agilon health, with Nine Independent Physician Practice Partners, Applied to Participate in New CMS Direct Contracting Payment Model
March 11, 2020, Long Beach, CA – agilon health, in conjunction with nine independent physician practice partners, applied to participate in the Centers for Medicare and Medicaid Services (CMS) Innovation Center Direct Contracting model. The model is aimed at reducing expenditures and enhancing the quality of care for seniors in fee-for-service Medicare. The applications represent potential participation by over 500 primary care doctors providing care to 78,000 fee-for-service Medicare patients in five states.
The Direct Contracting model is a voluntary demonstration project that changes the way that physicians and physician practices are paid, moving away from a fee-for-service system that incentivizes volume to a capitated model that rewards better health outcomes for patients. The model seeks to align payment models across traditional Medicare and Medicare Advantage, creating efficiencies for physician practices. Furthermore, the ability to offer enhanced benefits gives Direct Contracting model participants additional tools to improve patient care.
“We see tremendous potential for the Direct Contracting model to improve the quality of care for seniors in traditional Medicare while alleviating the burden for primary care physicians. This model places our primary care physician partners at the center of the health care system and will drive a patient-centered approach in traditional Medicare. Our applications demonstrate a robust commitment to advancing and fulfilling the promise of value-based care models, like Direct Contracting, for our physician partners and their senior patients,” said Ron Kuerbitz, Chief Executive Officer, agilon health.
CMS announced the Direct Contracting model as part of the agency’s Primary Cares Initiative in April 2019. The initial phase of the program is scheduled to begin in July 2020, and CMS is expected to release additional details about the model later this year. “We look forward to continuing to work with the federal government to design and implement this model going forward,” Ron continued.
Meet Benjamin Kornitzer, MD: Chief Medical Officer for agilon health
agilon health is pleased to welcome our new Chief Medical Officer, Benjamin Kornitzer, MD! Dr. Kornitzer joins agilon health with broad clinical and operational experience leading a diverse range of medical enterprises, including community-based practices, ACOs, IPAs, and integrated ambulatory networks. For the past six years, Dr. Kornitzer has served as Chief Medical Officer of the Mount Sinai Health Network, which spans over 50 practice sites in New York, New Jersey, and Florida. As CMO, Dr. Kornitzer oversaw one of the premier academic delivery networks in the country as the system developed robust population health tools, quality programs, care coordination resources, and invested in practice transformation. As a faculty member of the Icahn School of Medicine, Dr. Kornitzer founded and directed Mount Sinai’s Physician Leadership Academy.
Dr. Kornitzer is board-certified in Internal Medicine and his clinical practice focuses on primary care for high risk, home-bound older adults. Earlier in his career, Dr. Kornitzer had operational and strategic positions at leading community-based healthcare organizations focused on quality and value, including Balance ACO and House Calls Medical Group. In addition to his clinical and operational roles, Dr. Kornitzer previously served as a strategic consultant with McKinsey & Company, where he worked with the U.S. and foreign governments, hospital systems, and pharmaceutical companies on some of their most critical strategic priorities. Dr. Kornitzer earned his medical degree with Alpha Omega Alpha honors from Mount Sinai School of Medicine and completed his residency at Harvard Medical School/Massachusetts General Hospital. He received his undergraduate degree in History from Brown University. When he is not rolling up his sleeves working with physicians, practices, and patients, Dr. Kornitzer enjoys travel, skiing, ice hockey, cooking, spending time with family, and trying (mostly in vain) to keep up with repairs in his 1890s loft apartment.
Dr. Kornitzer is eager to work with our exceptional partners and team members to transform care delivery and provide the best experience and outcomes for our patients and return the sense of joy and fulfillment to primary care.
Humana and agilon health Expand Relationship, Announce Value-Based Agreements with Physician Groups
Working Together to Help Independent Practices Transition from Fee-for-Service
LOUISVILLE, Ky. & LONG BEACH, Calif. – November 20, 2019 –Humana Inc. (NYSE: HUM), one of the nation’s leading health and well-being companies, announced today that it has signed value-based care agreements with agilon health, which helps physicians and medical groups manage the transition from fee-for-service reimbursement, on behalf of three independent physician practices located in Ohio and Texas.
Effective January 1, 2020, the contracts are designed to improve health outcomes and the patient experience for Humana Medicare Advantage Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) members seeking care from physicians and other clinicians at Physicians Group of Southeastern Ohio (PGSEO) in southeast Ohio, PriMed Physicians in southwest Ohio, and Capital Medical Clinic in central Texas. Clinicians participating in Humana’s Medicare Advantage network will be able to utilize tools and resources from both agilon health and Humana in delivering value-based care.
These agreements supplement existing value-based contracts between Humana and agilon health for MDX Hawai‘i in Hawaii, Central Ohio Primary Care (COPC) and Pioneer Physicians Network in Ohio, and Austin Regional Clinic (ARC) and Premier Family Physicians in Texas, for a total collaboration involving more than 1,800 independent primary care clinicians.
“We’re proud to deepen our work with Humana in support of independent physician groups as they care for their patients,” said Ron Kuerbitz, CEO of agilon health. “We’re pleased that through our expanding network of physician partners, and in collaboration with Humana, we can help additional communities become healthier, and enable a growing number of primary care physicians to spend more time with patients toward improving their care.”
Agilon health partners with primary care physician groups, and provides the tools – the data, technology, capital, and workflow – so doctors are free to be the doctors they trained to be and ready to take on the responsibility for quality care of their patients.
“Through our work with agilon health, Humana is pleased to expand our ability to support independent physicians interested in moving to a value-based care model,” said Oraida Roman, Vice President, Value Based Strategies at Humana. “We look forward to sharing data and analytics with these physicians, and improving health outcomes and the patient experience for our Medicare Advantage members in Ohio and Texas.”
The value-based agreements with agilon health are in keeping with Humana’s longstanding commitment to value-based care, which emphasizes:
- More personal time with health professionals and personalized care that is tailored to each person’s unique health situation;
- Access to proactive health screenings and programs that are focused on preventing illness;
- Improved care for people living with chronic conditions with a focus on avoiding health complications;
- Leveraging technologies, such as data analytics, that connect physicians and help them work as a team to coordinate care around the patient; and
- Reimbursement to physicians linked to the health outcomes of their patients rather than based solely on the quantity of services they provide (fee-for-service).
Humana has an extensive and growing value-based care presence. As of Sept. 30, 2019, Humana has more than 2.3 million individual Medicare Advantage members and approximately 115,000 commercial members who are cared for by more than 60,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico. Humana’s total Medicare Advantage membership is more than four million members, which includes members affiliated with providers in value-based and standard Medicare Advantage settings.
Terms of the agreements were not disclosed.
About agilon health
agilon health of Long Beach, California, a company founded in 2016 by world-class health care leaders, is helping U.S. physicians manage the leap from fee for service to global risk-based health care. Recognizing the increasing pressure on physicians caused by the existing healthcare system, agilon health has created a complete operating platform for managing global risk-based health care that brings people, processes and proprietary technology together in partnership with physicians to take responsibility for total healthcare spend. The company has now expanded its operations to leading positions in nine U.S. markets. For more information visit www.agilonhealth.com.
Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.
To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.
More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:
- Annual reports to stockholders
- Securities and Exchange Commission filings
- Most recent investor conference presentations
- Quarterly earnings news releases and conference calls
- Calendar of events
- Corporate Governance information
Humana is a Medicare Advantage HMO and PPO organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. Other providers are available in our network. The provider may contract with other Plans.
As we continue to grow as a company, we know it’s important to define the core values that drive us. We hope these values will reflect on why we do what we do. #agilonhealth #ONEteam
As announced at our All-Employee meeting last week, we are excited to share agilon health’s core values that you (our teammates), our physician partners, and leadership teams collaborated so passionately on. We especially appreciate your Partnership and Collaboration throughout the journey by giving us feedback via employee focus groups and the all-employee survey along the way.
These core values and commitments represent our identity and reflect who we are and how we want to show up, both internally and with our external partnerships. This is the foundation by which our company culture will thrive and set us up for long-term success.
• Partnership & Collaboration – We are One Team. With our partner physicians, we empower the care that our family and friends deserve.
• Quality & Execution – We value results, not activity.
• Accountability & Integrity – We do the right thing even when it’s hard.
• Expertise – We are curious. We aspire to be experts in our field and share our knowledge with each other.
• Service Excellence – We serve others with passion and humility. We strive to exceed expectations.
• Continuous Improvement – We find practical solutions to complex problems. We strive to be world class in what matters most.
In the upcoming months, our Managers and HR Business Partners will collaborate with our employees to better understand the definition of the core values and what it means for them and their jobs. There will be company-wide activities reinforcing the values and commitments, culminating in fun, reflective, end-of-summer celebrations.
In living the core value of Continuous Improvement, we are going to look to you, employees and partners for suggestions on affecting and improving our culture. Stay tuned for an announcement on upcoming opportunities to submit ideas based on the themes we saw from the Employee Engagement Survey. As we stated in the All-Employee meeting, it starts with each and every one of us!
Newly announced models may provide unique opportunity for high-performing physician practices to expand access to care for traditional Medicare beneficiaries
agilon health Responds to the Centers for Medicare and Medicaid Services Request for Information on Proposed Direct Contracting Models
LONG BEACH, Calif., June 4, 2019 /PRNewswire/ — In response to a request for information from the Centers for Medicare and Medicaid Services (CMS), agilon health has submitted comments applauding the agency’s work on developing Direct Contracting models in traditional Medicare, while calling on CMS to ensure that new payment models adhere to certain guiding principles, including:
Creating models which support high-performing physician practices as they expand access to traditional Medicare patients in their local communities through beneficiary engagement and payment design elements that align with the Medicare Advantage program. Encouraging and incentivizing the adoption of financial risk models along with a progression from existing accountable care organizations and primary care models to delegated risk models, like the Global Direct Contracting option described in Primary Cares First.
Protecting and empowering consumers by emphasizing the importance of the physician-patient relationship and providing Medicare beneficiaries with clear and detailed information about their Medicare coverage choices.
agilon health’s letter is intended to further inform the agency’s effort to design models within the Primary Cares Initiative, first announced in April. The new project advances Direct Contracting payment models in traditional Medicare. These models start with the premise that the primary care physician is central to the patient’s long-term engagement with the health care delivery system and consequently to a satisfying and high-quality care experience. These models will restructure the way that physicians and physician groups are paid, moving away from a broken fee-for-service system toward a system of greater financial and clinical accountability.
In the letter, Ron Kuerbitz, CEO of agilon health, states, “We are committed to advancing models that allow physicians to focus on what matters most—providing high-quality care to their patients.” The letter goes on to say, “Global risk delegated services models have been proven to be effective in improving population health and individual patient care in the Medicare Advantage program, Medicaid programs, and commercial plans. The Direct Contracting models are a step toward achieving the benefits of this model for physicians and patients in traditional Medicare.”
agilon health physician practice partners in Austin, Texas, Akron, Ohio and Columbus, Ohio, representing 400 primary care physicians and over 50,000 traditional Medicare beneficiaries, also submitted their comments to the agency. Dr. Gary Pinta, practicing internist and President of Pioneer Physicians Network in Akron, suggested that “Aligning the model to Medicare Advantage is particularly important for benchmarking, risk adjustment and quality measurement reporting. Creating consistency across programs will allow us to reduce burdens, make the program more easily understandable, and allow us to make consistent investments across our entire Medicare population. We encourage the agency to consider how alignment to the Medicare Advantage benchmark could create stronger incentives for efficient, high-quality provider organizations to participate in the Direct Contracting global model.”
CMS is expected to release further details about the Direct Contracting models later this summer. Click here to read the agilon health response to CMS.
About agilon health
Founded in 2016, agilon health is a platform that empowers physicians with the operating model, technology, solutions, and capital required to transition from fee-for-service to integrated payment and delivery. Through agilon health’s innovative physician-first partnership model, primary care physicians can lead the transformation of their local markets through value-based care, expand their long-term growth opportunity, share best practices with like-minded physicians, and recapture the joy of practicing medicine. Since its inception, more than 2,200 primary care physicians, including numerous thought-leading independent physician organizations, have partnered through the agilon health platform to redesign the system of care for more than 410, 000 patients.