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Central Ohio Primary Care helped build and owns part of startup that just had $1B IPO

Columbus Business First highlighted the role that Central Ohio Primary Care played in the $1B IPO. Read the article below or Click here to read.

By Carrie Ghose  –  Staff reporter, Columbus Business First

Bill Wulf, MD, COPC Central Ohio Primary Care Physicians Inc., the nation’s largest independent practice of its kind, was the first customer and owns a minority stake in a southern California startup that raised more than $1 billion in its IPO Thursday.

Agilon Health Inc. went public with a valuation of more than $9 billion. Westerville-based COPC was listed in regulatory filings as one in a group of entities that collectively hold 25% after the offering. Clayton Dubilier & Rice LLC, a New York City private equity firm, controls 58%.

The primary care group was the founding partner in 2017. Its doctors’ feedback helped shape the software platform called a “total care model” that collects and analyzes the data needed to pay doctors for achieving better patient health.

Under the model, COPC is paid a set monthly rate for seniors covered by Medicare Advantage plan – so it profits only if they don’t need costly care such as emergency department visits.

Clayton Dubilier & Rice invited COPC precisely because of its size, practice CEO Dr. William Wulf said via email. Owned by member physicians, the practice was awarded shares as part of the 2017 deal and based on performance since.

In the first year, seniors within the model had medical costs that were 10% lower than market averages, Wulf told me for a 2017 story.

Since then, Agilon has established partnerships with 17 practices, including several in Ohio. The Long Beach, California-based company had a net loss of $60 million on $1.2 billion revenue in 2020, according to its securities registration.

“The data analytics capability has helped us to risk-stratify our patients and identify both high- and low-value services and procedures,” Wulf said. “We also receive performance measures on physicians, which helps them to continuously refine & optimize their care.”

Patients in the plan have more frequent screenings and wellness checkups, and fewer emergency visits and preventable hospitalizations, COPC said.

“Agilon respects our independence as a local physician group,” Chief Medical Officer Dr.  said in a news release.

Wulf also is on the board of directors for the new public company.

Source

https://www.bizjournals.com/columbus/news/2021/04/16/central-ohio-primary-care-role-in-agilon-ipo.html

2021-04-19T07:55:53-07:00April 19th, 2021|

agilon health Announces Pricing of Initial Public Offering

04/14/2021

LONG BEACH, Calif.–(BUSINESS WIRE)–agilon health, inc. (“agilon health”), which partners with primary care physicians to unlock value-based healthcare delivery, announced the pricing of its initial public offering of 46,600,000 shares of its common stock at a public offering price of $23.00. All of the shares of common stock are being offered by agilon health. The gross proceeds of the offering, before deducting underwriting discounts and commissions and other expenses payable by agilon health, are expected to be approximately $1,072 million. agilon health has granted the underwriters a 30-day option to purchase up to an additional 6,990,000 shares of its common stock at the initial public offering price, less underwriting discounts and commissions.

The shares are expected to begin trading on the New York Stock Exchange on April 15, under the ticker symbol AGL. The offering is expected to close on April 19, 2021, subject to customary closing conditions.

J.P. Morgan, Goldman Sachs & Co. LLC, and BofA Securities are acting as lead book-running managers for the proposed offering. Deutsche Bank Securities, Wells Fargo Securities, William Blair, Truist Securities, and Nomura are acting as additional book-running managers.

A registration statement relating to these securities was declared effective by the U.S. Securities and Exchange Commission (“SEC”) on April 14, 2021. The offering is being made only by means of a prospectus. Copies of the preliminary prospectus, when available, may be obtained from: J.P. Morgan Securities LLC, c/o Broadridge Financial Solutions, 1155 Long Island Avenue, Edgewood, NY 11717, or by telephone at (866) 803-9204, or by email at prospectus-eq_fi@jpmchase.com; or Goldman Sachs & Co. LLC, Attention: Prospectus Department, 200 West Street, New York, New York 10282, telephone: 1-866-471-2526, facsimile: 212-902-9316 or by emailing prospectus-ny@ny.email.gs.com; or BofA Securities, Attention: Prospectus Department, NC1-004-03-43, 200 North College Street, 3rd Floor, Charlotte, NC 28255-0001, or by email at dg.prospectus_requests@bofa.com.

This press release shall not constitute an offer to sell or the solicitation of an offer to buy securities, nor shall there be any sale of these securities in any state or jurisdiction in which such offer, solicitation or sale would be unlawful prior to registration or qualification under the securities laws of any such state or jurisdiction. Any offers, solicitations or offers to buy, or any sales of securities will be made in accordance with the registration requirements of the Securities Act of 1933, as amended.

About agilon health

agilon health is transforming healthcare by empowering community-based physicians with the resources and expertise they need to innovate the payment and delivery of care for seniors. agilon health enables physicians to create their own Medicare-centric globally capitated line of business. The agilon Total Care Model is powered by our purpose-built platform and enabled through a growing national network of like-minded physician partners. With agilon, physicians are freed from the constraints of the transactional fee-for-service reimbursement model and are able to practice team-based, coordinated care to serve the individual needs of their senior patients and to transition to a sustainable and predictable, long-term business model. The rapidly growing appeal of the agilon platform, partnership model and network of leading community-based physicians has allowed us to expand to 17 local communities with 16 anchor physician groups, as well as a network of physicians across Hawaii, in fewer than five years.

Cautionary Note Regarding Forward-Looking Statements

This press release contains statements that constitute “forward-looking statements,” including with respect to the proposed initial public offering. No assurance can be given that the offering discussed above will be completed on the terms described, or at all. Forward-looking statements are subject to numerous conditions, many of which are beyond the control of agilon health, including those set forth in the Risk Factors section of the registration statement and the preliminary prospectus included therein. Copies are available on the SEC’s website at www.sec.gov. agilon health undertakes no obligation to update these statements for revisions or changes after the date of this press release, except as required by law.

Contacts
Investor Contact
Matthew Gillmor
VP of Investor Relations
investor.relations@agilonhealth.com

Media Contact
Shannan Siemens
Managing Director, Mercury
media@agilonhealth.com

View All News

2021-04-14T19:18:17-07:00April 14th, 2021|

agilon health Announces Launch of Initial Public Offering

April 07, 2021 08:00 AM Eastern Daylight Time

LONG BEACH, Calif.–(BUSINESS WIRE)–agilon health, inc. (“agilon health”), which partners with primary care physicians to unlock value-based healthcare delivery, announced the launch of its initial public offering of 46,600,000 shares of its common stock pursuant to a registration statement on Form S-1 filed with the U.S. Securities and Exchange Commission (“SEC”). The initial public offering price is currently expected to be between $20.00 and $23.00 per share. agilon health expects to grant the underwriters a 30-day option to purchase up to an additional 6,990,000 shares of its common stock at the initial public offering price, less underwriting discounts and commissions.

agilon health has applied to list its common stock on the New York Stock Exchange, under the ticker symbol “AGL”.

J.P. Morgan, Goldman Sachs & Co. LLC, and BofA Securities are acting as lead book-running managers for the proposed offering. Deutsche Bank Securities, Wells Fargo Securities, William Blair, Truist Securities, and Nomura are acting as additional book-running managers.

The offering is being made only by means of a prospectus. Copies of the preliminary prospectus, when available, may be obtained from: J.P. Morgan Securities LLC, c/o Broadridge Financial Solutions, 1155 Long Island Avenue, Edgewood, NY 11717, or by telephone at (866) 803-9204, or by email at prospectus-eq_fi@jpmchase.com; or Goldman Sachs & Co. LLC, Attention: Prospectus Department, 200 West Street, New York, New York 10282, telephone: 1-866-471-2526, facsimile: 212-902-9316 or by emailing prospectus-ny@ny.email.gs.com; or BofA Securities, Attention: Prospectus Department, NC1-004-03-43, 200 North College Street, 3rd Floor, Charlotte, NC 28255-0001, or by email at dg.prospectus_requests@bofa.com.

A registration statement relating to these securities has been filed with the SEC but has not yet become effective. These securities may not be sold nor may offers to buy be accepted prior to the time the registration statement becomes effective. This press release shall not constitute an offer to sell or the solicitation of an offer to buy securities, nor shall there be any sale of these securities in any state or jurisdiction in which such offer, solicitation or sale would be unlawful prior to registration or qualification under the securities laws of any such state or jurisdiction. Any offers, solicitations or offers to buy, or any sales of securities will be made in accordance with the registration requirements of the Securities Act of 1933, as amended.

About agilon health

agilon health is transforming healthcare by empowering community-based physicians with the resources and expertise they need to innovate the payment and delivery of care for seniors. agilon health enables physicians to create their own Medicare-centric globally capitated line of business. The agilon Total Care Model is powered by our purpose-built platform and enabled through a growing national network of like-minded physician partners. With agilon, physicians are freed from the constraints of the transactional fee-for-service reimbursement model and are able to practice team-based, coordinated care to serve the individual needs of their senior patients and to transition to a sustainable and predictable, long-term business model. The rapidly growing appeal of the agilon platform, partnership model and network of leading community-based physicians has allowed us to expand to 17 local communities with 16 anchor physician groups, as well as a network of physicians across Hawaii, in fewer than five years.

Cautionary Note Regarding Forward-Looking Statements

This press release contains statements that constitute “forward-looking statements,” including with respect to the proposed initial public offering. No assurance can be given that the offering discussed above will be completed on the terms described, or at all. Forward-looking statements are subject to numerous conditions, many of which are beyond the control of agilon health, including those set forth in the Risk Factors section of the registration statement and the preliminary prospectus included therein. Copies are available on the SEC’s website at www.sec.gov. agilon health undertakes no obligation to update these statements for revisions or changes after the date of this press release, except as required by law.

Contacts

Investor Contact
Matthew Gillmor
VP of Investor Relations
investor.relations@agilonhealth.com

Media Contact
Shannan Siemens
Managing Director, Mercury
media@agilonhealth.com

2021-04-07T18:09:43-07:00April 7th, 2021|

agilon health Files Registration Statement for Proposed Initial Public Offering

agilon health Files Registration Statement for Proposed Initial Public Offering

March 18, 2021 05:00 PM Eastern Daylight Time

LONG BEACH, Calif.–(BUSINESS WIRE)–agilon health, inc. (“agilon health”), which partners with primary care physicians to unlock value-based healthcare delivery, announced it has publicly filed a registration statement on Form S-1 with the U.S. Securities and Exchange Commission (the “SEC”) for a proposed initial public offering of shares of its common stock. The number of shares to be offered and the price range for the offering have not yet been determined.

agilon health intends to list its common stock on the New York Stock Exchange, under the ticker symbol AGL.

J.P. Morgan, Goldman Sachs & Co. LLC, and BofA Securities are acting as lead book-running managers for the proposed offering. Deutsche Bank Securities, Wells Fargo Securities, William Blair, Truist Securities, and Nomura are acting as additional book-running managers. The offering is subject to market and other conditions, and there can be no assurance as to whether or when the offering may be completed, or as to the actual size and terms of the offering.

The offering is being made only by means of a prospectus. Copies of the preliminary prospectus, when available, may be obtained from: J.P. Morgan Securities LLC, c/o Broadridge Financial Solutions, 1155 Long Island Avenue, Edgewood, NY 11717, or by telephone at (866) 803-9204, or by email at prospectus-eq_fi@jpmchase.com; or Goldman Sachs & Co. LLC, Attention: Prospectus Department, 200 West Street, New York, New York 10282, telephone: 1-866-471-2526, facsimile: 212-902-9316 or by emailing prospectus-ny@ny.email.gs.com; or BofA Securities, Attention: Prospectus Department, NC1-004-03-43, 200 North College Street, 3rd Floor, Charlotte, NC 28255-0001, or by email at dg.prospectus_requests@bofa.com.

A registration statement relating to these securities has been filed with the SEC but has not yet become effective. These securities may not be sold nor may offers to buy be accepted prior to the time the registration statement becomes effective. This press release shall not constitute an offer to sell or the solicitation of an offer to buy securities, nor shall there be any sale of these securities in any state or jurisdiction in which such offer, solicitation or sale would be unlawful prior to registration or qualification under the securities laws of any such state or jurisdiction. Any offers, solicitations or offers to buy, or any sales of securities will be made in accordance with the registration requirements of the Securities Act of 1933, as amended.

About agilon health

agilon health is transforming healthcare by empowering community-based physicians with the resources and expertise they need to innovate the payment and delivery of care for seniors. agilon health enables physicians to create their own Medicare-centric globally capitated line of business. The agilon Total Care Model is powered by our purpose-built platform and enabled through a growing national network of like-minded physician partners. With agilon, physicians are freed from the constraints of the transactional fee-for-service reimbursement model and are able to practice team-based, coordinated care to serve the individual needs of their senior patients and to transition to a sustainable and predictable, long-term business model. The rapidly growing appeal of the agilon platform, partnership model and network of leading community-based physicians has allowed us to expand to 17 local communities with 16 anchor physician groups, as well as a network of physicians across Hawaii, in fewer than five years.

Cautionary Note Regarding Forward-Looking Statements

This press release contains statements that constitute “forward-looking statements,” including with respect to the proposed initial public offering. No assurance can be given that the offering discussed above will be completed on the terms described, or at all. Forward-looking statements are subject to numerous conditions, many of which are beyond the control of agilon health, including those set forth in the Risk Factors section of the registration statement and the preliminary prospectus included therein. Copies are available on the SEC’s website at www.sec.gov. agilon health undertakes no obligation to update these statements for revisions or changes after the date of this press release, except as required by law.

Contacts
Investor Contact
Matthew Gillmor
VP of Investor Relations
investor.relations@agilonhealth.com

Media Contact
Shannan Siemens
Managing Director, Mercury
media@agilonhealth.com

2021-03-18T14:31:04-07:00March 18th, 2021|

Partnerships Extend to Buffalo, NY; Wilmington, NC; Hartford, CT; and Toledo, OH; Presence Now in 11 Geographies

agilon health Expands Partnerships with Market-Leading Independent Physician Groups in Four States

LONG BEACH, Calif., March 15, 2021  agilon health, which partners with primary care physicians to unlock the value inherent in the leap from fee-for-service to a global-risk-based business model, today announced it has entered into a joint venture with four more leading independent physician practices. They are Buffalo Medical Group (BMG) in Buffalo, NY; Wilmington Health in Wilmington, NC; Starling Physicians in Hartford, CT and The Toledo Clinic, in Toledo, Ohio.

These new partnerships expand upon agilon health’s efforts to improve and accelerate the growth of risk-based models of care in key geographies across the country by introducing a complete operating platform for integrated payment and delivery.

With today’s announcement, agilon health has successfully entered into thirteen partnerships with leading physician groups and networks, including Central Ohio Primary Care in Columbus, Ohio, and Austin Regional Clinic in Austin, Texas – in total empowering primary care providers in eleven geographies to influence the continued transformation of their local care delivery systems around the principles of cost and quality.

Across these geographies, agilon health has signed more than 40 global risk contracts with multiple payors, including leading national and regional plans that will serve the Medicare Advantage population in 2021. Our multi-payor approach ensures patient choice of the health plan benefits that serve them best.

In addition, seven of our market-leading primary care practice partners have expanded the scope of our collaboration to include traditional Medicare patients through the CMS Direct Contracting program. This expansion affirms their commitment to the partnership with agilon health and enables a consistent provider experience and patient-centered approach to quality, efficiency and care for all of their Medicare beneficiaries.

According to the Health Care Payment Learning & Action Network, approximately 46 percent of all seniors nationally are in advanced payment models. In, contrast, agilon health’s partnership model platform represents hundreds of independent primary care physicians with 100 percent of their collectively attributed Medicare Beneficiaries in advanced payment models tied to quality and efficiency. Throughout the pandemic, the practices who are in risk arrangements through agilon’s platform as of 2020 performed more than 115,000 virtual visits on their Medicare Advantage patients, a rate that is 15 percent per thousand beneficiaries higher than national benchmarks. Furthermore, during these unprecedented times, where care for many with chronic conditions has been disrupted, 15 percent of the virtual visits performed have been for patients with more than four chronic conditions.

“I am exceptionally proud of the work done by our team over the past four years to establish truly collaborative partnerships with physicians that are fundamentally changing the way health care is provided to seniors across the country,” said Steven Sell, CEO of agilon health. “We see the transformation our model brings, not only in our partner practices, but also in the communities they serve. Our expansion into a total care model for traditional Medicare patients broadens our opportunity to build exceptional experiences for both providers and patients. The value of our partnership model has also been a significantly stabilizing force for our practices during the public health emergency. Our practice partners continue to expand access, especially in areas of their communities where underserved senior populations reside at a time when many independent practices are contracting.”

 

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2021-03-18T14:27:03-07:00March 15th, 2021|

agilon health Partner Innovation & Platform Updates – February 2021 Newsletter

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Partner Innovation & Platform Updates

Partner Leadership

Team Member Bulletin

Innovation on the agilon health Platform

Industry News

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2021-03-09T16:01:20-07:00March 9th, 2021|

Doctors Nationwide Band Together to Launch Initiative Urging Patients to Get Vaccinated for COVID-19

“Roll Up Our Sleeves” Viral Video Aims to Allay Fears and Galvanize Doubtful Citizens

LONG BEACH, Calf., Feb. 25, 2021 — With 30 percent of the U.S. population still admitting they won’t or may not get the vaccine, physicians across the country are joining forces in a viral video initiative inciting Americans to “roll up our sleeves together” and help stop the spread of COVID-19.

Feeling a duty to their patients — and fellow Americans in general — physicians representing more than 50 communities from Syracuse, New York, to Honolulu, Hawaii, created the “Roll up Our Sleeves” website and video campaign to educate those who are expressing doubt or opposition and urge everyone that “it’s time” to get vaccinated and help stop the spread of COVID-19.

Already, COVID-19 has taken the lives of 500,000 Americans and over two million people worldwide.  Despite this staggering and growing number, a recent poll by The Associated Press-NORC Center for Public Research shows about one in three Americans definitely or probably will not get a vaccine.

“As physicians, we are deeply concerned about continued vaccine hesitancy across the country,” says Ben Kornitzer, M.D., Chief Medical and Quality Officer for agilon health, an organization that champions the roles of independent physician practices.  “While we encourage all patients to get vaccinated, we feel compelled to do something on a larger scale to urge patients to create herd immunity, which ultimately will stop the infection and help save lives.”

‘Herd immunity,’ or ‘population immunity,’ happens when a population is immune either through vaccination or immunity developed through the previous infection.  The World Health Organization recommends creating herd immunity by vaccination.  Anthony D. Fauci, M.D., Director of the National Institute of Allergy and Infectious Diseases and Advisor to the Biden Administration, reports that 70 to 85 percent of the U.S. population would have to be vaccinated in order to obtain herd immunity.

The “Roll Up Our Sleeves” campaign is a combined effort of primary care physicians representing more than 50 independent physician practices across the country and agilon health. Their goal is to combat the doubt felt by an alarming percentage of Americans who say they have no plans to get vaccinated.

Reasons for the opposition are varied, ranging from concerns about safety and effectiveness to the belief that the vaccine has not been thoroughly tested.  For people of color, who have made up nearly 60 percent of COVID-19 hospitalizations in the U.S., the message is especially urgent. According to research released by the Kaiser Family Foundation, 35 percent of black Americans have expressed hesitancy towards getting vaccinated.

The ““Roll Up Our Sleeves” video highlights the effectiveness of vaccinations over the past century, such as polio, mumps, and measle vaccines, which have wiped out infections and drastically reduced mortality rates.  The website contains information about the effectiveness of the vaccine, side effects, phases of eligibility, tips about how to sign up for vaccines, and resources for healthcare professionals.

2021-03-18T14:30:28-07:00February 25th, 2021|

Former CMS Administrator, Mark McClellan acknowledges agilon health as the organization leading the value-based care transformation

In the January 2021 Medical Economics issue, Mark McClellan, MD, Ph.D., former CMS Administrator, and FDA Commissioner, now Director of the Duke-Margolis Center for Health Policy at Duke University, spoke with Chris Mazzolini about what a post-pandemic health care delivery system should look like and the role primary care physicians should hold in this system. Mr. McClellan recognized agilon health as the organization leading the value-based health care transformation and supporting like-minded primary care physicians in the endeavor. Read the full article below or here.

 

Medical Economics Journal, Medical Economics January 2021, Volume 98, Issue 01

January 12, 2021

Chris Mazzolini

Creating a post-COVID health care system

What should a post-pandemic health care delivery system look like? And what role should primary care physicians hold in this system?

The COVID-19 pandemic is a monumental challenge for the U.S. health care system. But it’s also a once-in-a-lifetime opportunity to shake up the status quo, which relies on a-fee for-service system that is outdated and leaves both physicians and patients wanting more.

What should a post-pandemic health care delivery system look like? And what role should primary care physicians hold in this system?

Medical Economics® sat down recently via Zoom with Mark McClellan, M.D., Ph.D., to discuss that opportunity. McClellan is a former CMS administrator and FDA commissioner, and now serves as director of the Duke-Margolis Center for Health Policy at Duke University. This transcript was edited for length and clarity.

Medical Economics®: How would you assess the performance of the health care system during COVID-19?

Mark McClellan: I think it’s been mixed. First of all, health professionals in this country have done an incredible job working under often very difficult conditions and a pandemic where we never seem to be able to get to full containment. So it’s continuing to be a heavy burden on health care workers all over the country as we keep seeing recurrent cases and continued heavy burdens on our health care system throughout hospitals and detecting cases and managing patients with COVID-19.

I’ve also been impressed with the progress that we’ve made on therapeutics. I’m glad that Remdesivir seems to be moving beyond a shortage, limited access stage and becoming more broadly available. And we’ve clearly learned a lot about how to manage severe cases. Where it’s been tougher is in just how well prepared and robust our health care systems are. At the beginning of the pandemic, we just weren’t well prepared for this. We faced shortages in everything from diagnostic testing to PPE, and that had big consequences for our ability to contain the spread.

Now, people have commented a lot about the relative weakness of the U.S. public health system. I’ve seen a lot of examples of health care organizations moving upstream and doing more testing and at-risk communities helping integrate with public health. That may be the best path forward for our country for the future, since we just don’t have a well-developed public health system.

And then finally, in terms of the way our health care system has responded, I’ve been particularly impressed with organizations that have already moved away from fee-for-service payments. Some of the organizations that are more advanced in capitated type models, those organizations didn’t have their revenue floor fall out from under them when utilization fell in March and April. They were already engaged in a lot of telehealth and longitudinal data management to monitor their higher risk patients. They had a relatively easy time adapting to what was needed in the pandemic, which was a shift towards early intervention with patients, managing risks, redesigning care to put an emphasis on sites of service that were more community- and home-based.

I hope those features of our health care system, the interaction with public health, the building on population- based, value-based care models are something that we can develop further as we get through the rest of this pandemic and move beyond. It would make for a much more resilient health care system, one that’s much easier on health professionals the next time around.

ME: What should that post COVID-19 health care delivery system look like? And how do we take the next step with value-based care?

McClellan: In Duke Margolis, we’ve been collaborating with a lot of organizations and experts around the country, including six former CMS administrators who have worked from different perspectives, Republican and Democrat, on value-based care and payment reforms, including organizations like Families USA that are very concerned about the well-being of lower- and middle-income families that have really struggled during the pandemic.

And it all comes back to changing the way that we support our health professionals so they have an easier job not only responding to the pandemic but delivering care that reflects the opportunities for keeping people out of the hospital, for early diagnosis, and for dealing with the root causes of health problems much better than we have in the past. You know, people have been talking about value-based care for a while and it I think the evidence confirms that it does support paying differently by designing care differently.

Working as teams, using longitudinal data systems, we can do a better job of keeping people out of the hospital, improving patient experience, avoiding complications, and even get some savings at the same time. It’s been slow going, but I’m hoping that this will be a time for some further progress. I think it’s something that health care providers are maybe a bit more open to after seeing their fee-for-service revenues go down.

From a patient standpoint, people really have appreciated not just the ability to set up a telehealth visit, but all these services being reorganized around them and meeting their needs. Things like phone calls to let them know their risk. Or if they do have symptoms or a problem, connecting 24/7 to a nurse practitioner who knows their care and their and their records. It’s just a better way of delivering care. Here in North Carolina, Blue Cross of North Carolina has implemented a program where they’re giving some of their primary care groups some additional payments to help them get through the pandemic, who haven’t had as much assistance as some of the hospitals from the CARES Act and other emergency funding.

So they’re getting some financial help right now. And in conjunction with that they’re planning to move into so-called advanced medical home models over the next couple of years. This was a strategic direction that Blue Cross wanted to move in anyway, to get to better care. But it’s a special opportunity to do it now with some of the savings from reduced utilization that we’ve seen over the last few months, channeled directly into strengthening the practices and helping them move into these better models.

And we’re seeing some other examples like that around the country. CMS is starting some new programs that permit some upfront payments to physicians as part of their direct contracting and primary care first models and retooled oncology care model and kidney care model. Many other private insurers are interested in the same kinds of approaches. So it does seem like an opportune time to reflect on what went wrong, and really try to advance some of these value-based care models.

ME: I’m wondering what you think the correct approach is to getting providers to embrace value-based care? There’s the carrot and there’s the stick, and we sort of applied both of them in different ways. I’m wondering what you think is the way to really get physicians and health systems to leap with both feet into value-based care?

McClellan: Yeah, there are carrots and sticks. And from my time at CMS, a lot of providers complained about too much paperwork. So obviously, the more this is carrot-incentive oriented, the better. I actually think that the challenge with MIPS is that it puts a lot of emphasis on some minor adjustments in fee-for-service. You still get paid on a fee-for-service basis. You still have to do all the billing, all the paperwork, and on top of that, you’ve got to make sure you’re reporting on all the measures and things like that. And some of the things that the metrics are intended to do, like avoid readmissions, or improve other aspects of quality, the fee-for- service system doesn’t really pay you that well to support.

So the kinds of reforms I think are more promising, and the ones that in recent CMS reports they’ve shown have led to more savings and bigger measurable improvements in care, are ones that do move a bit more away from fee-for-service. So for a primary care group, giving them a payment per person, as a medical home or direct contract payment, that they get up front, and that they can use to make new kinds of investments, restructuring their practice, moving towards more of a team-based approach to care, investing in new IT capabilities that they can use in collaboration with health plans and other community organizations to augment the scope of services they can provide to keep people healthy.

And it’s those shifts away from the fee-for-service hamster wheel that give providers a chance to take a step back and say, okay, how do I really want to design my practice, that I think can make the most difference. And we’re seeing those kinds of models, not just in primary care, but in oncology, and kidney care. Getting kidney patients out of the dialysis clinics, which are generally not associated with the best outcomes and instead using models that enable more dialysis at home. That just wasn’t possible under the old here’s-your-payment-for-each-dialysis-service approach. And same thing true for other areas of specialized care and for accountable care organizations, as well.

CMS has tried to take a step in a number of their major Alternative Payment Model programs recently, pushing a bit more towards bigger shifts away from fee-for-service. I get nervous when I hear terms like downside risk, but really the flip side of that is money that you get up front that you can spend on what you think is most important, not just money where you have to ask, “do I have to do this procedure, this visit, and document this MIPS measure in order to get it?”

So it’s those bigger shifts that I think are more promising. And the good news here too, is that there are more supports and more experience available for all types of providers, small and large, primary care and specialty, to understand better how they can succeed in these approaches. It’s something that we work on a lot at Duke Margolis. There are other large collaborations producing more examples of successes. Other programs that really can help providers that are interested in these models look at and understand what they need to do. It is some work but in terms of provider experience—the quality part of the quadruple aim that’s very important for practice sustainability, as well as patient experience and quality of care and outcomes — these really are, it is increasingly clear, better ways of delivering care.

ME: Primary care physicians often feel very undervalued. And they feel like they’re on the hamster wheel, maybe more than a lot of other specialties. What do you see as the ideal role for primary care in the health care system?

McClellan: They need to have a bigger role. That means more support for more enhanced kinds of primary care programs, the kinds of things I’ve just been talking about. They involve primary care physicians not just doing a couple of office visits a year, but really being the coordinators, or the integrators of better care models that include working with a team, a nurse who can help with ongoing chronic care management, a social worker who can help with root causes of patients not taking their medication, or having some kind of issue that keeps them from getting into the office when a checkup is needed. Working with someone in the community who can help them as well as be sort of a trusted voice.

What we’re really talking about is an enhanced primary care model that costs more money. And that’s why I think some of the major payers for value-based care models are trying to get there by really creating significant payments to the enhanced primary care groups that are more than what they would have gotten before. But it’s also not linked to fee-for-service, because all those things I just mentioned are not things that are paid for in fee for service but instead are related to additional capabilities for helping to manage patients more effectively, getting better results, keeping them at home more. And they typically come with some accountability around health outcomes for their population or experience for their population. And getting total cost of care down.

We saw a number of models tried in the 2000s and 2010s, that were kind of additional payments for primary care. And those were helpful, and they made a difference in terms of supporting these kinds of additional capabilities, strengthening the primary care offices. Unfortunately, especially if you count the additional payments to primary care, they didn’t generally show overall health care savings, at least in the first few years after they were implemented.

The models that have shown more of an effect are these kinds of direct contracting or advanced primary care models that are more like physician led ACOs where the physician groups do take on at least some limited accountability for the total cost of care for their patients. It gives them more opportunities for additional revenues when they keep patients out of the hospital, get them into more effective care models, use specialty care more efficiently. Bring costs down as well as improving outcomes.

There are more programs available that physicians can get engaged in, like Aledade Health or Agilon, to provide support for some of these additional capabilities. Or they can work with health plans and Medicare Advantage and the Blue Cross plan that I mentioned earlier. So those kinds of opportunities look very promising as a realistic path available increasingly now to primary care docs to take primary care reimbursement from the really low5% or thereabouts of spending in the US, up to 10% or more. If you count all the integrated services, the coordination with behavioral health, and so forth, it makes for what should be a much stronger, enhanced primary care for the future.

Download Issue: Medical Economics January 2021

2021-03-18T14:27:58-07:00January 13th, 2021|

agilon health Partner Innovation & Platform Updates – December 2020 Newsletter

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Partner Innovation & Platform Updates

Partner Leadership

Team Member Bulletin

Innovation on the agilon health Platform

Industry News

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2020-12-14T13:22:58-07:00December 14th, 2020|

agilon health Applauds Additional Participation Options for Centers for Medicare & Medicaid Innovation Direct Contracting Initiative

 

LONG BEACH, California, December 4, 2020 – The Centers for Medicare & Medicaid Innovation announced an additional Geographic participation option for its Direct Contracting model. The new option will expand and advance the portfolio of accountable, coordinated care models offered for traditional Medicare patients.

The Direct Contracting model is a voluntary demonstration project that incentivizes better health outcomes for patients rather than the volume of services provided. The model seeks to align traditional Medicare and Medicare Advantage, creating efficiencies and reducing burden for physician practices. The model also gives physician practices additional tools to coordinate and improve care for seniors in traditional Medicare. The Geographic option will give physician practices additional mechanisms to participate in total cost of care risk models with additional features and benefits.

“The agency’s action yesterday is the next step forward in designing bold new care delivery and payment options in traditional Medicare that can improve care and lower costs in traditional Medicare” said Steven Sell, Chief Executive Officer, agilon health. “This participation option provides another opportunity to build on the success our partners have seen in value-based models including accountable care organizations, CPC Plus, and Medicare Advantage,” Sell concluded.

Earlier this year, agilon health announced that, together with its physician practice partners, it is participating in six Global Direct Contracting Entities effective October 1, 2020. The agilon health partners participating in the model represent approximately 500 primary care doctors providing care to more than 60,000 fee-for-service Medicare patients in seven states.

About agilon health

agilon health is the only health-care company of its kind, empowering and partnering with doctors to lead the transformation of their practices toward a future that rewards bold action, market-leading growth and durable patient relationships. Through the power of a national community of like-minded physicians and an integrated operating platform, we are leading the reinvention of health care delivery.

A unique and practice-branded joint operating model developed with its physician partners allows practices to boldly design and launch a financially aligned total care model for Medicare Advantage patients, unifying the physician and patient experience.  The result: empowered physician leaders, thriving practices, healthier communities, and practicing physicians who are rewarded intrinsically and financially by spending the right amount of time with the right patients who get the right treatments.

Since its founding in 2016, the agilon health community of physician partners has grown to 11 markets across 7 states.  Leading physician groups such as Austin Regional Clinic, Buffalo Medical Group, Central Ohio Primary Care, Preferred Primary Care Physicians, and Wilmington Health are collaborating through the agilon health platform. Today there are more than 160,000 Medicare Advantage members on the agilon health platform with 1,400 primary care physicians. Visit www.agilonhealth.com.

 

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2020-12-07T11:28:33-07:00December 4th, 2020|
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