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So far agilon health has created 31 blog entries.

Modern Healthcare highlights results from an agilon health survey of primary care physician satisfaction amongst its platform partners.

Modern Healthcare highlights results from an agilon health survey of primary care physician satisfaction amongst its platform partners. agilon health’s partnership model simplifies practice workflow across health plan contracts, invests in advance of financial returns in infrastructure and physician incentives, and provides a platform for physicians to transform their practices under health plan arrangements that fully align the physicians’ professional needs of mastery and a sense of purpose with the resource requirements for optimal care. To read the article on Modern Healthcare site, click here.

PCPs improve care and patient satisfaction through partnership with agilon health

The dawning of 2019 brings to Akron, Ohio and Austin, Texas what Columbus, Ohio residents already know well: A unique model of care enabled by global risk contracts for Medicare Advantage patients with regional and national health plans that allows primary care physicians to spend the right amount of time with the right patient at the right time. And primary care physicians and patients alike love it.

The proof of its effectiveness rests with the measurable satisfaction of patients like Vicki S. in Columbus who commented in a patient survey, “He is a wonderful man. Not only is he an excellent doctor, but he also spends quality time with me,” Vicki continued, “He remembers everything about my family and I feel like I can talk to him about anything. He always goes the extra mile.” Rather than being an outlier at Central Ohio Primary Care (COPC), Vicki is the norm. In 2018, 95% of their senior patients underwent an annual wellness visit, a 10% increase over the year before and three-fold the national rate. Built into the physicians’ schedules, this additional time with patients was made possible by a new reimbursement and care delivery model offered through a partnership with agilon health.

And patients aren’t the only ones benefiting from this new model of care. “Our partnership on the agilon health platform has led to significant improvements across our practice – strong physician engagement, the implementation of network management strategies such as centralized referral management, new sites of care such as a high-risk clinic, and robust patient engagement – to name just a few,” said Bill Wulf, MD, CEO, COPC. “Our physicians can dedicate themselves to the care of their patients with the knowledge that our practice’s new Medicare Advantage program, and consequently the practice itself, will grow and thrive.”

These improvements have delivered an industry-leading Net Promoter Score of 85 and demonstrate a continued record of extraordinary physician satisfaction.

“The promise of value-based care is reflected in the satisfaction of COPC physicians,” said Dr. Amy Nguyen Howell, chief medical officer at America’s Physician Groups. “It offers the tools to increase time at the bedside while reducing the burden of paperwork. By embracing this model, COPC has invested not only in its physicians, but also in the patients and communities they serve.”

Despite published physician burnout rates ranging from 30 to 65 percent across specialties, with the highest rates incurred by physicians at the front lines of care, such as primary care, agilon health partner practices report high NPS across the board.

In 2018, agilon health partnered with Austin Regional Clinic, and Premier Physicians in Austin and Pioneer Network Physicians in Akron all of which report high NPS scores of 65, 66 and 76, respectively. Furthermore, 82% of the physicians responding to the survey at Pioneer Network Physicians, agilon health’s partner practice in Akron, Ohio, indicated feeling professionally satisfied at least several times per week, and only a third felt professionally drained by their work.

“Daily physicians find themselves on the front lines of the transition from fee-for-service to high-quality value-based care. That transition generally carries with it a significant increase in administrative burden and can create a conflict between these demands and those elements of practice that reward a physician’s professional knowledge, skill and independence. I fundamentally believe that practices must be positioned to make significant upfront investments in infrastructure and improvements in compensation models” said Ron Kuerbitz, CEO of agilon health. “These providers are doing a lot of work, but they’re not seeing improvement in their quality of life or sustainability in the investments necessary to support the transition from fee-for-service to risk contracts.”

Kuerbitz continued, “This is especially prevalent in primary care. The systems in place simply aren’t designed for physicians to be optimally effective. Physicians are managing patients in different lines of business, across numerous payers, in various reimbursement arrangements. The multiplicity of processes and the inability to change these circumstances is overwhelming and a catalyst for burnout. This is a key reason agilon health partnership practices report high Net Promoter Scores; our model simplifies practice workflow across health plan contracts, invests in advance of financial returns in infrastructure and physician incentives, and provides a platform for physicians to transform their practices under health plan arrangements that fully align the physician’s professional needs of mastery and sense of purpose with the resource requirements for optimal care.

 

2019-02-14T21:38:34+00:00 February 5th, 2019|

Austin American-Statesman Features Austin 60 Strong – A Public Service Initiative to Promote Wellness Among Baby Boomers by Celebrating and Honoring 12 Inspirational Ambassadors and Their Personal Stories.

 

60 Strong program showcases what Central Texans in their 60s are doing in fitness.

By Nicole Villalpando
Posted Jan 30, 2019 at 5:47 PM
Updated Jan 30, 2019 at 5:47 PM

 

Some ambassadors were nominated by their children, others by their doctors, and still others nominated themselves.

The 60 Strong program was created to inspire people older than 60 to take care of their health and is the brain child of Agilon Health, which worked locally with Austin Regional Clinic and Premier Physicians to create Connected Senior Care Advantage.

More than 100 people applied to be one of the 60 Strong ambassadors for Austin. A dozen people were chosen from a panel of judges that included former American-Statesman fitness writer Pam LeBlanc and well-known TV news anchors Sally Hernandez and Judy Maggio. The applicants had to be in their 60s and willing to share their fitness and health stories with the public.

The selected ambassadors climb mountains, practice Pilates and yoga, run marathons, are triathletes, do mixed martial arts and CrossFit, and more.

The ambassadors are featured in a calendar and will be at health fairs and other appearances to be examples of what 60 and beyond can be.

Dr. Kevin Spencer, the medical director of Connected Senior Care Advantage and chairman of the board at Premier Physicians, says the goal was to take better care of seniors as well as encourage them to become more active, but they needed examples of what your 60s and 70s could be, he says. “Being in your 60s and 70s can be the best season in your life,” he says. “These are inspiring stories.”

“You use it or lose it,” says Miriam Raviv, 68, about her healthy body. She has spent the last 20 years preparing for and competing in triathlons. She estimates she’s done about 100.

She and other ambassadors joke that the competition is getting slimmer with each year. “People are shocked when they learn I swim, bike and run,” she says. “I think
there are a lot of stereotypes about aging.”

Shelley Friend, 63, says some of the last socially acceptable jokes are the “little old lady jokes.” They are really not funny, she says. She’s made a point of having a mentor who is older than her and being a mentor to people younger than her. “Age isn’t relevant,” she says. “Your contributions are relevant.” She does Pilates, yoga and strength training to help her stay strong. Having people expecting her to show up for classes keeps her going. She says she knows she might not be the best yogi in class, but her competition is herself: “How can I be better at something every day?”

“You can be as young as you want to be,” says Mike Gassaway, 68. He hits the gym regularly and works out so he can work as a stuntman. Recently he’s been on the set of the new “Top Gun” movie and “John Wick: Chapter 3.”

Even on days when he doesn’t really want to go to the gym, he does. “You might have a bad day,” he says, but “it’s a (expletive) good life.” That attitude has kept many of the ambassadors going even when their own health gave them challenges.

Ben Barlin, 61, has survived both colon cancer and kidney cancer. In 2017, when he was diagnosed with stage 3 colon cancer, he says his relationship with his doctor saved his life. His doctor kept pushing him to have more tests when a previous test revealed Barlin was anemic. After four months of treatment, he climbed to the top of Aconcagua in the Andes, one of the seven summits. “I cried like a baby,” he says. He has plans for Everest and to complete all seven summits by age 65.

Cancer played a big role in Kim Cousins’ life, but it wasn’t her own. Both of her parents and many other family members died from cancer. 2/14/2019 60 Strong program showcases what Central Texans in their 60s are doing in fitness Cousins, 62, is fueled by their stories and the drive to continue playing tennis and teach kids in schools about fitness. “Neither one of my parents lived to the age of 60,” she says. “I wanted to grow up to just be 60.”

She is recovering from hip surgery, but she’s not letting that stop her from exercising and getting back on the tennis courts. “You don’t quit,” she says. “You keep going.”

Cousins, Gassaway and Barlin all have recovered from major orthopedic surgery. They make sure their doctors know that returning to fitness activities is important to them.

Barlin says when he broke his fibia and tibia in a mixed martial arts match, he wanted to have the plate that held the bones together removed after healing so he could return to the ring. The doctor told him he was too old to do that; Barlin got a new doctor.

Many of the 60 Strong have been athletic their whole lives, but for Lisa Kurek, 62, the loss of her daughter Sophia, 23, in an accident more than four years ago made her start really exercising. She walked into CrossFit South Lamar and found a support network and encouragement that helped her keep living after that loss. “CrossFit got me to realize how strong I was,” she says. She shares her values through the tattoos on her arm, which started as a way to remember her daughter. One is a compass and represents four principles she wants to live by: grace, discipline, gratitude and passion. That carries her through when she doesn’t want to go to the gym at 6:30 a.m.

Susan Mobley, 68, runs marathons around the world. She makes it fun by rewarding herself with leggings with wild patterns or references to pop culture such as “Game of Thrones.” “I’m trying to be present and not hiding,” she says. As she runs by in her vibrant pants, people cheer her on.

Mobley runs for herself, but she’s also running for other people. The shooting at Sandy Hook Elementary School in 2012 had a big effect on her. She wears a bracelet she had made that has the names and ages of all the kids and adults who died there: 26, one for every mile of a marathon. When she’s running a marathon, she dedicates each mile to a different victim.

The ambassadors all have advice for their peers about how to get more fitness in their lives. “Get busy living,” Cousins says. Or put another way: “Get your (expletive) in gear,” Barlin says. Raviv encourages baby steps and to begin showing up. Mobley suggests exercising with a friend. Kurek says to think about, “What am I going to do today?”

You have to find your people, the group that you want to work out with who will make it fun, she says. Gassaway likens the gym of today to the barbershop of yesteryear. It’s where you come together with your community to talk sports and politics and what’s going on with the guys. “You look forward to it,” he says. One of the things that connects these ambassadors is the way they look at life. Cousins says she can’t live her life like the cup is half empty; she has to see it as half full.

And while some of their peers talk only about their health problems, this group talks about all the things they get to do, the things they can do and the things they look forward to doing in the future.

Spencer says that’s the difference between the ambassadors and some of his patients who go to the gym but don’t really want to. The ambassadors, he says, “are running to something.” They see exercise as positive and not punishment.

To view the story in a web browser, click here.

 

2019-02-18T20:39:37+00:00 January 30th, 2019|

Kevin Spencer, MD, Medical Director for Connected Senior Care Advantage, along with Lisa Kurek, one of 12 Austin 60 Strong ambassadors interviewed on the morning show shoe at KEYE-TV.

 

“We Are Austin”, CBS Austin interviews Dr. Kevin Spencer and Lisa Kurek about 60 Strong campaign. Find out why age is just a number when it comes to good health and strong communities.

Kevin Spencer, MD, Medical Director for Connected Senior Care Advantage, and Lisa Kurek, an Austin 60 Strong Ambassador, were interviewed on the morning show at KEYE-TV, the CBS affiliate in Austin, about the Austin 60 Strong Campaign. The public service initiative, the brainchild of agilon health, was launched in partnership with physician groups throughout the country.  The 60 Strong Ambassadors who have overcome adversity and represent what it takes to be inspiring in mind, are spreading the word about good health and the importance of annual exams and regular screenings to other seniors. Click here to watch

2019-02-14T21:38:08+00:00 January 29th, 2019|

60 Strong Campaign, introduced in Columbus, Akron and Austin, as a public service initiative to promote wellness among baby boomers is another example of the strategy and execution around the high-quality care that agilon health delivers across its platform.

 

The pages of the calendar reveal a new year…and for many Baby Boomers, “take better care of myself” is likely on their 2019 resolution list. Exemplifying that is a dynamic group of 60 somethings in Columbus, Akron, and Austin – seniors who prove that a positive attitude helps them overcome the debilitating effects of chronic health conditions and live a longer, more productive life.

In an effort to “pay it forward,” these beacons of tenacity — ranging in age from 60 to 69 — are showing the world that it’s all about mindset and spreading the word to other seniors who have chronic health issues. The 60 Strong Ambassadors were chosen by a celebrity panel of judges to be highlighted in a 2019 calendar featuring activities and events that many seniors enjoy.

Ben Barlin, a 60 Strong Ambassador in Austin, was diagnosed with Stage III colon cancer. Ben could have easily become immobilized with self-pity. Instead, he decided to climb mountains. “To get my spirit back, I decided to summit Aconcagua, the highest peak in the Western Hemisphere,” he says.

The 60 Strong Ambassadors program is the brainchild of agilon health. The 60 Strong initiative was launched as a public service by agilon health with its partnership practices: Austin Regional Clinic and Premier Family Physicians, Austin; Central Ohio Primary Care Physicians, Columbus; and Pioneer Physicians Network, Akron; to transform the way they care for seniors. Sixty Strong Calendar Contests are slated for several other markets, including Pittsburg and Dayton, in 2019.

Kevin Spencer, M.D., Medical Director for the Austin-based partnership with agilon health and Chairman of the Board of Premier Family Physicians, says, “Like Ben, all of our winners in the 60 Strong Campaign are very inspiring. Although many of them struggle with debilitating health issues, they all make fitness a priority and remain positive about the future. Some have founded their own charities, and all are donating time to non-profits and their communities.”

The Ambassadors speak at Medicare expos and senior events, and while their life challenges differ, they all have a common message about the importance of preventing chronic disease and maintaining good health, which is a growing concern in this age group.

The Centers for Disease Control (CDC) reports three in four US adults aged 65 and older have a chronic disease, such as cancer, heart disease or diabetes. Those numbers are expected to rise significantly with a rapidly growing population and increased life expectancy in the U.S. The Population Reference Bureau estimates the number of Americans 65 and older will more than double from 46 million today to 98 million by 2060.

Angela Bosela, an Akron 60 Strong Ambassador who had 70% of her stomach removed in 2007 and endured chemotherapy and radiation treatments, was inspired to become a competitive runner.

“After cheering for my daughter at a race, I was motivated to start running,” Angela says. “I’ve now completed 200 races, including a marathon and 15 half marathons, and I often place in my age group.”

Angela is also a volunteer counselor for stomach cancer survivors, and she and her husband Paul founded the Ohio Chapter of Debbie’s Dream Foundation, an organization that provides support to stomach cancer patients and their families.

Some of the 60 Strong Ambassadors are grief counselors; they also serve as spokespersons about Medicare coverage and other healthcare decisions and emphasize the importance of annual physicals, regular screenings, and exercise.

The last point is critical. According to the CDC, one-third of older adults do not get regular physical activity.

In gratitude for their newfound lease on life, the 60 Strong Ambassadors are literally paying it forward,” says Bill Wulf, M.D., CEO of Central Ohio Primary Care Physicians.  “The 60s are a difficult period — it’s often the first time people experience real health struggles. The Ambassadors have already experienced adversity, so they provide encouragement to others and give them hope.”

For the list of the ambassadors and to learn more about their inspirational stories, click here for Akron Austin, and Columbus.

2019-02-05T18:54:48+00:00 January 18th, 2019|

Ron Kuerbitz, agilon health CEO, was featured in the 2019 Healthcare Predictions, released by Canton & Company. The publication delivers perspectives from prominent thought leaders in the industry as well as insights from two of the top physician leaders in the United States.

Along with Ron Kuerbitz’s perspectives, the 2019 Healthcare Predictions includes commentaries from Bruce Leff, MD, Director for The Center for Transformative Geriatric Research at Johns Hopkins, Don McDaniel, Canton & Company CEO, David Nash, MD, Dean of the Jefferson College of Population Health, and Jon Zimmerman, President of Virence Health Technologies.

Here is what Ron had to share.

1. What is your outlook for healthcare in 2019? What will change or not?

Overall, I am tremendously bullish for the industry’s abilities to deliver on the quadruple aim, and I expect the current tailwinds to continue. We see pockets of significant innovation across the landscape, the current administration appears to be introducing the right constructs and policies to reward quality and efficiency, and leading practices have shown that investments in coordinating care and identifying and managing outlier populations can effectively bend the cost curve.

On the other hand, we should closely monitor the hardships endured by the majority of physicians who still today practice in smaller independent practices. Many find it difficult to make the necessary investments to make a sustainable transition to managing total cost and quality of care. I especially worry that physician burnout and frustration with the transition to risk will increase for most of these providers.

2. Why will these trends continue?

We continue to closely watch the policymaking coming out of Washington. We applaud the administration’s support for the growth of Medicare Advantage and for the continued enablement of providers to assume more risk for the traditional Medicare population. Those trends will continue to support investment into integrated payment and care delivery that are critical to the sustainability of our healthcare system. Our physician partners and health plan collaborators recognize that we are at an important inflection point, and both are committed to working together to create an innovative, yet efficient, delivery system.

I believe, however, the most significant risk we have to fulfilling our mission of achieving the highest-quality value-based care at national scale is the leap required to fully integrate healthcare financing with the provision of care.

I consistently see practices and health systems struggle to operationalize a gradual glide path to risk. I don’t think that’s possible. I believe that practices must be positioned to make significant upfront investments in infrastructure and physician incentives, and without that, are likely to experience a growing sense of burnout and frustration in managing risk. These providers – caught with one leg on the fee-for-service dock and one in the value-based care boat – are doing a lot of work, but they’re not seeing a lot of improvement in their quality of life at work or sustainability in the investments they’ve had to make to support this kind of transition.

This is especially prevalent in primary care. Recent studies report up to 65% of family practice physicians are experiencing burnout. Think about the systems in place today; they aren’t designed for physicians to be optimally effective.

Physicians are managing patients in different lines of business, across numerous payers, in various reimbursement arrangements. The multiplicity of processes, the impossibility of making the right investment, and the inability to change these circumstances is overwhelming and a catalyst for burnout.

3. What impact will this have?

As I said earlier, I’m extremely bullish for the practices and health systems that have taken the leap and made the necessary investments to be successful in true value-based care. I see that physicians have more time to spend with the right patients at the right time. As a result, these physicians are being rewarded for their mastery and sense of purpose and have the capability to make the right investments to sustain their practice and improve their engagement with patients.

However, today these successful practices are still among the minority. The vast majority of others are seemingly caught in a vicious cycle of too little time and insufficient resources to make the leap to risk. They are inclined to become disenchanted with new team-based care models and protocols and might regress back to a focus on pure fee-for-service economics and paradigms.

 4. What advice do you have for industry stakeholders who want to prepare for the forecast you’ve outlined today?

For industry veterans like myself, we’ve never seen a time where there are such significant tailwinds for improving our healthcare delivery system. Our technologies, policies, capabilities, and economics are highly aligned around quality and efficiency. But we need to take advantage of it, and as such, we need to embrace a mindset change. We’re going to have to become collaborators with one another and build better partnerships to take advantage of the opportunities before us. We need to get physicians constructively engaged in the transition from fee-for-service to risk. We have to think about providing support to get them into organized systems on terms that make sense to them.

It’s akin to when the Detroit automotive manufacturers embraced vendors in the supply chain. They realized collaboration needed to happen for quality and value to improve. Vendors started attending design sessions and really participating as partners with the manufacturers. The result was quality cars built at lower prices that better met consumer needs. They understood that simply squeezing your counterparts doesn’t create value.

Healthcare stakeholders can partake in that kind of thinking – it’s the fundamental change that needs to happen.

 

The paper is available to download here from Canton & Company. To learn more about Canton & Company, click here.

 

2019-01-16T00:01:21+00:00 January 15th, 2019|

Ron Kuerbitz, agilon health CEO, delivers his New Year’s address to employees.

 

Go confidently in the direction of your dreams…. If one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with a success unexpected in common hours…

Henry David Thoreau, Walden

Now this is not the end.  It is not even the beginning of the end. But it is, perhaps, the end of the  beginning.”

Winston Churchill, The Lord Mayor’s Luncheon, November 10, 1942

 

 

Happy New Year!  As we look back at 2018 and as 2019 begins to unfold, it seems like an opportune time to reflect on what we’ve accomplished, the journey we have set out on to transform the delivery of care and the plans we have for an exciting, bright future.

Last year was a year of growth and transition, one in which we completed the initial work necessary to consolidate our platform programs in Hawaii and California and established long-term partnerships with leading physician groups across the country.

We successfully launched our COPC Senior Care Advantage partnership in collaboration with Central Ohio Primary Care and finished the year by helping COPC serve more than 25,000 Medicare Advantage patients in the greater Columbus area with a patient net promoter score of 55.  In 2018, COPC physicians performed wellness visits for more than 95% or their patients, setting the stage for substantial innovation and improvement in care with a singular focus on individual patient needs.

Through the intense collaborative efforts of both local and enterprise-based teams, we transformed the economic sustainability of our MDX Hawaii network, enabled double-digit annual growth, and created the leading delivery model in Hawaii, serving more than 33,000 members.

Two market-leading physician practices in Austin, Texas – Austin Regional Clinic and Premier Physicians – joined the agilon health platform and together we established the Connected Senior Care Advantage program, which will serve more than 17,000 patients in its inaugural year.  And finally, we welcomed the physicians and staff of Pioneer Family Physicians, who are developing and expanding the Paradigm Senior Care Advantage partnership in Akron, Ohio with us.  During our preparations to go live on January 1, 2019, Pioneer’s physicians performed annual wellness visits for more than 90%, or over 7,800, of their patients.

I am especially pleased that all the Senior Care Advantage partnerships on our platform are well-positioned to deliver 4-Star, efficient care in 2019.  We celebrated an industry-leading 75 Net Promoter Score (“NPS”) amongst our physician partners in Columbus, Austin and Akron, and an NPS improvement of 70% in Hawaii, indicating that our focus on physician engagement and streamlining administrative processes and procedures is on the right track.

I am tremendously proud of the team and infrastructure we’ve built and the results we’ve delivered in two short years.  But perhaps what I’m most proud of is the way the entire agilon health organization responded when ‘the going got tough’.  As many of you know, during 2018 a large part of our team was consumed with developing and executing remediation plans to address compliance issues that we identified in our legacy, California-based PPMC operations.  Following our self-disclosure and eight months of well-executed remediation, we passed audits from all our health plan partners and DMHC.  In short, we identified potential wrongdoing, we disclosed it, we investigated further to ensure the wellbeing of patients under our care was not impacted, and we swiftly corrected the issues.

While I’m confident the issues resident within our legacy operations are behind us, we know that with each new year comes new challenges and goals.  For agilon health, 2019 will be a year focused on scalability and growth.  We look forward to announcing new partnerships with leading health systems and physician organizations that are committed to taking the leap to integrated payment and delivery.  I expect we will at least double our partnerships, resulting in expansion into at least 15 markets over the next two years.

We look forward to seeing the evolving benefits of innovative physician leaders collaborating across markets as they work independently and collectively to transform payment and care delivery.  We look forward to expanding our health plan arrangements to include new geographies, new products, and deeper relationships.  Most importantly, we look forward to being closer to fulfilling our mission of providing a platform from which physicians can lead the transformation of both their local markets and the nation to value-based care as they strive to recapture the joy of practicing medicine.

There is no roadmap for what we’re doing.  No one has been successful previously in building a national platform… partner… integrated payment and delivery…  So, like Churchill, we cannot be sure precisely where we are in that journey and like Thoreau, we cannot precisely determine next steps.  But like Churchill, we can see that we are emerging from the initial phase of our journey and, like Thoreau, we can be confident that great success lies in following our dreams – the kind of achievement that is unexpected by those who do what is expected and anticipated.

I’d like to conclude by sharing how proud I am of the courage, innovation and determination you have each displayed in 2018.  The confidence, hard work, expertise, collaboration and integrity of each agilon health team member and every partner on our platform has allowed us to confidently pursue a vision of a healthcare system across the nation that delivers high-quality care at sustainable cost with high levels of satisfaction – even joy – to patients, physicians and all our partners in care. Thank you for your unwavering dedication and support.  Here’s to a momentous 2019.

 

2019-01-16T00:47:30+00:00 January 15th, 2019|

MDX Hawaii, an agilon health platform company, introduced Excellence in Kupuna Care in 2018 to recognize the high performing physicians in six quality care metrics. This campaign is just one example of the strategy and execution around the high-quality care that agilon health delivers across its platform.

The January 9th issue of MidWeek highlights  Excellence In Kupuna Care, an annual physician recognition program, introduced in 2018 by MDX Hawaii to acknowledge and celebrate the high performing primary care physicians throughout the Hawaii who excel in six quality care metrics. This campaign is just one example of the strategy and execution around the high-quality care that agilon health delivers across its platform.

Excellence in Kupuna Care

The selection criteria included six aspects of medical care which are important for patients over the age of 65.

The primary care physicians recognized in the campaign demonstrated excellence in:

  • Providing patients access to primary care services through flexible office hours, phone availability during non-business hours, and helpful office staff which reduces the frequency in which their patients utilize the emergency room.
  • Closely managing chronic conditions, as measured by the number of their patients with acceptable blood pressure and glucose levels
  • Recognizing the importance of follow-up visits with primary care physicians after discharge from the hospital to ensure patients understand the changes in medications, diet or lifestyle and patient care is monitored and coordinated.
  • Offering preventative care and patient education through the performance of annual wellness visits for their Medicare patients.
  • Rendering preventive screenings to identify disease early, such as breast and colon cancers, as well as the performance of routine Influenza immunizations.

The 2018 honorees are:

Emergency Department Utilization: Jinichi Tokeshi M.D., ManKwan Wong M.D.
Chronic Disease Quality Measures: Elizaga V. Fortunato M.D., Chang-Dich Lai M.D., Sharon Lawler M.D.
Annual Wellness Visits: Jose De Leon M.D., Chang-Dich Lai M.D.
Access to Care/Frequency of Primary Care Visits: Pon Sang Chan M.D.
Preventive Care: Kimberly K. Lund M.D., Maria C. Ilar-Revilla M.D.
The transition of Care Post Hospital Discharge: Keiichi Kobayashi M.D.

Quality healthcare starts in the primary care physician’s office. Congratulations to 10 primary care physicians who have been recognized for demonstrating their commitment to proving quality care to Medicare beneficiaries

For more information about the Excellence in Kupuna Care campaign, click here.

To read the MidWeek article, click here.

2019-01-11T05:29:43+00:00 January 9th, 2019|

Akron Fox 8 News Interviews Gary Pinta, MD, President of agilon health Partner Practice, Pioneer Physicians Network, and Two Paradigm Senior Care Advantage 60Strong Ambassadors.

agilon health is proud to share a news segment from our partnership and care delivery network in Akron, Paradigm Senior Care Advantage.  In partnership with a local leading primary care practice, Pioneer Physicians Network, this segment celebrates the leadership of practice CEO, Gary Pinta, MD, and two of twelve 60Strong ambassadors, who are featured on a 2019 calendar.  The 60 Strong Ambassadors, who range in age from 60 to 69, were chosen by a celebrity panel of judges, and embody how life after 60 can be vibrant and active time.  Watch the segment here.

agilon health launched the 60Strong initiative as a public service for seniors and to raise awareness for its physician partner’s commitment to expanded and highly coordinated senior care.

2019-01-14T17:35:50+00:00 January 8th, 2019|

Ron Kuerbitz, CEO, Reaffirms agilon health’s Commitment to Compliance and Integrity as a Leader in Care Delivery.

I wrote to you this past summer as we developed and executed remediation plans to address compliance issues that we identified in our historical PPMC operations.  From time to time we get questions regarding our progress on the remediation and about the compliance issues from our legacy California operations.  As the year comes to a close, I would like to reaffirm that the facts we disclosed were accurate and no new information has come to our attention; our view has not changed.

As part of our work to centralize and standardize our claims payment operations into a single, high-functioning department, we identified practices in the claims audit processes of our legacy California operations that required remediation.  We immediately, and without hesitation, disclosed these claims issues to the California Department of Managed Health Care (DMHC) and our plan partners in February 2018 and engaged outside experts to conduct a thorough investigation.  This voluntary self-disclosure reflects our singular commitment to compliance and our integrity as leaders in care delivery.

The investigation confirmed improprieties in the claims audit process but did not identify systemic errors or processes that would have impacted patient care. Following a complete remediation of those processes, we have since passed audits from all our health plan partners as well as DMHC. Our remediation plan focused on three key initiatives:

  1. The appointment of highly experienced new leadership to oversee the claims, customer service and utilization management functions;
  2. The implementation of new claims processing and operating system and enhanced management processes and procedures;
  3. The dismissal of all employees who took part in the improper activities.

In short, we identified potential wrongdoing, we disclosed it, we investigated further to ensure the wellbeing of patients under our care was not impacted, and we swiftly corrected the issues.

We continue to work closely with our health plan partners to improve the care for patients in California and across the nation and we are excited about the innovative steps we are taking to bring new levels of quality and efficiency to our physician partners, health plan collaborators, and patients in 2019.  I look forward to being able to share more details on those plans as the new year unfolds.

 

2018-12-20T17:31:55+00:00 December 18th, 2018|

In the December issue of Texas Medicine, Austin Regional Clinic describes their process of selecting agilon health as their long-term partner to make the leap to integrated payment and delivery; one of the strategic steps they’ve taken to preserve their independence.

When Austin Regional Clinic (ARC) went looking for an investor to help the large group change its payment model in 2016, the practice had a lot going for it: more than 300 physicians, a patient base of 450,000, and a strong financial track record.

Written by Sean Price 

The original article was published in the December 2018 issue of the Texas Medicine by Texas Medical Association.

Despite these advantages, ARC quickly found that the pool of potential investors resembled a bad dating scene. Lots of investors wanted to woo ARC, but most of them were either too controlling or just didn’t share ARC’s vision.

“We had to kiss a lot of frogs to find the right [investor],” ARC Chief Medical Officer Jay Zdunek, DO, told a crowded room at the Dawn Duster presentation on venture capital in medicine at the Texas Medical Association’s 2018 Fall Conference in September.

But better to kiss a lot of frogs than to settle for the first one that comes along, Dr. Zdunek says. That, unfortunately, is a common experience for physicians and physician groups looking to line up venture capital. It’s easy for medical practices to be tempted by business agreements that appear lucrative in the short term, without realizing the extent to which they may sacrifice long-term independence, he warns.

That’s especially true for physician groups with an increasing financial burden. Many practices urgently need to acquire more capital because operating costs have been on a steep rise since 2001 while Medicare payments — which set the pace for commercial payers — have not kept up with practice expenses, says Dr. Zdunek, who also has a master’s degree in business administration.

The need for outside capital “is not unique to Texas. I have not met a physician group that has not been struggling with this for some period of time,” he told Texas Medicine in a separate interview.

There are many types of investors, including private investors, hospital groups, and insurance companies. Most of them look to buy or control practices to create broader networks, says Kevin Wood, a lawyer with the Austin law firm Clark Hill Strasburger who specializes in business deals for health care organizations and who also spoke at Fall Conference.

Physician practices, in general, are hot investments, but some specialties are hotter than others. The most popular are dermatology, ophthalmology, orthopedics, gastroenterology, and urology, according to Becker’s ASC Review, an online health care business publication. Each specialty is popular for different reasons, but many ties back to the United States’ rapidly aging population and expectations for increasing health care demands. Transactions involving dermatology practices alone rose about 46 percent between 2016 and 2017, according to Irving Levin Associates, a publisher of investor newsletters.

Before beginning an investor search, physicians should have a clear idea of what they want out of the deal, Mr. Wood says. They also should focus on how any agreement will affect their organizational structure, governance rights, and contract rights. Because once everything is signed, it will be too late for second-guessing.

“Knowing who you are and where you want to go are the key pieces,” he said. “What you do with your partner and what you do going forward is going to be key. You want to make sure the culture of who you’re partnering with marries up with the culture of your practice.”

Who needs capital? 

The past 40 years have brought several waves of financial consolidation and increased investment activity among physician practices, Mr. Wood says. These waves typically occur because some regulatory shift makes practicing medicine more expensive or changes payment.

In the 1980s, major changes in Medicare payment prompted consolidation; in the 1990s, it was the advent of health maintenance organizations. In both cases, hospitals typically bought out or partnered with physician practices. The latest round, triggered by federal health care reforms under President Barack Obama, prompted more private investors to buy or partner with physician practices.

For instance, the American Recovery and Reinvestment Act of 2009 mandated the use of electronic health records (EHRs). The transition cost practices on average $80,000 to $85,000 per physician upfront, plus maintenance fees, says Dr. Zdunek. It also slowed physicians’ productivity because their workload increased.

Given these and other changes, some practices need investment capital just to keep up with normal expenses, Dr. Zdunek says. Others might try to upgrade their quality reporting tools to comply with the Medicare Access and CHIP Reauthorization Act (MACRA) and its Merit-Based Incentive Payment System (MIPS). (See www.texmed.org/MACRA and “The Results Are In: Physicians Finally See How They Fared In First Year of MIPS,” September 2018 Texas Medicine, pages 36-39, www.texmed.org/FirstYearMIPS.)

Practices looking to expand also face significant costs. At ARC, hiring just one physician runs anywhere from $250,000 to $500,000 in the first year of employment when counting the costs of recruitment, salary, benefits, support staff, and other related expenses, Dr. Zdunek says. That new physician, in time, will make money for the practice, but the upfront costs must be met first.

Most investors are looking to buy physician practices outright, and most of these purchasers are hospital groups or insurance companies.

In 2016, about 42 percent of U.S. physicians worked for hospitals, up from about 26 percent in 2012, according to health care consulting firm Avalere Health. Not all of this physician employment is a result of acquisitions, but hospitals have been aggressive buyers of medical practices, Mr. Wood told Texas Medicine in a separate interview.

Another aggressive investor is OptumCare, a subsidiary of UnitedHealth Group, the biggest U.S. health insurer. It’s most recent blockbuster deal came in 2017 with the purchase of DaVita Medical Group, which employed 17,000 physicians. But its own website makes clear it is on the lookout to buy out or partner with physician groups. Even before the DaVita purchase, OptumCare had employed or partnered with 30,000 physicians across the country, compared with the 37,000 working for HCA Healthcare Inc., the largest for-profit U.S. hospital system, according to Bloomberg.

Texas can be a more difficult investment market because it has strict “corporate practice of medicine” laws, which, among other things, forbid businesses from practicing medicine or employing physicians to provide medical services here, Mr. Wood says. (See “Corporate Encroachment,” July 2018 Texas Medicine, pages 36-41, www.texmed.org/CorporateEncroachment.) The laws are designed to preserve doctors’ independent medical judgment. However, certain legal agreements can give nonphysicians effective control over physician practices, and that frequently happens when doctors don’t guard their rights to make practice-related decisions, says Mr. Wood.

“When [capital groups] are throwing around their money they expect to have the control,” Mr. Wood said. “It’s a rare instance where the physician group maintains total control or even majority control. For decisions that you’re making, be sure that the physician group keeps a seat at the table,” even after negotiations end.

Getting to yes

ARC Chief Medical Officer, Jay Zdunek, DO

Having clear goals is key, Dr. Zdunek says. For instance, a practice made up of older physicians may be more interested in maximizing financial return so those physicians can retire sooner; maintaining self-governance might be less important. A practice of younger physicians might want to guard self-governance and instead give in on cash value.

Practices that give up too much control can quickly find investors dictating medical policy, Mr. Wood warns. In some cases he’s represented and researched, the physicians thought they’d found an investor who respected their independence, but that investor turned around and sold the practice to a third party. The physicians had no say in the new arrangement.

The most successful business deals he’s seen are ones where physicians held firm on what they wanted and actively negotiated to maintain their independence.

“[Investors] are coming to you for a reason,” he said. “Whatever size group, whatever size market, whatever size patient base you have, you’re the one bringing value to the table. The key to remember in those negotiations is — that’s why you’re there. … If [the proposed deal] is not what you want, it’s OK to walk away from the negotiations.”

In 2016, ARC did just that. The practice made the strategic decision to switch from fee-for-service payments to global capitation with Medicare Advantage plans, which entails a fixed per-patient (or “capitated”) payment for all care as an incentive for the practice to control costs.

To transition, ARC needed a large influx of capital to brace for longer patient appointments and administrative changes under the new payment model. Its physicians were determined to preserve their independence, so finding the right investor was difficult, Dr. Zdunek says. One investor waited until late in the negotiations to inform ARC that it wanted total control of the practice in order to invest, apparently assuming the doctors would cave into this demand. Instead, ARC turned them down. But that meant ARC had to start over in its investor search.

“I got to tell you — there are a lot of people who want to talk to you, but there aren’t a lot who want to give you the things that you want,” Dr. Zdunek said. “It’s a labor-intensive endeavor looking for that right partner.”

At roughly the same time, Premier Family Physicians, an Austin practice of about 30 physicians and a 90,000 patient base, also was looking for investment money to hire more physicians to make the switch to a capitation payment model. Unlike ARC, Premier was willing to consider a buyout, but it ultimately decided that remaining independent made better business sense, says Kevin Spencer, MD, Premier’s CEO.

Eventually, ARC and Premier found the right partner in Agilon Health. The company boosts practices with the technology and funding to switch to global capitation. Its business model is to partner with, not buy, medical practices, says Ravi Sachdev, a partner at Clayton, Dubilier and Rice, the private equity firm that owns Agilon.

“The future is letting physicians remain independent, maintain their culture, maintain their brand, maintain their relationship as a group,” Mr. Sachdev told Texas Medicine. He acknowledges the approach does not work for all practices. “In a partnership, you don’t have control. It’s about trust. It’s about transparency. It’s about shared decisionmaking.”

ARC, Premier, and Agilon created a three-way partnership in which the two practices get 50-percent control and Agilon gets 50 percent. The arrangement covers only Medicare Advantage patients, which make up a minority of both practices’ patient base — about 20,000 out of 540,000 total, Dr. Spencer says.

Agilon’s desire to partner with doctors is unusual for an investor, Dr. Spencer says. It allows physicians to participate fully in the financial side while being left alone to practice medicine.

“We don’t think independence exists in the real world,” he said. “You need to be interdependent with the right people.”

Dr. Zdunek says he understands physicians’ resistance to outside authority. The appeal of being a doctor traditionally has been working in a small business and controlling your own destiny. But the economic pressures physicians face today make that increasingly difficult.

“As an independent physician group or an independent physician, you’re constantly trying to play in a land of giants and not get squashed,” he said. “The only way you can do that sometimes is to find outside capital.”

The original article was published in the December 2018 issue of the Texas Medicine by Texas Medical Association. To view the original article, click here

2018-12-18T19:43:38+00:00 December 5th, 2018|
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