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agilon health Responds to the Centers for Medicare and Medicaid Services Request for Information on Proposed Direct Contracting Models

Newly announced models may provide a unique opportunity for high performing physician practices to expand access to care for traditional Medicare beneficiaries

Adam Boehler
Director, Center for Medicare & Medicaid Innovation
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

Re: Request for Information on Direct Contracting—Geographic Population-Based Payment Model Option

Dear Director Boehler:

On behalf of agilon health, we appreciate the opportunity to respond to the Request for Information (RFI) on Direct Contracting—Geographic Population-Based Payment (PBP) Model Option.  agilon health partners with primary care physicians to define a new standard of quality, efficiency and patient experience.  We bring the people, solutions, capital and technology necessary to ensure long-term success and to bring back the joy of practicing medicine.  We work with physician practices in California, Hawaii, Texas, Ohio and Pennsylvania, serving 1,500 primary care physicians caring for more than 360,000 patients. We will be expanding to four additional states in 2020.

We applaud the Innovation Center on its new direction for developing the global risk payment model in traditional Medicare.  Global risk delegated service models are effective in integrating financial and clinical accountability and have demonstrated success 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.

Global risk delegated service models like Direct Contracting are among the most successful payment models to move physicians away from a broken fee-for-service system.  If structured appropriately, Direct Contracting models restructure and align incentives toward high-quality patient care.  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 life-long high quality, satisfying and cost-effective care.  The models enable investment in resources that identify patient risk factors, allowing the provider to more effectively organize individualized care.  The payment model supports organization and infrastructure that allows physicians to invest time and resources to better streamline workflows, using health information and analytics, chronic condition and episodic care management, care coordination and social support services for patients.

As a result, physicians participating in these models recover their sense of mission, mastery and autonomy, prerequisites to restoring joy in the practice of medicine.  Physician burnout has been on the rise and administrative burdens have taken a severe toll on the medical profession, and as a result, on access to high-quality care and systemic stability.[1]  We are committed to advancing models that allow physicians to focus on what matters most – providing high-quality care to their patients.  Our experience is demonstrating the positive impact on global risk models like Direct Contracting have on primary care physicians’ professional satisfaction.  The average Net Promoter Score (NPS) for each of our primary care partnerships or networks has shown year-over-year improvement since the implementation of delegated full risk payment models in partnership with agilon health.

Direct Contracting models in traditional Medicare offer the opportunity to expand on the success of delegated risk models.  We welcome the opportunity to provide feedback on the Direct Contracting professional, global and geographic models and to offer specific responses to the questions set forth in the RFI.  We recognize the key elements for the Direct Contracting model portfolio are yet to be released and we hope to serve as a resource as you finalize the model design. As you further refine the Direct Contracting model options, we recommend the following guiding principles:

  • Fostering predictability, stability and fairness for physicians and patients. New models should be implemented in a manner that creates stability, predictability and fairness for providers and patients.  We agree that reforms to the payment and delivery system can be bold.  But, the success of these transitions will rely on stable and predictable payments.  For example, global payment models in Medicare Advantage have been so successful in part because of the relative stability and predictability of a payment model based on market benchmarks which allow physicians and health plans to invest in the long-term care of beneficiaries.  We encourage CMMI to focus on replicating the long-term predictability of revenue based on Medicare Advantage-like market benchmarks in order to encourage early investment and long-term participation by high performing medical groups.


  • Creating consistency across Medicare programs and aligning model design to Medicare Advantage. New models should be designed and implemented with an eye toward creating consistency across payers.  Today, physicians face conflicting and overlapping requirements across different payer types, including across traditional Medicare and Medicare Advantage.  For example, physicians typically report different sets of quality metrics across Medicare fee-for-service alternative payment models (APMs) and Medicare Advantage.  Streamlining these and other program requirements will reduce the burden on physician practices – a shared goal of the Administration and physicians across the country.  Where conflicting requirements exist, we urge CMMI to use the Medicare Advantage program as the standard.  Our experience with physician practices shows that delegated capitation in Medicare Advantage is the gold standard for a model that incentivizes a team-based approach that is focused on patient outcomes and that standardization of goals across Medicare Advantage plans results in significant process improvement, with gains in quality, efficiency and physician and patient satisfaction.


  • Protecting beneficiary choice. New models should protect the beneficiary’s choice of provider and should not disrupt existing physician-patient relationships.  As new models are designed and implemented, they should continue to empower consumers to make informed choices about their healthcare.  New models should focus on providing consumers with complete information about the choices that are available, whether they are enrolled in traditional Medicare or Medicare Advantage.  CMS should empower consumers with information about quality and cost sharing in each option.


  • Encouraging early adoption of financial risk models. As new models are introduced, we ask that the agency use caution so as not to disadvantage early adopters of financial risk arrangements.  The early investments physician practices have made in setting up value-based programs should be taken into consideration as new models are designed and implemented.  Specifically, physicians participating in Comprehensive Primary Care Plus (CPC+) or Accountable Care Organizations (ACOs) should be able to immediately transition to the new DCE payment model without loss of surplus sharing from their prior participation in value-based programs.  Recognizing their early commitment to this new direction will also foster greater participation in new models as they are released, rather than creating incentives for providers to sit on the sidelines waiting for the next new model to be introduced.


  • Incentivizing uptake of higher levels of financial risk. We agree with the agency that incentives should be put in place to encourage uptake of higher levels of financial risk. These incentives can take a variety of forms, including a greater share of financial savings and waivers of burdensome administrative requirements and rules that are intended to protect against fee-for-service incentives for overutilization and self-referral.


  • Being mindful of unintended consequences such as provider consolidation and hospital acquisition of physician practices. Evidence shows that hospital acquisition of physician practices leads to increased healthcare costs, including higher out-of-pocket costs for patients.[2]  We encourage the agency to adopt rules that do not tip the balance in favor of health system participation, leading to additional acquisition of physician practices, but instead equally allow physicians to maintain their independence while embracing the move to global payment methodologies.

Specific Considerations for Direct Contracting Models

As you continue to develop Direct Contracting professional, global and geographic options, we offer the following considerations that are not specifically raised in the scope of the RFI.

Financial Model Considerations

We understand that key features of the financial model for all tracks of Direct Contracting are still under development.  We have several recommendations rooted in our experience with managed care and risk-based arrangements.

For the global Direct Contracting model, the Innovation Center should offer a benchmarking model that will be attractive to providers who are performing below their regional benchmarks, creating a model that is more attractive to high-performing groups.  To achieve this goal, the benchmark should use a higher weighted regional component.  This approach will attract efficient providers to participate in the model—the very practices that CMS and CMMI should be encouraging to participate in a global model that involves significant financial and clinical accountability.  These practices have the core competencies to manage the risk and improve the health of the patient population.

Testing a benchmark with a higher regional blend would create a distinct model design element as compared to the other offerings in the Medicare ACO space.  Both the Medicare Shared Savings Program and the Next Generation ACO program have relatively small regional adjustments.  Adding a model with a benchmark consisting of a higher regional blend offers an alternative model design option for efficient providers to engage in CMMI programs.

By designing the financial model this way, the Innovation Center can create incentives for participation that change market dynamics for traditional Medicare beneficiaries and physicians.  Offering a model that encourages participation by high performers will allow those organizations to begin to streamline their practices and improve efficiencies and to better compete for traditional Medicare patients. This model will give high performing providers an additional tool to attract less efficient physicians in their local market to the delegated capitated model.  Letting these high performers drive the model expansion is another approach to spreading risk models in local communities—an approach that has not been explicitly tested by CMMI before. Rather than designing the benchmark that facilitates participation by providers with spending higher than their region, this model should be designed to encourage efficient providers to participate and to grow their practice with the available resources to compete for traditional Medicare beneficiaries.  To achieve this, the model should include a more Medicare Advantage-like blend of regional factors.  We are conducting extensive analysis on benchmarking options and will look forward to sharing our findings upon completion of that work.

Timing Considerations

agilon health works with providers who are currently participating in MSSP ENHANCED, CPC+ and other models.  We recognize that some of these participants may want to transition to Direct Contracting professional or global models in 2020 or 2021.  We respectfully request that the agency quickly identify the options and pathways for these organizations to make this transition.

We also ask that agency keep in mind an important consideration for entities participating in advanced Alternative Payment Models (APMs) in 2020 with regards to their Quality Payment Program (QPP) status.  Our understanding is that the alignment year, or performance year (PY) zero, of Direct Contracting would not qualify as an advanced APM for QPP purposes. Therefore, we request that entities that are currently participating in advanced APMs in 2020 be permitted to continue with that participation and to make a smooth transition into new models in 2021, should they desire to do so.

To the extent that the agency is considering additional flexibility or tools for DCEs to use voluntary alignment, organizations participating in advanced APMs in 2020 but preparing to make the move to Direct Contracting in 2021 should be afforded access to these same tools in the 2020 performance year.  This could be achieved either by allowing these entities to participate in both their existing advanced APM and PY zero in 2020, or by extending the PY zero tools and flexibilities to participants in other models.  This approach will ensure that early adopters of advanced APMs are not penalized and are permitted to operate on a level playing field with new DCEs.

Agency Commitment to Payment Model Stability

The Direct Contracting model portfolio offers a higher level of potential risk and reward for participating entities.  Given that these models incorporate some level of capitation, we request that the agency use a more transparent, Medicare Advantage rate notice-like process when announcing the model to afford DCEs an opportunity to review key model design elements and to provide feedback before those elements are finalized.  We also ask that the agency commit to maintaining key design elements for a full performance year before making changes.  In the current risk models at the Innovation Center, the agency has, at times, made mid-year changes to key program design elements such as risk adjustment.  These types of changes can be disruptive in a capitated environment.  Providing an opportunity for comment and then adhering to model terms for a defined period of time will increase stability and predictability in the program and will better align the program operations to Medicare Advantage.


Questions Related to General Model Design

  1. How might DCEs in the geographic model address beneficiary needs related to social determinants of health?

DCEs across all models of Direct Contracting (professional, global and geographic) should have the opportunity and flexibility to address the social determinants of health for their aligned beneficiary populations. In a recent speech, Department of Health and Human Services Secretary Azar commented that social determinants are the root cause of much of our health care spending.  We agree that managing population health and controlling costs includes identifying and assisting patients in managing social determinants of health.

CMS recently finalized additional flexibility for Medicare Advantage plans and providers to address the social determinants of health.  We encourage the agency to continue to identify opportunities to align the flexibilities in Medicare Advantage with those in traditional Medicare performance-based risk models.  For example, in Medicare Advantage, there is greater flexibility and clarity around the rules for providing transportation, and other services like meals, to patients without potentially implicating the fraud and abuse prohibitions.  To achieve the goal of alignment, we would welcome the opportunity to work with the Innovation Center to further determine what waivers would allow risk-bearing provider organizations to better address patients’ total care needs, including the social determinants of health.

Questions Related to Selection of Target Regions

  1. What criteria should be considered for selecting target regions where the geographic model would be implemented?

As we mentioned above, a key principle for implementing new models should be to promote stability for the delivery system and for patients.  In order to achieve this goal, agilon health recommends that the agency select target areas for geographic DCEs where there has not been significant adoption of advanced APMs.  Where advanced APMs and care coordination efforts are already underway, a geographic DCE could disrupt care delivery redesign that is already underway and two-sided risk contracts that are midstream.  We recommend instead that the agency focus on areas that have not voluntarily adopted and implemented advanced APMs where there may be a more significant opportunity for a geographic DCE to enter a market and adopt new innovations to control costs and improve care coordination where existing models have not been successful.

Questions Related to DCE Eligibility

  1. What selection criteria and core competencies should CMS consider requiring of applicants?

The geographic Direct Contracting model as described by the agency contemplates a high level of financial risk across a potentially broad geographic area and for populations that could be randomly assigned to the DCE.  Given all of these factors, the selection criteria should be sufficiently stringent to ensure that beneficiaries are protected in the new model and that entities in the model have the capability to manage the risk.

Geographic DCEs should be required to meet the following criteria (in addition to the criteria set forth in the RFI):

  • Demonstrated experience and success with managing two-sided risk;
  • Evidence of the ability to deliver high-quality care in a risk-bearing contract;
  • The ability to pay claims downstream and experience in structuring innovative downstream reimbursement models that encourage member engagement and provider coordination; and
  • Ability to manage Part D (discussed below).

Questions Related to Beneficiary Alignment

  1. How should CMS think about attribution for geographic DCEs?

In general, we caution against the use of random assignment in this model, as it may be confusing for beneficiaries and providers in geographic model regions.  Instead, attribution for geographic DCEs should prioritize the beneficiary’s choice of provider.  Protecting this choice should be the first principle.  The attribution methodologies should not advantage geographic DCEs over other types of performance-based risk model participants.

Consistent with our principle around not disadvantaging early adopters of performance-based risk, geographic DCEs should not be attributed beneficiaries that have already been aligned to another performance-based risk model.  We recommend that the Innovation Center adopt a more formal approach to addressing potential overlaps in attribution between models.  Models with the greatest amount of financial risk should take precedence over lower risk models.  We recommend a model precedence “waterfall” that would operate as follows:

  • Direct Contracting Global
  • Direct Contracting Professional
  • Accountable Care Organization
  • Primary Care First or CPC+
  • Geographic model takes the remainder of unassigned beneficiaries

agilon health also recommends that Direct Contracting Model professional and global participants and ACOs be able to nest primary care medical home, bundles and other specialty models within the total cost of care model, as is currently done in Medicare Advantage arrangements.

  1. How might DCEs inform beneficiaries of payment model options and engage them in their care? What barriers would DCEs face in engaging with beneficiaries in their target region?

With regard to the Direct Contracting geographic model, CMS will have to carefully consider the types of communications that beneficiaries receive, especially with regards to designing the model.  CMS should build on the experience of the Medicare ACO programs and Medicare Advantage when determining how to communicate the new program to beneficiaries, including emphasizing beneficiaries’ options when it comes to freedom of choice of provider and maintaining their physician-patient relationship.  Communications to beneficiaries should be clear and transparent and should be tested to ensure that they do not create confusion for seniors.

For the Direct Contracting professional and global models, CMS should allow DCEs waiver flexibility to engage beneficiaries in the model.  We understand the agency’s commitment to the open network concept of traditional Medicare and maintaining beneficiary freedom of choice of provider.  But we also understand that capitated models work best when paired with an engaged beneficiary.  Therefore, we recommend that the Innovation Center work with DCEs to determine what types of tools and incentives would be most valuable to educate beneficiaries about their choices and high-value health care options.  This flexibility could build on the flexibility that was offered in the Next Generation ACO program, including the coordinated care reward payment to certain beneficiaries who received primary care services from NextGen ACO providers.[3]

Furthermore, agilon health recommends that CMS incorporate flexibility and any necessary waivers to allow providers in all Direct Contracting models (geographic, professional and global) to talk to patients about the Medicare model that is best for the patient, including an assessment of their Medicare Advantage options.  In some cases, the beneficiary’s health and financial status may indicate that a different Medicare coverage option provides the beneficiary better care coordination or lower out-of-pocket spending.  In that case, providers should be able to communicate with the patient about which option is best for them.  The agency should provide information to providers to help them understand which patients might benefit from Medicare Advantage coverage.  We ask that the agency simultaneously continue to evolve the Medicare Marketing Guidelines to allow providers to proactively engage with patients regarding the most appropriate type of Medicare coverage for their needs.

Questions Related to Payment

  1. CMS envisions applicants proposing a discount to the benchmark for the aligned population. What is the range of discounts CMS can expect applicants to propose and why?  How should the agency think about structuring discounts over the life of the model?

For the geographic Direct Contracting model, CMS should expect applicants to propose a five percent discount. This discount is consistent with the Medicare Advantage program.  In addition to considerations about discounting related to cost savings, we underscore the importance of maintaining quality performance standards in capitated risk arrangements to ensure that cost savings are not achieved at the expense of patient care.  External (e.g., Medicare Advantage Star Ratings) and internal facing (e.g., dashboards and scorecards) quality performance measurement and reporting continues to be a critical feature of the success of Medicare Advantage in general and delegated capitation in particular.  Therefore, we recommend that CMS consider a way to incorporate quality performance in the payment model for DCEs.  Again, the Medicare Advantage experience could serve as a guide.

  1. Should geographic DCEs benchmarks include accountability for Part D drug costs?

The geographic Direct Contracting model is an appropriate vehicle for CMS to begin smaller scale testing of incorporating accountability for Part D drug costs.  In the recent Pathways to Success rulemaking cycle, CMS solicited and received comments on the desirability of incorporating Part D drug risk into accountable care models.  Commenters suggested that CMS develop a voluntary demonstration to test accountable care model accountability for Part D costs.[4]  Commenters stated that integrating pharmacy care for fee-for-service beneficiaries could have benefits, such as reducing the risk of adverse events, improving medication adherence and facilitating counseling services.  However, some commenters also expressed concerns about barriers to information sharing and variation across plans. Given both the potential opportunities and challenges, a narrower test of this integration seems appropriate, and given that CMS intends to select a limited number of regions for the Direct Contracting geographic model, it seems to be a good candidate for such testing.  Furthermore, incorporating accountability for prescription drug spending could serve as another prong in the Administration’s strategy to control prescription drug costs.

  1. If DCEs enter downstream payment arrangements with providers, how should cost-sharing amounts be determined and collected from beneficiaries?

Geographic DCEs will have to create implementation plans for their downstream providers to collect cost-sharing amounts.  The Innovation Center should develop a process for reviewing and approving such plans.  In addition, the Innovation Center should ensure that cost-sharing amounts collected from beneficiaries remain consistent across Direct Contracting model options.  The geographic model beneficiaries should not have advantages or flexibilities that the Direct Contracting global risk beneficiaries do not also have.


We appreciate the opportunity to comment on this RFI.  Please do not hesitate to contact Lisa Dombro, Senior Vice President & Chief of Provider Network Strategies & Engagement, with additional questions.


Ron Kuerbitz

Chief Executive Officer

agilon health



[1] Shanafelt, T. et al, Changes in Burnout and Satisfaction with Work-Life Integration in Physicians and the General US Working Population between 2011 and 2017, Mayo Clin. Proc (2019), available at (accessed May 17, 2019).

[2] See e.g.,;


[4] (at 68,031).

2019-06-02T08:06:50+00:00 June 1st, 2019|

agilon health Partner Innovation & Platform Updates – May 2019

May 2019

Partner Innovation & Platform Updates

Partner Leadership

Innovation on the agilon health Platform

Industry News

agilon health

© agilon health. All rights reserved.
1 World Trade Center | Suite 2000 | Long Beach, CA | 90831

2019-06-10T09:09:15+00:00 May 4th, 2019|

agilon health Partner Innovation & Platform Updates – April 2019 Newsletter

April 2019

Partner Innovation & Platform Updates

Partner Leadership

Innovation on the agilon health Platform

Industry News

agilon health

© agilon health. All rights reserved.
1 World Trade Center | Suite 2000 | Long Beach, CA | 90831

2019-06-10T09:15:30+00:00 April 6th, 2019|

agilon health Partner Innovation & Platform Updates – March 2019 Newsletter

March 2019

Partner Innovation & Platform Updates

Partner Leadership

Innovation on the agilon health Platform

Industry News

agilon health

© agilon health. All rights reserved.
1 World Trade Center | Suite 2000 | Long Beach, CA | 90831

2019-06-10T09:24:58+00:00 March 28th, 2019|

Vantage Medical Group Making a Difference through the California Health Homes Program.

High Touch Program for Vulnerable Members made possible through collaboration with Molina Health Care

Patient testimonial – Vantage Medical Group

Rasaq Hassan was on the verge of a downward spiral, feeling like no one cared about his health and well-being. He was feeling neglected and didn’t have full confidence that his physicians were looking out for his well-being. As a result, he was only keeping 60 to 70 percent of his doctor’s appointments with his primary care clinic. Enter Margarita Rosado, a licensed vocational nurse with Vantage Medical Group, an agilon health platform company. In coordination with Molina Health Care and the California Health Homes Program, which provides enhanced care management and coordination to chronically ill patients, Margarita was able to help coordinate Rasaq’s healthcare. According to Rasaq, Margarita is an “angel” and is the best thing to step into his life over the last few years.

After Margarita’s home visit, Rasaq felt that his primary care clinic’s medical team began paying more attention and making concrete efforts to engage him. Not only did Margarita schedule three physician appointments for Rasaq that he had trouble making in the past, she even accompanied him to an appointment on a particularly rainy Valentine’s Day!

All these efforts have shown Rasaq that his primary care clinic and providers do value its patients. Rasaq now feels like he has an active partner who will work with him to ensure that his healthcare needs are met. He considers the Health Homes Program to be extremely important to people like himself and hopes to see it continue.


2019-03-22T00:55:40+00:00 March 12th, 2019|

Lessons In Leadership: Ron Williams Shares excerpts from His Book (Releasing in May) and His Best Leadership Advice.


agilon health chairman, Ron Williams, and author of Learning to Lead: The Journey to Leading Yourself, Leading Others and Leading an Organization (releasing in May), shares excerpts from his book about his best leadership advice with Thrive Global.  In addition to his perspectives on leadership, Ron also shared his recommendations for the U.S. healthcare industry in saying  “My personal view is that we need to get value back into the health care equation. We need to pay based on the value provided versus the number of services provided. agilon health, ….., is a company based in California working on physician-centric models for value-based health care.  Read more about the interview with Ron Williams here.


2019-03-09T18:02:00+00:00 March 9th, 2019|

Bill, Wulf, MD, CEO of Central Ohio Primary Care Shares Inspiring Stories from the COPC Senior Care Advantage 60 Strong Ambassadors and the Practice’s Focus on Creating an Innovative and Unique Model of Care for Seniors in the Greater Columbus, Ohio area.

There are certain milestones in life many approach with a mix of excitement and trepidation. For some, hitting age 60 is one of them.

So we get a little inspiration from the 60 Strong calendar. Learn about this inspiring project and how it hopes to inspire you at

Click here to watch one of our 60 Strong ambassadors sharing his inspiring story.

2019-03-24T05:16:44+00:00 February 23rd, 2019|

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|
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