well. The safety systems work. Her daughter understands this isn't Alzheimer's and what to expect.

The lesson I teach residents:
Listen to the pattern of what's preserved versus lost. Memory problems alone don't tell you much. The pattern of cognitive changes reveals the diagnosis.

Ask families:
What can they still do perfectly?
What have they completely lost?
How did it progress?

These answers matter more than any score on a screening test.

Pattern recognition beats screening scores every time.

⁉️ Have you seen cases where the initial diagnosis was wrong?
♻️ Repost if you think detailed history beats screening tests
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for clinical neurology insights

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Jennie Chin Hansen

60% of EHR implementations fail because of user resistance.

Not because of the technology. Because doctors refuse to use it.

I've watched five EHR rollouts in my career. The technology worked fine. The humans didn't.

Here's what actually happens:
- Hospital spends $2 million on a new EHR system
- IT implements it perfectly
- Training happens for 2 weeks
- 6 months later, adoption rate for workflows is 23%

The problem nobody wants to talk about:
We designed EHRs for billing and compliance. Not for doctors actually taking care of patients.

A study in Mayo Clinic Proceedings surveyed thousands of US physicians. They rated their EHR on the System Usability Scale. The scale goes from A to F.

The average score? F.

An F in usability for a system that doctors are required to use for 4-6 hours per day.

Three reasons EHRs keep failing:
1. They add cognitive load during patient care
2. Doctors are trying to listen to patients while clicking through 47 screens to document a visit. This isn't a training problem. This is a design problem.
3. They optimize for the wrong things

EHRs excel at billing codes and compliance documentation. They're terrible at showing me what I need to know about a patient in 10 seconds.

Doctors had no say in the design

Systems built by IT departments and administrators for their workflows. Not for clinical workflows.

The data on this is brutal:
- 20% of EHR installations are outright failures
- 50% fail to be properly utilized
- 70% of academic hospital physicians report burnout from EHR use
- $5,600 per minute average cost of EHR downtime

We spent billions forcing doctors to use systems that make their jobs harder. Then we're surprised when they resist.

The fix isn't more training. The fix is building systems that actually help doctors do their jobs instead of just documenting that they did them.

Until EHR vendors understand that clinical workflow matters more than billing optimization, we'll keep seeing these same failures.

⁉️ What's your biggest frustration with your EHR?
♻️ Repost if you think EHRs should be designed for clinicians
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for healthcare technology reality checks

Citations: Fox Group "10 EHR failure statistics". 2024. & Melnick et al. The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians. Mayo Clinic Proceedings. 2020.

73% of hospitals plan to increase AI spending in 2025.
But most AI projects fail because of one critical mistake.

I've implemented AI in 3 different healthcare organizations. The technology is never the problem.

Here's what breaks AI adoption:
The failure pattern I see everywhere:

Leadership buys impressive AI technology

IT implements it technically correct

Training happens for 2 weeks

Then everyone goes back to their old workflow

6 months later the AI tool has 12% adoption

The problem isn't the AI. It's change management.

Healthcare has a unique challenge. We're asking burned-out clinicians to learn new systems while they're already underwater with documentation.

What works:
Start with the workflow problem, not the technology

Ask: What takes the most time?

Then ask: Will this AI remove work or add work?

Most AI adds steps before it removes them. Good ambient scribes work because they immediately reduce documentation time. No added steps.

Get clinical champions first

Find 3 doctors who will use it. Not the CMO. Not the department chair. The ones doing 30 patients a day.

When they say it works, others will follow.

Measure time savings, not adoption rates

Nobody cares about 80% adoption if it doesn't save time. Show me 45 minutes saved per day for each clinician. That's ROI.

Fix the change management before scaling

Run it with 10 people for 3 months. Learn what breaks. Fix the workflow integration. Then scale.

I watched a health system spend $2 million on an AI diagnostic tool. The technology was solid. But they rolled it out to 200 doctors in one week.

3 months later, 8 doctors were using it.

The ones who are succeeding with AI in 2025:

Start small with real pain points

Integrate into existing workflows

Get clinical staff bought in first

Scale only after proving it removes work

AI won't fix a broken workflow. It will just automate the broken parts faster.

The organizations winning with AI aren't the ones with the biggest budgets. They're the ones who understand their clinicians need less work, not more technology.

⁉️ What's the biggest barrier to AI adoption you've seen?
♻️ Repost if you think change management matters more than technology
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for healthcare leadership insights

Citations: State of AI in Healthcare 2025. Survey of 400+ healthcare professionals. NVIDIA Healthcare and Life Sciences. 2025.

We kept hearing operating in both fee-for-service and value-based contracts simultaneously was temporary.

This has likely turned out to be wrong. 

It now seems to be the permanent reality for healthcare.

Here's what 14% of all healthcare payments now flowing through capitated models actually means for providers.

The uncomfortable truth about value-based care in 2025:
Only 40% of practice leaders have a positive outlook on VBC this year. The rest are neutral or negative.

Why? Because the industry created over 50 different payment models in the last decade.

Shared savings. Downside risk. Bundled payments. Direct contracting. Quality payments. 
ACO arrangements. Each with different tracking requirements.

What this looked like in practice on any given day: 
See patients under fee-for-service contracts
(Track every CPT code, maximize billable time, optimize for coding accuracy)

Then in the same clinic, different payer contracts 
(now measured on population health outcomes, documentation focused on care coordination, revenue based on keeping patients healthy)

This wasn't temporary. This is how healthcare works now.

The data backs this up:
14% of provider payments now capitated (doubled since 2021)

But 40% still pure fee-for-service across all lines of business

The rest is a complicated mix of both

Three reasons the hybrid model is permanent:
Payers can't agree on one approach

Every insurance company designed their own version of value-based care. Zero standardization. Each requires different reporting, different quality metrics, different benchmarking.

Small practices can't afford full-risk models

Taking downside risk requires sophisticated data analytics and care coordination infrastructure. Most practices don't have the capital or staff.

Fee-for-service still generates reliable revenue

When VBC contracts don't meet benchmarks, FFS keeps the lights on. Nobody's abandoning that safety net.

What I've seen work:
- Build workflows that served both models simultaneously
- Hire care coordinators who improve VBC outcomes
- Use technology to automate across different contracts
- Design for this permanent complexity

The mistake I see practices making:
Waiting for the industry to "figure it out" before committing to either model.

The industry did figure it out. The answer is both. For the foreseeable future.

That's why I'm focused on workflow automation now. The administrative burden of dual payment models isn't going away. We need technology that makes it manageable.

Value-based care grew from 2% to 14% of payments in three years. But fee-for-service isn't disappearing. We're going to operate in both worlds for the next decade at minimum.

Build for that reality.

⁉️ Is your organization prepared to operate in both payment models permanently?
♻️ Repost if you think hybrid payment models are here to stay
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for healthcare operations insights

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