Strategies to Transition from Fee-for-Service to Full-Risk Value-Based Care

Transitioning from Fee-for-Service to Full-Risk Value-Based Reimbursement

The market shift from the fee-for-service (FFS) model toward value-based care (VBC) presents extraordinary opportunities and challenges for the U.S. health care system and individual physicians. Moving to VBC means that medical providers can focus on the value of care, not the volume of fees.  How will this shift affect you as a primary care physician and your practice? Are you ready to make the transition?

According to National Health Expenditure data from 2020, health spending accounted for 19.7% of the nation’s Gross Domestic Product, and health spending in the U.S. has consistently grown faster than the economy. The Centers for Medicare and Medicaid Services (CMS) has made improving care and lowering costs a priority, with all Medicare fee-for-service beneficiaries in a care relationship with accountability for quality and total cost of care by 2030. We’ll look at how partnering with agilon could greatly benefit your practice and support you in the transition to a VBC model.

Overcoming the Challenges to Implementing Value-Based Care

Responding to the American Academy of Family Physicians (AAFP) 2022 value-based care survey, 49% of practices said they are participating in some form of value-based payment, and 18% are developing the capabilities to do so. While VBC is seen as the future of health care, it can present unique challenges for primary care physicians moving from a FFS system. These include payment concerns, data management, and health system integration.

Overcoming Cost/Payment Concerns

As with anything new, a successful transition to implementing and then being paid for value-based care can take time. In addition, there are many physician compensation models in VBC.

Navigating the changing landscape of payment models can be complicated for physicians. Those that partner with agilon health gain the benefit of our platform that allows them to participate in a full-risk value-based care model – a next-generation care delivery system in which physicians can focus on total quality and cost of care for their Medicare patients. Our physician partners receive a stable monthly payment to deliver specific services for each enrolled patient. That payment is made regardless of whether patients seek those services or not. Payments to the partnership are based on the expected care the patient will receive, and higher payments are made for patients who have more extensive medical histories.

Overcoming Data Collection Tracking and Analysis Obstacles

Because of the sheer volume of data collected, health care providers have struggled with how to record, access, and share that data effectively. Within value-based care models, different data points often need to be collected and addressed to enhance the delivery of quality care and patient outcomes. Access to patient information has been cited by providers as another critical issue. Complicating matters, providers may need to overhaul or replace their software, which can be expensive and time-consuming.

Physicians who partner with agilon health find that data collection and analysis becomes easier because of the agilon platform. Physician practices are not required to migrate their existing systems. The agilon platform seamlessly integrates with existing payor data, EMR data, labs, pharmacies, and other third-party information. It also extracts financial, clinical, and social determinants data. All of this is presented in one view for easy consumption by physicians making it easier to provide quality care. Most important, agilon can have all systems up and running within a 12-month implementation period.

Additional Benefits of Partnering with agilon health

At agilon, we are solely dedicated to partnering in trust with community-based physicians as they reimagine the care delivery experience. Our physician partners can have confidence their business will thrive long-term – and they get to invest more in the coordinated, team-based care their patients deserve. By eliminating the obstacles physicians face in transitioning to a Total Care Model, we help them have a sustained, thriving future. Here’s how we do that:

1. agilon purpose-built platform and partnership model, empowers the primary care physician to serve as the care quarterback, creating a better-quality experience for senior patients.
2. agilon partnership model enables reinvestment into the practice and the community, enabling practices to invest in clinical programs and care team resources that will continually improve their business performance and provide better outcomes for patients.
3. agilon has the tools and roadmaps to seamlessly help physicians move to a new care model and stay profitable all while economically and successfully treating patients.
4. agilon is able to transform physicians’ practices to a full-risk value-based care model within a 12-month time period, making the transition extremely time-efficient.

In addition, when you partner with agilon, you become part of a network of like-minded physicians in different communities that you can learn from and share insights and best practices with.

agilon’s Total Care Model

Our Total Care Model was created by physicians for physicians to improve outcomes, reduce costs, and help PCPs grow their practices. Working together, we can help you reimagine the future of health care in your community.