“The new year stands before us, like a chapter in a book, waiting to be written. We can help write that story by setting goals.” Melody Beatty (writer)
I’ve spent nearly thirty years in the healthcare industry, and I’m still amazed by the tremendous changes we continue to see and excited by the opportunities in front of us. 2017 was no exception. The new administration in Washington made substantial changes to programs impacting physicians; we continued to see large-scale consolidation among many of the organizations that drove innovation in prior years and at which many of our colleagues honed their skills; and we saw an organization that managed risk on behalf of physicians in our own backyard significantly stumble because of a lack of control over critical functions.
All these changes reaffirm our opportunity to be a leader in this industry. The privilege of partnering with primary care providers and empowering them, through people, process, and technology, to take control over the delivery of healthcare is ours. It has been entrusted to us by our partners in the physician community and our colleagues in the payer community. But it is a privilege that we must continue to earn every day. We have an opportunity to succeed where many others have failed. We have an opportunity to build on the success of many predecessor organizations. We have the opportunity to help transform care delivery across the country for Seniors and Medicaid patients. We made great strides toward that goal in 2017 and we’ve made even more ambitious plans for 2018.
Like the New Year’s tradition of personal resolutions, our senior management team and I have made significant commitments to our Board of Directors and each other for 2018. Achieving these goals will require a focus on operational excellence across all capabilities of our organization. Our 2018 agilon health commitments include:
- Successfully serving a growing number of primary care physicians across four states;
- Enabling them to better care for more than 750,000 patients;
- Achieving exemplary performance in our quality metrics and severe and chronic condition identification and management program (15% projected improvement in HEDIS measures; 57% growth in annual wellness visits in HI, 90% AWV compliance rate in OH, and 4 Star quality across all MA networks);
- Standardizing our operating technology platform, processes and procedures around utilization management, customer service, credentialing and claims processing functions to achieve world-class provider and member satisfaction;
- Demonstrating that our medical management capabilities can transform care for our members and at the same time enhance the sustainability of our health care system.
Perhaps most importantly, for the first time ever, we are setting these goals and commitments as ONE team. I am excited to chart a new path forward as a unified organization working to transform healthcare delivery across the communities we serve. Together, we have the opportunity to build a truly special organization.
What’s most promising about our goals for 2018 is that we have a tremendous head start. Exceptional work throughout the organization during 2017 positions us well to deliver on these promises. I thank all of you for your steadfast dedication and your continued service to our physician partners and their patients. For example, the implementation of MDX Hawaii, Sequoia Health IPA, and COPC Senior Care Advantage on the new CORE technology system and our launch of enterprise operations in Anaheim lay the groundwork for furthering the move to the enterprise operating platform across the California market in 2018.
Similarly, the 2017 work the team did on enhanced quality program performance provides a glide path to 2018 success. Despite industry averages for quality improvement which hover at 3%, the Corona-based quality team, with close collaboration from Enterprise-based leaders, closed nearly 15% more gaps in care for IEHP patients than the prior year. Take pride in knowing we closed 50% more gaps in retinal eye exams for our diabetic patients compared to the prior year. This is a remarkable accomplishment and fuels improved relationships with both IEHP and our primary care physicians. We are also deeply proud of the work our Hawaii and Ohio healthcare quality teams led around our Burden of Illness program. This translated into a ~60% and ~20% growth in annual wellness visits, respectively, for our senior members, which enables our physicians to provide more attention and care to those patients that need it most.
Our challenge for 2018 is to take this management focus and rigor and bring that to all members throughout our markets.
Like the structure which supported excellence in Quality and Burden of Illness performance for 2017, Enterprise-based leaders will closely work with market-led functions for the medical management, provider relations, data and analytics, and finance to ensure sharing of best practices, expeditious resource deployment, and reporting consistency.
Foundational to future growth is achieving world-class excellence in key functions which significantly impact our physician partner’s experience with agilon health, including utilization management, customer service, and claims processing. As such, we have made the decision to centralize management for these functions across the Enterprise and will be repositioning the teams in Hawaii and California to report to new leaders. As part of the planning for these centralized Enterprise services (eMSO), management has made the commitment to achieve:
- 25% improvement in claims turnaround time and payment accuracy
- Improve and streamline referral authorization process and turnaround time
- Increased satisfaction levels and call resolution rates in customer service
In addition to changes in reporting structure, several departments currently based in Corona and Long Beach will be relocating to the Anaheim office to accommodate expanded resources in Corona to support the significant growth in members secured by the California provider relations team over the last two months. Also, the technology team supporting the CORE & HCC Manager application will be relocated to Anaheim as part of our efforts to advance our technology delivery excellence.
In closing, I hope you all embrace the changes we are implementing throughout the organization to improve our ability to add sustainable value to the health care delivery system. We are on track to double the size of agilon health by the end of 2018. In addition to exceptional growth, I look forward to sharing stories of operational success & human impact with you throughout the year, stories that highlight our enhanced ability to quickly and accurately process referral requests, get our providers paid timely and accurately, and answer customer questions with one call.
I look forward to sharing the success of the Hawaii team’s Emergency Room utilization reduction program and the results of the Ohio team’s innovation in SNF care. I know these efforts will translate into improved confidence from our health plan partners and provider customers. And at the end of the day, I know our progress will lead to more professional fulfillment for each of us as we re-imagine and transform healthcare together.