Interview with Chamber CEO George Aloth

Join me in exploring value-based care with George Aloth, co-founder and CEO of Chamber. George shares his inspiring journey from his upbringing in Baltimore to his pivotal role in shaping healthcare. With a unique educational background in accounting and law, he honed his expertise in Medicaid and Medicare through early career experiences at CMS and Cigna. His entrepreneurial spirit led him to co-found a Medicaid insurance startup and eventually become CEO of CareFirst's Medicaid division. George reflects on his tenure at Somatus, a kidney value-based care company, which sparked his passion for transforming specialty care, specifically cardiology, into a value-based model.

In our conversation, we tackle the pressing issues of cardiology access and equity, emphasizing the challenges faced by vulnerable populations reliant on Medicaid. The discussion highlights the economic decisions cardiology practices must make amidst high demand and limited supply. We explore strategies to enhance efficiency and ensure equitable treatment for all patients, regardless of insurance status. Drawing insights from the book "Good to Great" by Jim Collins, we underscore the importance of building a strong team during rapid growth phases. Don't miss this enlightening discussion with George Aloth as we envision a future of improved access and quality in cardiology care.

As of March 2025 HealthBiz is part of CareTalk. Healthcare. Unfiltered and can be found at the following links:

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• Apple https://podcasts.apple.com/us/podcast/caretalk-healthcare-unfiltered/id1532402352
• YouTube https://www.youtube.com/@CareTalkPodcast
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Host David E. Williams is president of healthcare strategy consulting firm Health Business Group.

Episodes through March 2025 were produced by Dafna Williams.

Transcript

0:00:00 - David Williams
Value-based care is touted as a solution for high costs and fragmentation, but it's usually focused on primary care, even though most costs are accrued in specialties. So what does value-based care look like for high-cost specialties, and who's making it happen? Hi everyone, I'm David Williams, President of Strategy Consulting Firm Health Business Group and host of the Health Biz Podcast, where I interview top healthcare leaders about their lives and careers. My guest today is George Aloth. He's co-founder and CEO of Chamber, which empowers cardiology teams for value-based care. Do you like the show? If so, please subscribe and leave a review. George, welcome to the Health Biz Podcast. 

0:00:50 - George Aloth
Thanks, david, I appreciate you having me here today. 

0:00:54 - David Williams
Let's talk a little bit about your background and upbringing. I'm interested in what your childhood was like and if there's been any childhood influences that have stuck with you through your career. 

0:01:04 - George Aloth
Yeah, David, so I was born and raised in Baltimore and actually I consider myself lucky. I've spent my entire life in this northeast corridor, so between DC and New York which I say is the epicenter of everything that's going on in the country. 

I grew up in a really diverse area. I got to see it all. And when you're in this part of the country, you know, because it's such a condensed small space, you know you can go a few blocks. You're around the richest of the rich, you're around the poorest of the poor and you kind of see it all. And I really did see it all growing up. 

0:01:32 - David Williams
And. 

0:01:32 - George Aloth
I think that had a big influence on me. 

0:01:34 - David Williams
It really made me think about you know, when I get older, I really want to do something that's meaningful. 

0:01:39 - George Aloth
I got to see a lot of folks that really struggled in all aspects of life, but also in healthcare, which is the space that I'm in today. 

0:01:51 - David Williams
And that's really driven me to do what I do today. I saw in terms of your educational background. It's a little different than some of the other healthcare entrepreneurs and executives I have on the show. You studied accounting and then you did law, and an emphasis on insurance law. What was your thinking in terms of your education? 

0:02:08 - George Aloth
Yeah, like all kids growing up, I really had no clue what I was going to do. The one thing I was sure about is that I wanted to move to New York City. So you know, coming out of high school you went to Fordham University in New York and it was intentional. 

0:02:21 - David Williams
So you know for me, my mantra going into that was, you know, make the most of your situation. 

0:02:26 - George Aloth
whatever you're doing, make the most of it and I you know Fordham was my top choice, but it was an amazing experience. Really enjoyed my time there. 

0:02:33 - David Williams
And what I did when I got there was really experience life in New York City so you know, I worked 20 hours a week the entire four years of college. 

0:02:41 - George Aloth
I got a chance to intern at hedge funds and financial firms and even Sony. Records. So I really got a background in what it was like in New York. And I'll say this but I really learned how to hustle and I really learned how to grind it was quite an experience moving to New York at the age of 18. 

0:02:56 - David Williams
But I majored in accounting I was good with numbers. 

0:02:58 - George Aloth
My dad was a CPA. 

0:03:00 - David Williams
And for me, I really wanted to do something bigger. For me, accounting was sort of that plan B. Things didn't work out and luckily for me, things did. That's great. And then early career. I saw that you worked for, I think, clifton Larson Allen, a Medicare contractor, and then was at Cigna, I think, doing compliance as well. What was that early experience like? 

0:03:23 - George Aloth
Yeah. So once I got to law school I packed my bags, I moved down to Philly and it wasn't a top tier law school, but they were very good at healthcare law. So, like my mantra making the most of my any situation that I'm in I really leaned into healthcare while I was in law school. So once I graduated, you know, my first gig was was working for CMS, which is the Centers for Medicare and Medicaid. 

And I really specialized in Medicaid and Medicare services and I really have spent the majority of my healthcare career doing just that. From there I went to Cigna where I was also doing Medicaid and Medicaid work, and then from there I ended up going to a startup, which was kind of this interesting experience it was one of those moments of are you sure you're doing the right thing, but it was an amazing experience. 

I was an early employee at a Medicaid insurance company and that's where I really learned the space really well, and I would say one learning healthcare, but two learning about entrepreneurism, and it was an amazing experience. I spent seven years doing it. I learned from one of the best the founder and CEO, a guy named Tommy Duncan really taught me a lot about the healthcare space, but also how to be a good entrepreneur. So I did that for a number of years and really honed my skills and at one point we were acquired and that's when I got my first opportunity to be CEO of CareFirst. 

Blue Cross, Blue Shield had acquired us. 

0:04:38 - David Williams
They asked us to stick around post-acquisition to be CEO of their Medicaid division and it was a wonderful experience for me, and it's been off to the races since then, outstanding George. So after you were doing that at CareFirst, then there was Somatis. So what was Somatis? 

0:04:57 - George Aloth
Yeah, so after a number of years at CareFirst, I really started to think about what was next. 

0:05:02 - David Williams
And as a health plan CEO cardiology was always the most expensive thing by PNL, and so I really started to think about the specialty space and value-based care and things like that. So I ended up leaving. 

0:05:13 - George Aloth
I went to Somatis, which was a large, premier kidney value-based care company really wanting to learn about specialty, value-based care, that the space in nephrology was really big. 

0:05:24 - David Williams
And I thought I could learn a lot there, so there. 

0:05:26 - George Aloth
I went there in a group president role was managing most of the country. 

0:05:30 - David Williams
And that's when I really started to think about this next idea Value based care taken off from primary care, but really only certain specialties like nephrology and oncology at that point. 

0:05:39 - George Aloth
Again, I thought there was this huge opportunity in cardiology and eventually ended up leaving there to start this company. 

0:05:46 - David Williams
I mean, as you say, you know, heart is the big one, it's not just some random specialty. So, as big as you know kidney care is and oncology, heart is certainly bigger than nephrology and it's right up there with cardiology, right up there with oncology, if not above. So you know, what did you see in terms of why value-based care in cardiology? Because other people knew that it was big, but maybe they were thinking it's just not a place you can do value-based care. 

0:06:15 - George Aloth
Yeah, you know. I mean, I think, if it was easy everybody would be doing it right, I think there's challenges, but the opportunity is there. It's the biggest expense in healthcare, it's the number one killer in America. I think that you know, typically in value-based care they really followed CMS right. 

So there was programs for primary care, then there came programs for kidney and oncology and that's really what drove the marketplace, and I think that because there were not programs, fully fledged value-based care programs for cardiology, there was a slower adoption rate. I think what we're seeing today is that the problem is just too big to ignore the spend is out of control. The outcomes for patients with heart disease are not getting better. And really there needs to be a solution and I thought you know it's going to be hard. 

0:07:01 - David Williams
It's different, there aren't a lot of people doing this, but the opportunity is there and someone needs to do it, and so that's what really drove me to start this company. You know, one of the ways that value-based care can work is by having care be coordinated, which is a reason why you often see it in primary care, even though that's where most of the cost is. Primary care can be the quarterback, but healthcare is so fragmented, and I'm wondering if care can really be coordinated and how you can actually hold anybody accountable, say for a cardiology patient. 

0:07:33 - George Aloth
Yeah, I think that the most important thing in value-based care and healthcare in general is engagement. The only way it's going to work work if everyone's engaged. And I think that the second part of that is really collaboration and connecting those dots and so if you think about any patient, there's the patients themselves that have to engage. But there's the doctors, there's the health insurance company. There's the other specialists that may be involved in the patient's ecosystem of care and I think that when you think about the population, there's not one solution that makes sense for everybody. 

There's some people that make sense for primary care, value-based care. There's some that make sense for specialty and I think that there's a large portion of the population where their care is really dictated by the cardiologist right Once you have heart disease and it's far enough along you may not be thinking about those other things. You may not be thinking about primary care or other issues that you may have, because your biggest concern is your heart disease. 

0:08:22 - David Williams
And so I think for that portion of the population. 

0:08:24 - George Aloth
Our argument is that cardiology and value-based care makes sense for them, the cardiologists and our care team and chamber in general. Our solution really should be the quarterback for those patients. 

0:08:37 - David Williams
So, as you mentioned, heart disease is a top cause of death. It's a big expense in the healthcare system. You've got these expensive patients At the end of the day. Is there a strategy for these advanced patients in terms of cost and quality? Is there anything that you can actually do about it? If you focus on it, yeah, there's a lot that we actually do about it. 

0:08:59 - George Aloth
if you focus on it. Yeah, there's a lot that we can do about it and that's what we're working on. I think you know there's a lot of low hanging fruit there, right, there's inertia when managing these patients. A lot of times you see cardiologists that are seeing 30, 40 patients a day. It's hard to really manage them. 

You know we work with practices all over the country and sometimes we'll talk to the doctor and say I'm seeing 30 people tomorrow. I actually don't really know. You know who has what and what their conditions are, and things like that, and that's where we come in. So we help stratify their patients, understand who are the patients that need those extra touch points. Are they? You know, we think about GDMT. Are they on the right medications? Have they had the right titrations of medications? 

0:09:33 - David Williams
We think about site of service. 

0:09:41 - George Aloth
are there things that could be done in a more simple environment versus going to a facility? And a big part of it is just keeping people out of the hospital, keep people out of the ER. A lot of times folks would use the ER as their doctor, which doesn't make sense in a sidetracks to a whole health voyage. And I think for us you know we really want to manage that more holistically. 

So the technology and the data and really supplementing those gaps that cardiology practices have today we really think is the solution in improving heart disease. 

0:10:02 - David Williams
So help me understand from the perspective of a patient. Let's say I'm on patient with serious heart disease. What does it feel like? What is my experience like in a practice that you're working with, compared with the sort of typical unmanaged practice or where you've just got the traditional cardiology approach, or maybe a patient is actually going to the emergency room, as you were mentioning before? 

0:10:28 - George Aloth
Yeah, I think we really drive ourselves on having a more positive patient experience and I think it starts with the touch points, right, the cardiologists themselves don't always have time to engage with other patients. They're busy, right. So part of this is where can our care team come in? What kind of education and counseling and support can they provide outside of the cardiology practice? So that's one really important part of our model. 

I think another important part is wait times right, so we help stratify these patient populations for our doctors meaning you know, I embrace my heart when you hear you know some people have six, nine month wait times just to see a cardiologist and that's a big part of why we're doing. Our solution is make sure these folks are seen whether it's in a virtual setting, whether it's by a care team member, or whether it's just elevating the urgency of their appointment so they can get into the practice. 

These are some of the things that the patient experiences much better, especially when they're really concerned about their heart disease. 

0:11:21 - David Williams
You know, when you talk about this sort of wait times, which I hope aren't typical, but I can actually understand how that may occur. It seems nuts because we spend so much money on healthcare in this country and unless people will say, well, you know it's, we spend a lot, but you know, I'd hate to be like in another country because they have rationing of healthcare. I mean, what's the problem? Why is there such poor access, including for patients that have insurance? 

0:11:50 - George Aloth
Yeah, you know. I mean, I think part of the problem, the biggest part of the problem is so many people have heart disease. So if you think about our space, does the demand meet the supply? There's only so many cardiologists out there. 

I think the other part that is concerning for us is that there's a disproportionate share of cardiology services, meaning for a lot of the vulnerable populations, do they have to travel across town to get to a certain cardiologist because there aren't cardiologists in their neighborhoods? Are there certain cardiology practices that won't see certain populations? There's a lot of dynamics that we're trying to solve for, at the end of the day, there's a bandwidth issue, and I think that's where solutions like us come in. We have to supplement these practices. 

0:12:27 - David Williams
The doctors are doing fantastic work. 

0:12:29 - George Aloth
They just need help. Right, there's lower level of services that other folks could be doing to support these practices. There's other things that are technology and the data, and all that stuff will help with, and that's really what we're aiming to do here at Chamber. 

0:12:44 - David Williams
George, did I hear that right when you were saying there's some cardiologists that won't see certain populations of patients? Did I hear that? And what do you mean by that? Cardiologists that? 

0:12:51 - George Aloth
won't see certain populations of patients. Did I hear that, and what do you mean by that? Yeah, I mean there are some cardiology practices that may not see Medicaid patients or they may only see commercial patients, right, I think you know practices are so busy that sometimes they have they themselves have to prioritize economically which patients they're going to see, and so that's why we really want to help with that and say that all patients are equal. 

Everybody that has heart disease should get the same level of treatment, no matter which doctor they're seeing or which insurance that they have covering them, and so that's really what we're looking to solve for. 

0:13:18 - David Williams
Got it. So, even if Medicaid is going to pay less, then you're still going to make sure that those patients are seen by making it more economically feasible, at least for the physician, if their practice is worried they're busy as it is and they don't want to take a money losing patient and you make it so that that they can see them efficiently and not lose money. Is that fair? Yeah, that's fair. Good, all right. Well, I'm glad someone's looking out for the Medicaid patient. I want to ask you a final question. That's not necessarily it could be related to what we've been talking about, but maybe something totally different, and that's whether you've had a chance to read any good books lately, anything you would recommend to the audience, or, conversely, if you read anything bad that you think we should avoid, let us know about that. 

0:14:03 - George Aloth
Yeah, david, you know, between trying to grow this company and I have three little kids under the age of eight I don't do as much personal reading as I used to. 

0:14:11 - David Williams
I spent a lot of time reading children's books with my kids but you know one book that. 

0:14:15 - George Aloth
I did just start Jim Collins From Good to Great and you know a lot of really valuable lessons in there that I've picked up, especially at the stage of the company that we're at. 

And one of the probably the main ones is you know focusing on the who, not the what and you know, it's something that I think about every day when we're building the team and we're trying to build the solutions. You have to have the right players and I think about life you know, if you got on a bus and you thought the bus was taking you to Miami, but the bus ended up taking you to Iowa. You know, would you care? Well, if you? 

0:14:44 - David Williams
have the right people on the bus you guys are going to. 

we're going through some pretty rapid growth at Chamber, so it's been a good read that I've just gotten into recently and a lot better than some of the children's books I've been reading. You know I have had some people recommend a children's book like Good Night Moon. I haven't heard anybody recommend the one. I think there's one, something like Everything I Needed to Learn you know I learned in kindergarten or something but I think that the Jim Collins one is a better choice. Well, george A Loth, co-founder and CEO of Chamber, thank you for talking to me today about cardiology, value-based care and your life's journey. 

0:15:22 - George Aloth
Thanks for having me, David. 

0:15:22 - David Williams
Really enjoyed it. You've been listening to the Health Biz Podcast with me, David Williams, President of Health Business Group. I conduct in-depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website, healthbusinessgroupcom.