agilon health and Its Physician Group Partners Continue to Move Forward in the CMS Direct Contracting Model Options Process 

CMS

Together with nine independent physician practice partners across the platform, this past February, agilon health applied to participate in the Centers for Medicare and Medicaid Services (CMS) Innovation Center Direct Contracting model. The applications represent potential participation by over 500 primary care doctors across our markets, adding over 85,000 fee-for-service Medicare patients in seven states on to the agilon health platform.

By aligning financial incentives, the Direct Contracting model, the progression of the ACO payment model, is aimed at:

  • enhancing the quality of care and reducing expenditures for seniors in fee-for-service Medicare
  • enabling our physician partners to care for their MA patients and Medicare FFS patients as one line of business, necessitating only incremental increases in resources
  • empowering beneficiaries to engage in their care delivery through voluntary alignment and benefit enhancements that are typically available only to Medicare Advantage members
  • reducing provider burden through a smaller set of core quality measures, with a heavy emphasis on patient experience

In early July, CMS selected applicants to begin participation for the Performance Year 2021, with the revised start date of April 1, 2020. CMS allows a six-month implementation period, from October 1, 2020, to March 30, 2021.

Starting October 1, agilon health, in partnership with participating practices, will commence the implementation work, which will include introducing a focus on quality gaps and burden of illness, developing preferred network partnerships, aligning beneficiaries and testing the attractiveness of supplemental dental coverage for select beneficiaries.  Investments are already underway to enhance the organizational capacity of data acquisition and analytics functions. During the implementation period, the Medicare FFS patient outreach and alignment initiative will also get underway.

agilon health is very excited to be at the forefront of the CMS Innovation model and to bring value-based healthcare to our practices Traditional Medicare patients.