Agilon Health: The Keys to Sustainable Healthcare for Seniors


“The great thing about partnering with Agilon Health is that we have support, both financial and professional, but also that our doctors feel like they’re doing something and that they are empowered and in fact have the opportunity to transform care within the health system. “
Dr Frank Civitarese, preferred primary care physicians

Over the past decade, more and more senior Americans have enrolled in Medicare Advantage, with the program playing an increasingly important role in the global Medicare landscape. Today more than 26 million seniors are enrolled in a Medicare Advantage plan. Agilon Health has kept pace and is doing its part in helping to transform healthcare for the elderly with Medicare Advantage. But how? Through partnerships with groups of independent physicians, Agilon Health is able to offer our Total care model, allowing community physicians to focus on all health of their patients Medicare – a system that is based on value of care (also known as “value-based care”), not volume of service.

Agilon Health has convened a Expert Group independent physicians from across the United States – with experience in delivering value-based care through our total care model – to discuss Medicare Advantage, the role of independent primary care, and this new way of caring seniors. Moderated by Mara McDermott, Vice President of McDermott + Consulting, the panel covered six key areas:

1. How much value does Medicare Advantage bring to the health care system? Why is value-based care important for older people?

Medicare Advantage is “leading the movement” in value-based care and is a “unique and exciting opportunity to change the way we care for the elderly,” said Dr. Frank Civitarese, President of Preferred Primary Care Physicians (PPCP), located in the greater Pittsburgh area of ​​Pennsylvania. Thanks to his partnership with agilon santé, PPPP physicians can focus on the overall health of patients by managing them in a value-based model of care. And the results are impressive. Patients “readily recognized the value of Medicare Advantage” and are saving money compared to the original Medicare; they even use inpatient services less frequently (47% less, in fact) – a “remarkable number,” notes Dr Civitarese.

2. What is an “aggregate risk” model and what does it mean for patients?

With the “aggregate risk” model, Medicare Advantage enables groups of physicians to access prepayments for their patients through Medicare Advantage. Instead of being reimbursed for each patient visit, the physician group receives a fixed monthly payment from Medicare Advantage plans to cover virtually all of the member’s health needs. “We manage the entire cost of care in our model,” says Dr. Kevin Spencer, CEO of Premier Family Physicians, based in Austin, TX. Any remaining money – the savings associated with keeping patients healthier and out of hospital – is used to fund clinical programs, cover operating expenses as well as to support primary care and multispecialty groups with incentives. fairness of payments within the practice.

When it comes to results, we’ve consistently seen “better experiences and better results,” says Dr. Spencer. For example, 90% of members said they were satisfied with their care and 95% strongly agreed that they received comprehensive care. He adds: “On the results side, we are seeing emergency room use down 42%, and that was before COVID.”

3. What abilities have you been able to develop in providing value-based care?

Dr Bill Wulf, CEO of Central Ohio Primary Care Physicians, headquartered in Westerville, Ohio, says they have been able to add comprehensive programs that provide “better and safer care for our patients.” Visualize a pyramid, with low risk patients requiring primary care at the bottom, then patients requiring specialist care, then those requiring hospital care, and finally those requiring end-of-life care at the top. “What the funding allows us to do is develop programs and capacities that allow us to provide comprehensive patient care, and essentially wrap our patients and especially those who are at high risk.” Some programs that have been added as a result of its partnership with Agilon Health include:

  • same day centers (emergency care)

  • skilled nursing facilities preferred

  • 24/7 helpline to handle hospital admissions and floor calls

  • centralized management of references

  • home doctors

  • multiple care coordination programs for chronic patients

  • high-risk patient clinic and emergency diversion programs

He concludes, “We would like to see more independent physicians in each market because of what we can offer our patients.

4. How did the “whole risk” model and value-based care create better access for patients?

Through its partnership with Agilon Health, Premier Family Physicians (Texas) has been able to strengthen its business, especially for senior patients, by adding new practices (which are “convenient” and “close to where people live” ) and by hiring new doctors. In the past, Dr Spencer has stated that it takes “a few months or more for a new Medicare patient to be seen … we can now see a new Medicare member in less than two weeks.” Dr Spencer has also observed improvement in prevention services, including well visits and vaccination rates. “Access is essential,” says Dr Spencer.

5. How has the agilon health partnership helped your practice reach underserved communities and achieve health equity?

Dr Keisha Jarrett, a family doctor at Wilmington Health in North Carolina, shared some interesting statistics: 59 million people in the United States live in areas where there is a shortage of health care providers, and 43% agilon en santé partner firms are in some of these areas. “We are constantly growing,” she said, noting the increase in the retiree population in the region. “We provide a lot of after-hours care” and “try to reach as many of these patients as possible.”

Other examples:

  • Wulf (Ohio): “agilon has given us the opportunity to invest in our own community to provide better care to those in need”, noting that they have established two clinics in low income and high need areas .

  • Spencer (Texas): A struggling rural practice of seven providers in two poor locations has been integrated into Premier Family Physicians. “They had no infrastructure to manage telemedicine care, transition of care, emergency diversion… and so now these patients are in this community and are now receiving care.”

  • Civitarese, Pennsylvania: During the COVID-19 pandemic, a drive-through clinic was opened for patients who did not have access to computers or smartphones. When a patient arrives, a staff member brings an iPad into their car, allowing them to virtually connect with their doctor.

6. Why is independent primary care so important and how can independent practices be supported?

“The good thing about partnering with Agilon Health is that we have support, both financial and professional, but also that our doctors feel like they’re doing something and that they are empowered and empowered. makes the potential to transform care within the healthcare system, “says Dr Civitarese (Pa.). He explains that doctors can only see patients three or four times a year for 20 to 30 minutes, but the rest of their life is spent outside the examination room.

“That’s the beauty of this model… we can now reach out to them with programs that are outside the four walls of our exam room, and ultimately we believe they will improve and have an impact on them. care they provide as well as their results. It was an “exhilarating experience,” he adds.

To view the full webinar, Click here.

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