Our Culture of High Integrity and Compliance

As part of our ongoing work to centralize and standardize our claims payment operations into a single, high-functioning department, we identified practices in the claims audit processes of our legacy California operations that require remediation.  We immediately, and without hesitation, disclosed these claims issues to the California Department of Managed Health Care (DMHC) and our plan partners in February 2018 and engaged outside experts to conduct a thorough investigation.  This voluntary self-disclosure reflects our singular commitment to compliance and our integrity as leaders in care delivery.

Since then, we have met in person with DMHC, completed our claims process investigation, taken steps to fully remediate those processes and have supported numerous health plan audits.  We remain committed to our physician partners and members in California and continue to make significant progress in the implementation of our new MSO, and quality systems in the California market. These initiatives include:

  • The appointment of highly experienced leadership at the MSO;
  • The implementation of enhanced controls and management oversight of our legacy system;
  • The adoption of an accelerated timeline for the movement to CORE, our new operating system; and
  • Visits to over 100 primary care providers in May, which featured the delivery of comprehensive quality program toolkits that were well received across the board.

As of today, some audits are on-going and we are actively engaged in constructive and transparent remediation efforts with our contracted health plan partners.  Just as we have promised to do with the DMHC, we will keep you fully updated on our progress toward full remediation of all audit issues.

We are particularly grateful for the opportunity to continue to collaborate in California with Aetna, Anthem Blue Cross, Blue Shield, Brand New Day, Care1st, Health Net, Humana, and Molina.  We value these relationships and look forward to many years of successful collaboration with these plans in service to their members.  As some of you may know, however, IEHP has decided to terminate our contract effective August 31, 2018.   We regret that IEHP has felt it necessary to take this action, but our first concern is that we minimize adverse impacts on the members.  We are committed to work collaboratively with IEHP on its block transfer process and to ensure continuity of care.

I would like to recognize and thank the California team for their tireless commitment to our physician partners and members.  We know many of our employees live in the Riverside and San Bernardino communities we serve and are honored to be serving their neighbors, friends, and families. We all hold that trust and responsibility in high regard.

And while strength in California remains critical and is a testament to our history, the future of agilon health is also defined by our growing network of providers and members in Hawaii, Ohio, and Texas as well as new markets yet to come.  Today, we collaborate with approximately 1,000 primary care physicians outside of California who are partnering with us to care for over 65,000 Medicare Advantage members.  We continue to build our organization across the country to fulfill our promise of higher quality, more connected care for our partners and members across the country.





2018-06-06T01:31:50+00:00 June 6th, 2018|

Protecting a Reputation of High Moral and Ethical Standards

“A good reputation is hard-won and easily lost. But the lost reputation has invariably been given away by the actions of the holder, rather than been taken away by somebody else.”
– C. Beveridge

In a very short period of time, agilon health has established and enjoys a very positive reputation across our industry.  This reputation rests on all of our shoulders and is the direct result of the good work we all do day in and day out.  In these holiday months when we are reminded of all of our blessings and show our appreciation to those who mean so much to us, I want you to know that I feel it is a privilege to work with you on such an important endeavor and I thank you for your commitment to agilon health.  Your hard work and relentless pursuit of enabling our physicians to provide high quality and efficient health care to our members have already brought us very positive recognition at a national level.  Our reputation influences so many aspects of our company – the way our physician customers and partners value our services; whether or not health plans choose to contract with us and entrust their members to us; how regulators perceive us; and whether employees find agilon health a fulfilling place to work.  A strong reputation will fuel growth and future success.  We should not take it for granted.  Therefore, it is important for all of us to protect our reputation through a strong culture of integrity and ethical conduct.

As part of our evolution as a high performing organization which brings people, solutions, capital, and technology to enable primary care physicians to achieve long-term success, we have recently adopted a Code of Conduct that applies to all of us.  All employees of agilon health are responsible for knowing the Code of Conduct and for abiding by high legal, ethical and moral standards.  Every employee of agilon health is also required to be familiar with and comply with all federal and state laws, rules, and regulations that govern their role within the organization. If you are unfamiliar with what those rules are, it is your obligation to ask.  Not knowing the rules, or turning a blind-eye into activities you are not comfortable with is not acceptable and violates our Code of Conduct.

Whether you work in California, Hawaii or Ohio and no matter what your contributions and responsibilities are within the organization, we are all accountable for upholding these principles and behaviors in accordance with the highest of ethical and legal standards. Our Code of Conduct obligates us to avoid any conduct that even raises the appearance of impropriety and to hold ourselves to even higher ethical standards than the legal rules require.  It is also important that we recognize that breaches of the Code of Conduct will be taken seriously.

The Code of Conduct is now available on the agilon health website by clicking here.  In addition, all managers will receive a copy of the Code of Conduct and are expected to review it with their teams in December.  Given the importance of the Code of Conduct to all of us and the way that we do business, I trust you will read it with due care and attention. If you have any questions, are unsure about a particular policy or compliance issue, or believe, or even are just uncertain whether the Code of Conduct has been broken by anyone in the organization we urge you to speak to your supervisor or call the Compliance Hotline at 833-668-8638.  Asking questions and raising issues helps make us all smarter and more effective.  With your help, I am confident that our reputation will be upheld long into the future.


2018-02-26T21:15:12+00:00 December 15th, 2017|

agilon health In The News: agilon health Receives National Media Attention for the Quality Improvement Work.

Dangling A Carrot For Patients To Take Healthy Steps: Does It Work?

Patricia Alexander knew she needed a mammogram but just couldn’t find the time.

“Every time I made an appointment, something would come up,” said Alexander, 53, who lives in Moreno Valley, Calif.

Over the summer, her doctor’s office, part of Vantage Medical Group, promised her a $25 Target gift card if she got the exam. Alexander, who’s insured through Medi-Cal, California’s version of the Medicaid program for lower-income people, said that helped motivate her to make a new appointment — and keep it.

Health plans, medical practices and some Medicaid programs are increasingly offering financial incentives to motivate Medicaid patients to engage in more preventive care and make healthier lifestyle choices.

They are following the lead of private insurers and employers that have long rewarded people for healthy behavior such as quitting smoking or maintaining weight loss. Such changes in health-related behavior can lower the cost of care in the long run.

“We’ve seen incentive programs be quite popular in the insurance market, and now we are seeing those ramp up in the Medicaid space as well,” said Robert Saunders, research director at the Margolis Center for Health Policy at Duke University.

Medicaid patients who agree to be screened for cancer, attend health-related classes or complete health risk surveys can get gift cards, cash, gym memberships, pedometers or other rewards. They may also get discounts on their out-of-pocket health care costs or bonus benefits such as dental care.

Under the Affordable Care Act, 10 states received grants totaling $85 million to test the use of financial rewards as a way to reduce the risk of chronic disease among their Medicaid populations. During the five-year demonstration, states used the incentives to encourage people to enroll in diabetes prevention, weight management, smoking cessation and other preventive programs. The states participating were California, Connecticut, Hawaii, Minnesota, Montana, Nevada, New Hampshire, New York, Texas and Wisconsin.

Medi-Cal, for example, offered gift cards and nicotine replacement therapy to people who called the state’s smoking cessation line. Minnesota’s Medicaid program handed out cash to people who attended a diabetes prevention class and completed bloodwork.

An evaluation of these programs, released in April, showed that incentives help persuade Medicaid beneficiaries to take part in such preventive activities. Participants said gift cards and other rewards also helped them achieve their health goals. But the evaluators weren’t able to show that the programs prevented chronic disease or saved Medicaid money. That’s in part because those benefits could take years to manifest, according to the evaluation.

Overall, research on the effectiveness of financial incentives for the Medicaid population has been mixed. A report this year by the Center on Budget and Policy Priorities found that they can induce people to keep an appointment or attend a class but are less likely to yield long-term behavior changes, such as weight loss. And in some cases, the report said, incentives are given to people to get exams they would have gotten anyway.

The center’s report also found that penalties, including ones that limit coverage for people who don’t engage in healthful behaviors, were not effective. Instead, they can result in increased use of emergency rooms by restricting access to other forms of care, the report said.

Some of the biggest factors preventing Medicaid patients from adopting healthful behaviors are related not to medical care but to their circumstances, said Charlene Wong, a pediatrician and health policy researcher at Duke University.

That makes administering incentive programs more complicated. Even recruiting and enrolling participants has been a challenge for some states that received grants through the Affordable Care Act.

“The thing that is most likely to help Medicaid beneficiaries utilize care appropriately is actually just giving them access to that care — and that includes providing transportation and child care,” said Hannah Katch, one of the authors of the report by the Center on Budget and Policy Priorities. Another barrier is being able to take time off work to go to the doctor.

But health plans are eager to offer patients financial incentives because it can bring their quality scores up and attract more enrollees. And medical groups, which may receive fixed payments per patient, know they can reduce their costs — and increase their profits — if their patients are healthier.

Providing incentives to plans and medical groups has created a business opportunity for some companies. Gift Card Partners has been selling gift cards to Medicaid health plans for about five years, said CEO Deb Merkin. She said health insurers that serve Medicaid patients want to improve their quality metrics, and they can do that by giving incentives and getting patients to the doctor.

“It is things like that that are so important to get them to do the right thing so that it saves money in the long run,” she said.

Agilon Health, based in Long Beach, Calif., runs incentive programs and other services for several California medical groups that care for Medi-Cal patients. The medical groups contract with the company, which provides gift cards to patients who get mammograms, cervical cancer exams or childhood immunizations. People with diabetes also receive gift cards if they get their eyes examined or blood sugar checked. And the company offers bonuses to doctors if their Medicaid patients embrace healthier behaviors.

The incentives for patients are “massively important for the Medicaid population, because the gaps in care are historically so prevalent,” said Ron Kuerbitz, CEO of Agilon. Those gaps are a big factor pushing up costs for Medicaid patients, because if they don’t get preventive services, they may be more likely to need costlier specialty care later, Kuerbitz said.

Emma Alcanter, who lives in Temecula, Calif., received a gift card from her doctor’s office after getting a mammogram late this summer. Alcanter, 56, had noticed a lump in her breast but waited about two years before getting it checked, despite reminders from her doctor’s office. “I was scared they were going to find cancer,” she said.

Alcanter finally decided to get screened after her first grandchild was born. The gift card was an added bonus, and Alcanter said it showed her doctors cared about her. Her mammogram revealed that the lump wasn’t cancer, and she plans to use the gift card to buy a present for her grandson.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

2017-12-13T19:05:19+00:00 December 5th, 2017|

agilon health Expands Into Five Markets Through Innovative New Joint Venture Partnerships. Company Empowers Physician Partners to Win in Value-Based Care Through a Complete Integrated Operating Platform.


LONG BEACH, CA – agilon health of Long Beach, California, a year-old company founded by world-class health care leaders, is helping U.S. physicians manage the leap from fee for service to value-based health care.  Recognizing the increasing pressure on physicians caused by the existing healthcare system, agilon health has created a complete operating platform for value-based healthcare that brings people, process, and proprietary technology together in partnership with physicians to take responsibility for total healthcare spend.  The company has now expanded its operations to leading positions in five U.S. markets.

agilon health was founded in 2016 by Clayton Dubilier & Rice, one of the nation’s leading private equity firms.  The agilon health team includes Chairman Ronald A. Williams, formerly Chairman & Chief Executive Officer of Aetna, and CEO Ron Kuerbitz, formerly Chief Executive Officer of Fresenius Medical Care North America.  

Building upon a model of establishing anchor positions in key markets, agilon health has entered Central Ohio through a joint venture with Central Ohio Primary Care Physicians (“COPC”), the nation’s largest independent, physician-owned primary care medical group.  This pioneering model, called COPC Senior Care Advantage, supports comprehensive care in Central Ohio with a full risk model for over 20,000 Medicare Advantage members across multiple payers. agilon health’s proprietary technology-enabled clinical and administrative operating system will support the partnership’s ability to accept and manage this comprehensive care full risk model for Medicare Advantage patients in the Central Ohio geography.

In the Central Valley of California, agilon health formed Sequoia Health, a new risk-bearing partnership with Golden Valley Health Centers, one of central California’s largest non-profit networks of community clinics that provides care to thousands of underserved patients through California’s Medicaid program.  This new venture provides Golden Valley Health Centers the opportunity to direct not only the care their providers personally perform, but also to assume responsibility for coordinating all care and quality initiatives for their patients.  It positions Golden Valley Health Centers to expand access to primary and specialty care services in additional underserved communities.

These recent partnerships expand upon agilon health’s efforts to both improve and accelerate the growth of risk-based models of care in geographies across the country through the introduction of a complete operating platform for risk.  Beyond the Central Valley of California, agilon health has established positions in southern California and Fresno with significant investments in partnerships with leading local IPAs.  In greater Southern California these partnerships serve more than 390,000 Medi-Cal, including through the Vantage Medical Group.  In Fresno, agilon health is implementing its operating model through First Choice Medical Group, which serves over 70,000 Medi-Cal members and 7,000 MA members.  In Hawaii, agilon health, operating as MDX Hawaii, operates a full risk model to provide care to more than 28,000 MA members.  This full risk model is the first of its kind in Hawaii and enhances the value that MDX Hawaii currently provides to physicians, patients, and health plan partners.    

“Our mission is to be a great partner to physicians, whose pivotal role in improving care quality and efficiency puts them on the front lines of the transition from fee-for-service to high quality, sustainable value-based healthcare,” said Ron Kuerbitz, chief executive officer of agilon health.   “We know from experience that it is virtually impossible to effect a piecemeal migration out of fee for service care models and that even large, well-organized physician groups have a hard time making the full leap into value-based care.  By providing industry experience, process, technology platforms, capital and a value-based infrastructure, we are able to help them make the transition, and enable doctors to expand the capabilities they need to ensure the right care for each patient at the right time. My team at agilon health is driven by the opportunity to reduce physician burnout and to help physicians rediscover the joy of practicing medicine.”

Physicians from many of the U.S.’s largest medical groups have joined agilon health to help physicians improve quality and the patient experience.   “As a physician-led organization, our goal is to put the patient’s needs first and foremost, and our partnership with agilon health positions us perfectly to enhance the great care we have historically provided to our Medicare Advantage patients,” said William Wulf, M.D., chief executive officer of Central Ohio Primary Care Physicians.

“We are in the process of expanding to other markets in the U.S. based on our unique physician-centric partnership model tailored for each local area,” said Ronald A. Williams, chairman of the board for agilon health. “The growth in risk-based models driven by growth in government lives such as Medicare and Medicaid, and pervasive physician dissatisfaction with the current system is creating a need to reinvent local health care delivery systems through aligned partnerships,” he said.  “We are finding that our partner physicians are very pleased to be able to expand their focus on comprehensive management of patient care with a partner to help manage the complex business of health care financing and administration.”

Based in downtown Long Beach, California, agilon health has expanded its operations in Honolulu, Hawaii and Corona, California, with newly opened offices in Columbus, Ohio, Fresno, California and Anaheim, California to support its growth.  In total, agilon health, with a staff of more than 500 professionals, is currently serving 1,800 primary care physicians, caring for more than 500,000 patients in five markets.

2017-11-07T17:10:13+00:00 November 1st, 2017|

Golden Valley Health Centers Launches Sequoia Health, a New Populations Health Management Joint Venture, with agilon health.


Transformative Joint Venture with agilon health enables Golden Valley Health Centers To Focus on Prevention and Highly Coordinated Clinical Care and Access New Payment Model


Merced, CA (November 1, 2017) – Golden Valley Health Centers (GVHC), one of central California’s largest non-profit network of community health centers that provide care for thousands of underserved patients, has partnered with agilon health of Long Beach, California, to launch Sequoia Health, a new entity that will allow GVHC and other high-quality providers to offer a provider-led, value-based, population health program that improves access and quality care for the patients they serve.

Serving more than 150,000 patients through its network of 29 clinics, GVHC is one of the largest medical providers to Medi-Cal patients in the Central Valley. GVHC will continue to operate as it always has and the brand will not change. Sequoia Health will enable GVHC and other providers to participate in a population health program by providing contracting, data collection and management, care coordination, clinical programs and administrative services.

The nation’s health care system continues to transition from the fee-for-service model that rewards the volume of services a provider delivers, to a more value-based approach. Organizations like Sequoia Health, which offer risk-bearing population health programs that provide efficient coordinated clinical care and expanded access to high-quality care for vulnerable populations, allow providers like GVHC to stay ahead of the curve.

“Sequoia Health is a unique partnership with agilon health that will create a new footprint in how we expand and serve our patients,” said Tony Weber, Chief Executive Officer of GVHC, which is headquartered in Merced. “This new model puts the patient at the center of our clinical care model, with our dedicated care teams working side-by-side to ensure that each patient gets the appropriate care at the right place at the right time. This is an exciting new model for GVHC because it allows us to direct locally the dollars that are spent on the right care to meet the needs of our community. Moreover, it will allow us to recruit additional high performing providers and add more resources to improve access to high-quality care. “

GVHC’s partner in Sequoia Health is agilon health, a Long Beach, California-based company that serves nearly 500,000 Medi-Cal members, is investing capital and bringing resources in technology-enabled clinical, operational and administrative expertise that help independent organizations like GHVC to transition into value-based health care. “In Golden Valley Health Centers, we found a like-minded partner which has a rich history of providing great medical, behavioral, and dental care to the underserved,” said Manoj Mathew, MD, agilon health’s Market President for California. “GVHC is an ideal partner to embrace a transformative payment model which puts overall control for patient care back into the hands of physicians and care teams. Patients will benefit greatly with a focus on prevention and highly coordinated clinical care.”

The concept of highly coordinated care is effectuated through efficient processes, systems, and data that enables intense collaboration between doctors, nurses, assistants and other allied health care team members such as social services and specialists among others. In a population health model, preventive care is the flagship focus.

“This new partnership will allow Golden Valley Health Centers to expand existing efforts to provide high-quality cost-effective care to our patients. Through increased focus on clinical metrics such as childhood immunizations, age-appropriate well-child visits, preventative care screenings for breast and colon cancer as well as improved focus on the care of chronic diseases such as diabetes and hypertension, Sequoia Health will improve not just the care of our individual patients but of the entire community” said Ellen Piernot MD, MBA, Chief Medical Officer for Golden Valley Health Centers.

“Through GVHC’s participation in Sequoia Health, our team is responsible both financially and clinically for the health of each patient. Sequoia Health will partner with us to develop local programs to ensure higher quality health care, including programs that prevent people from needing emergency room care and help them remain independent in their homes. We value the trust our partners have shown in our ability to improve the health status of our communities,” added Weber.

In its launch, Sequoia Health has contracted with Health Net, a large California health plan that provides and administers health benefits to many Medi-Cal enrollees, as its first partner in this new model.

For more information, click www.SequoiaHealthIPA.com


2017-11-14T23:58:44+00:00 November 1st, 2017|

Introducing COPC Senior Care Advantage, the joint venture between Central Ohio Primary Care Physicians and agilon health

October has been a tremendous month, in which we together delivered very tangible accomplishments across the organization. These ongoing achievements, that I have the pleasure of highlighting each month, don’t belong to any individual. Rather they are the product of the good work all of you perform together each day. A reputation of enabling high-quality care, efficient processes, and speed to execution is critical to our ongoing success. I thank you for the strength of our reputation we are building on each day. We should all thank the teams that are striving to respond to customer calls faster than we’ve ever done before, focusing on processing referral authorizations with increased precision, and ensuring our physician partners receive timely and accurate payment for the good work and services they provide our members. These are the activities that build a strong, durable and admired organization and provide a reputation that enables future success.

This month’s focus is deservingly directed toward the newest agilon health market: Columbus, Ohio. Over the course of the last ten months, the local market team collaborated with enterprise-based colleagues in Long Beach, Corona and now Anaheim, to develop an operational and clinical model designed to transform the healthcare delivery system and launch an innovative new program called COPC Senior Care Advantage.

It is with great pleasure that I announce the launch of COPC Senior Care Advantage, the joint venture between Central Ohio Primary Care Physicians, the nation’s largest independent, physician-owned primary care practice and agilon health. COPC Senior Care Advantage is a new population health management program designed to improve the quality, value, efficiency, patient experience and outcomes for COPC’s Medicare Advantage patients. It is made possible through risk-based agreements with Aetna, Anthem, Humana, and MediGold, all of which were signed in the last four weeks. Executing risk-agreements, in a market that is unaccustomed to the healthcare delivery models we all take for granted in California, is no easy feat, even with the support and commitment of an incredible partner in COPC. Please join me in recognizing the contracting team that has paved the way for transforming the central Ohio market:

Market-based team
Ben Shaker, Ohio Market President
Mary Cook, MD, Ohio Market Medical Director
William Wulf, MD, CEO Central Ohio Primary Care Physicians

Enterprise team
Elizabeth Russell, Chief Payment Transformation Officer
Myong Lee, VP HMO Contracting
Ted Halkias, Chief Financial Officer
Maria Adams, Consultant
Katie Kauachi, VP, Payor Contract Analysis

I can’t underscore enough the importance securing these risk-based contracts in Columbus, Ohio holds for the future of our organization. Bringing new payment models to communities across the country will fuel the transformation of the delivery system and enable physicians to bring the right care to each patient at the right time. I know you all are motivated by this promise like I am. I invite you to enjoy a short, inspiring, video clip featuring Dr. Wulf and a COPC patient who has joined us in celebrating the launch of COPC Senior Care Advantage on a local news station by clicking here




2017-10-30T19:27:39+00:00 October 30th, 2017|

Central Ohio Primary Care Physicians and Area Medicare Health Plans Partner Through COPC Senior Care Advantage To Launch New Population Health Management Model to Revolutionize Care for Medicare Members in Central Ohio

COPC Senior Care Advantage Will Focus on Prevention and Highly Coordinated Care delivered through a Team of Experts to Improve the Health and Wellness of Medicare Advantage Patients in a Value-Based, Population Health Model.

To revolutionize the care it provides its Medicare Advantage patients, Columbus-based Central Ohio Primary Care (COPC), the largest physician-owned independent primary care medical group in Ohio and the largest in the U.S., has entered into an agreement with local and national Medicare Advantage plans through COPC Senior Care Advantage, a new population health management program designed to improve the quality, value, efficiency, patient experience and outcomes of Medicare Advantage patients.

COPC Senior Care Advantage will commence transforming care for Medicare Advantage patients beginning in January of 2018, thanks to new population-health based contracts with all Aetna Medicare Plans (HMO/PPO), Anthem Mediblue Dual Advantage, Anthem Mediblue Access, Anthem Mediblue Access Enhanced, Anthem Mediblue Access Core, Anthem Mediblue Access Basic, Humana Gold Plus HMOs and HumanaChoice PPOs, MediGold Classic Preferred (HMO), MediGold Essential Care (HMO), MediGold Flexible Choice (PPO) and MediGold Medical Only (HMO). COPC is also contracted with other Medicare Advantage plans through legacy agreements.

“As a physician-led organization, our goal is to put the patient’s needs first and foremost, and this program by COPC Senior Care Advantage will enhance the great care we have historically provided to our Medicare Advantage patients,” said William Wulf, M.D., chief executive officer of Central Ohio Primary Care Physicians, which has more than 350 providers and 62 practice locations throughout central Ohio. “This new model will be coordinated care on steroids,” said Dr. Wulf, a long-time advocate for value-based care. “COPC Senior Care Advantage is an innovative population health model designed to provide higher quality, more efficient care for local Medicare Advantage patients,” said Ben Shaker, President of COPC Senior Care Advantage. “Through this collaboration with COPC, we are taking the value-based model to a new level of health and wellness by focusing on prevention and highly coordinated clinical care.”

By partnering with like-minded Medicare health plans, COPC Senior Care Advantage will be accountable for improving the health care of COPC’s Medicare Advantage patients. Under this model, the physicians at COPC will coordinate all of the care for enrolled members, including primary care, specialists, major local health systems and hospitals, laboratories and all of the ancillary services necessary to improve the health status of such members. They will also engage in advanced data analytics to support clinical decisions, ensuring that the appropriate care is delivered at the right time and place.

“We believe that more efficient care is possible if physicians assume both clinical and financial responsibility for patient care. By having robust data and increased resources at their fingertips, COPC physicians will be better able to deploy highly integrated, prevention-oriented care. Better outcomes are possible when innovative clinical programs are supported by actionable and timely data,” said Ben Shaker.

The COPC Senior Care Advantage program is designed to allow COPC physicians to spend more time with their patients. “Taking care of senior patients is more complicated than ever before given the prevalence of chronic illness among this population. Through this new arrangement, COPC Senior Care Advantage will be supporting COPC physicians with case managers, social workers, nurses and quality assurance staff,” said Dr. Wulf. “The purpose is to allow our doctors to spend more time with patients, providing support, counseling and prevention services to help patients remain independent and improve their health.”

Across the country, health care officials are seeking ways to change the health care system from one that rewards the volume of services doctors provide to one that rewards high quality and value. The goal is to offer better quality care and save money by providing the right level of care at the right time with a focus on prevention. If patients are healthier, they are less likely to need expensive hospitalization or emergency care.

“This is an innovative approach to medical care for seniors, one that would benefit our members for years to come,” said Michael Vincent Smith, MD, FACC, FACS, FCCP, Regional Vice-President, Medical Director, Central Region Medicare, Anthem, Inc., one of the Medicare Advantage plans partnering with COPC Senior Care Advantage. “This new partnership has the potential to improve health outcomes and keep costs down for both members and health plans, particularly for those members who suffer from such prevalent chronic illnesses such as congestive heart failure, diabetes, COPD and hypertension. We are very excited to be a lead partner in this new model of care for our Medicare Advantage members.”

After more than a year of planning and staff additions, COPC Senior Care Advantage brings together multiple health care providers and health plans under a program dedicated to transform the health and wellbeing of Medicare Advantage members in the greater central Ohio area. The COPC Senior Care Advantage program through COPC will be available beginning January 1, 2018 for all Medicare Advantage members of participating health plans. For more information about COPC Senior Care Advantage, please visit www.COPCseniorcareadvantage.com

2017-10-23T16:28:31+00:00 October 23rd, 2017|

William Wulf, MD, agilon health board member and CEO of Central Ohio Primary Care Physicians, is one of esteemed speakers featured in an upcoming CAPG webinar on MACRA


agilon health board member and CEO of Central Ohio Primary Care Physicians (COPC), Willam Wulf, MD is one of the esteemed speakers featured in an upcoming CAPG webinar on MACRA (Medicare Access and CHIP Reauthorization Act).  COPC, the largest independent and physician-owned primary care practice in the country and partner with agilon health in a new healthcare delivery model in Columbus, Ohio called COPC Senior Care Advantage, is navigating the complexity of MACRA by not only participating in CPC Plus, which is recognized by CMS as an Advanced Alternative Payment Model which qualifies COPC for the preferential APM track within MACRA, but they are also focusing on growing the number of their patients in Medicare Advantage plans, thereby reducing their exposure to changes in traditional Medicare reimbursement. COPC Senior Care Advantage provides COPC patients a compelling alternative to traditional Medicare coverage and is made possible by the innovative payer agreements agilon health and COPC executed with the leading insurance plans in the market.

COPC Senior Care Advantage is a new program for patients covered by the Medicare Advantage plans from Aetna, Anthem, Humana and MediGold in Central Ohio, which expands the cooperation and coordination between COPC and these insurance companies*. COPC Senior Care Advantage is not a new Medicare Advantage plan.  Rather it is a new program that allows patients the flexibility to choose a health plan from four participating insurance companies and still have access to the same innovative care program COPC and agilon health have designed to enhance access to wellness and health education services, as well as care coordination resources.  It provides patients the best of both worlds – flexibility in choosing their benefits from any one of the health plan partners and at the same time consistent access to this new program at COPC.  COPC Senior Care Advantage will begin on January 1, 2018. 

2017-10-06T17:09:57+00:00 October 5th, 2017|

agilon health CEO, Ron Kuerbitz, Celebrates a Milestone at MDX Hawaii and Commitment to Collaboration


I am heartened to again showcase significant success in moving agilon health forward through collegial and effective collaboration between our market-based teams and resources in our Long Beach office. The team at MDX Hawaii is well-deserving of this month’s spotlight.

Over the course of the Labor Day weekend, the team at MDX Hawaii, directed by the tremendous leadership of Bill Farry, were the first to transition to our new CORE platform. By all accounts, the implementation was a resounding success, and could not have been possible without significant contributions from many colleagues in Honolulu, Long Beach and beyond. MDX Hawaii has paved the way for the remainder of our markets to transition to the CORE operating system over the next few months, which is critical to the ongoing success of our organization. I want to personally thank everyone involved in this significant achievement and for the commitment to collaboration across the organization you demonstrated with this success. While the entire MDX Hawaii team and many, many other colleagues supported the implementation, I would be remiss to not publicly acknowledge several key leaders, including:

Hawaii-based team
• Leah Kamalu was our claims champion throughout the process and led the effort to drive improvements and overall claims related functionality.
• Letty Lian-Segawa was our utilization management champion throughout the implementation. Letty led the efforts to drive and test improvements in UM workflow and processing functionality.
• Myra Wong demonstrated an unflappable commitment to the details! In addition, she ensured we leveraged new capabilities to support configuration.
• Renerose Peralta worked tirelessly and combined her expertise in legacy system functionality, business requirements and reporting with CORE functionality and improvements.
• Trisha Loo wore several hats throughout the process by initially leading compliance-related development and then stepped up to assist with overall project management.

Long Beach/Other teams
• Darren Braun is our indispensable developer and key knowledge expert on the legacy and future functionality capabilities.
• Gail Walker jumped in to focus on EDI and Imagenet implementation efforts.
• Ruby Nicolas provided claims domain subject matter expertise and supported system upgrade and testing.
• Virginia Mungia provided application domain subject matter expertise and supported system upgrade, configuration, and testing.
• The technology team deserves special recognition for getting the Las Vegas data center stood up and operational to support the launch of CORE in Hawaii.

In addition to the tremendous collaborative effort to launch CORE, I want to note other key points of collaboration between MDX Hawaii and the agilon health corporate team. Over the past few weeks, we’ve seen an encouraging increase in the number of annual health assessments performed through our Burden of Illness program in Hawaii. MDX Hawaii medical leadership provided by Dr. Desai and Dr. Uytingco, coupled with the dedication of the entire Healthcare Quality team, Provider Network Operations team along with data analytics, communications, and operations excellence support from Long Beach has resulted in over 8,600 annual health assessments performed so far this year. I appreciate the continued focus on these important efforts and encourage you all to continue to collaborate and innovate to meet our organizational goals.
Sharing these bright spots of collaboration with you from across the organization is one of the privileges I enjoy most. I hope you find them valuable in thinking through the opportunities we have in all of our markets to support our primary care physician partners in improving the health and well-being of our members.

2017-11-06T22:32:11+00:00 September 30th, 2017|

agilon health, a New Healthcare Services and Technology Company, Formed at the Forefront of Value-Based Healthcare

Partnering with Physician-Centric Organizations to Implement Next Generation Value-Based Care Delivery Systems That Improve Care Quality and System-wide Economics

Platform Currently Managing Over 475,000 Patients in Multiple Geographies Expects to Expand Nationally Supporting Medicaid, Medicare and Commercial Populations

Management Team Includes World Class Healthcare Operating Talent



Long Beach, Calif., October 4, 2016 – agilon health, a healthcare services and technology company aiming to accelerate the conversion to value-based healthcare, announced its formation today. The company brings together established value-based healthcare delivery systems, physician risk enabling infrastructure, and proven operating talent from across healthcare. The combination of these capabilities and a unique partnership-centric approach offers providers on a national basis the opportunity to successfully transition to risk-based business models.

agilon health empowers physicians and other providers with the clinical, technological and administrative capabilities to function effectively in a healthcare system undergoing a structural shift to a compensation model based on outcomes, rather than traditional fee-for-service, and to capture the inherent opportunity in bearing global financial risk associated with improving patient outcomes and lowering system costs. agilon health, through its value-based delivery systems, has a strong track record operating in multiple capitated markets, currently managing more than 475,000 patients through a network of more than 1,500 primary care physicians and 8,000 specialists. agilon health’s partnership solution includes information and support systems, data analytics and sophisticated medical management infrastructure to support physicians across the risk spectrum, from professional capitation to full capitation. Ronald A. Williams, former chairman and chief executive officer of Aetna, is agilon health’s chairman.

“Our mission is to be a great partner with physicians, whose pivotal role in improving care quality and efficiency puts them on the front lines of the transition to value-centric healthcare,” said Mr. Williams. “We have the specialized capabilities and clinical, administrative and technological infrastructure necessary to help providers navigate this transition.”

“We believe our innovative model improves quality, reduces cost, satisfies providers and engages patients, adding up to a system of care that any of us would want for our family and friends, all while transforming the physician economic model,” said Dr. Stuart Levine, Chief Medical and Innovation Officer for agilon health.

“In a very real way, agilon health is helping to revive the joy of practicing medicine by providing physicians with the opportunity to participate in a next generation care delivery system that allows them to focus more on quality of care and less on volume of activity,” said Dr. Manoj Mathew, agilon health’s National Medical Director.

Core to the company’s relationships with physicians are its integrated clinical, administrative and financial solutions, specifically built for the delegated physician risk market. Initially developed in 1996 by Gerry Ibanez, who remains a senior executive at agilon health, the company’s proprietary technology platform currently includes products for Medicare’s STARS program, burden of illness management (HCC), Pay for Performance (P4P), care management and a fully integrated administrative platform that includes claims payment, and is particularly tailored for managing the growing Medicaid, Medicare, Expansion and Duals populations, which agilon health currently serves directly in California and Hawaii.  The technology platform, which is highly portable to new markets, also supports the management of more than 1.3 million patients for numerous well-known third-party providers and health plans across the country.

In California, agilon health has made a significant investment in supporting and enhancing the quality of care delivery in the rapidly growing Medi-Cal market (California’s version of Medicaid). agilon health operates a leading Management Services Organization (MSO) that, along with its affiliated Independent Provider Associations (IPAs), services a patient base of more than 450,000 primarily Medi-Cal members in Riverside, San Bernardino, San Diego, Fresno, and Los Angeles. agilon health’s largest affiliated IPA, Vantage Medical Group (formed in 1993), is the largest independent Medi-Cal IPA in the Inland Empire (Riverside and San Bernardino counties), one of the largest and fastest growing Medicaid communities in the country.

In Hawaii, agilon health is delegated for professional and institutional risk, taking full risk for the management of approximately 24,000 Medicare Advantage patients in exchange for a percentage of the CMS premium. The full risk model developed by agilon health is the first of its kind in the Hawaii market, which has historically been defined by traditional, fragmented and more expensive fee-for-service healthcare. agilon health has been operating in Hawaii since 2003, and, as of today, more than 800 primary care physicians and 2,000 specialists are a part of the agilon health network in Hawaii. agilon health’s unique MSO model relies on its own proprietary clinical and administrative technology applications to support its management of delegated risk.

“I am excited to team up with a strong financial partner like Clayton, Dubilier & Rice (CD&R) and a growing group of operating talent to accelerate investment in the technology platform and unique physician risk infrastructure we have developed to expand our footprint and help transform care delivery nationally at a critical time in healthcare,” said Mr. Ibanez.

“We are in the process of expanding to other geographies based on agilon health’s unique physician-centric partnership model tailored for local market needs. The growth in risk-based models driven by reimbursement changes, growth in government lives, and growing physician dissatisfaction is creating an opportunity to re-invent local healthcare delivery markets through creative strategic partnerships with providers,” said Mr. Williams.

About agilon health

agilon health serves as a partner to physicians and other providers so that they can be more productive and effective in providing high-quality, value-based care. The company is both a management services organization serving more than 475,000 patients through a network of more than 9,500 physicians and a proprietary technology platform that both supports the management of agilon health’s delegated patients and is also offered to third-party provider organizations and payers. The company’s unique mix of technology-based services and clinical capabilities supports physicians serving a diverse mix of patients across multiple geographies, with differentiated expertise managing underserved Medicaid and Medicare Advantage patients. agilon health is also an important partner to payers, other providers and communities, positively impacting access, quality and cost of care for patients. agilon health was initially formed through the combination of leading MSO and technology businesses in California and Hawaii, facilitated by Clayton, Dubilier & Rice (CD&R), an investment firm. Mr. Williams is an Operating Advisor to CD&R’s funds. www.agilonhealth.com.

2017-07-13T18:48:13+00:00 October 4th, 2016|