Five Parts of a Whole
Our Operating System is designed around five core capabilities that work together to ensure the highest quality and most efficient care for the patients that have been entrusted to us. Enabled by our proprietary technology platform and analytics, these capabilities can be customized by partner, market and health plan offering to bring the right mix of centralized and local-market resources to bear.
Reinvention of Primary Care
We work hand in hand with our partners to implement a team-based, data-enabled approach. This allows primary care physicians to spend more time with the right patients, identify gaps in patient care and more proactively communicate with specialists.
Superior Specialist Network
agilon health collaborates with a full network of specialists who are committed to evidence-based care guidelines and lowest cost sites of service. We are enabling increases in access to specialty care for vulnerable populations in underserved markets through innovative programs, engagement models and aligned incentives. A critical differentiator in local markets, these specialists support a more coordinated care system and generate the best overall outcomes.
Our centralized approach to technology, analytics, and staff and management processes allows us to integrate our partner’s electronic health record and practice management systems with traditional health plan capabilities, enhancing the quality of clinical care. Integration with our service platform also provides access to:
Health Plan Contracting: . Our Payment Model Transformation team brings years of industry experience in contracting and health plan operations to the table. This gives us a detailed understanding of the control we need over certain administrative services, provider network development and the enforcement of care management guidelines to be successful.
Credentialing/Contracting Provider Networks: agilon health works with health plans and provider partners to identify the highest performing healthcare service providers to credential and contract in a given market, including hospitals, ancillary providers, specialists and primary care providers.
Acute/Post-Acute Services: agilon health medical management models include hospitalists, extensivists, SNFists, case management, care transitions, alternatives to long-inpatient stays and increased use of ambulatory facilities. Our medical officers have developed care delivery models for some of the nation’s most innovative providers, re-thinking what good care looks like from the patient’s perspective.
Care Management Guidelines and Adherence: We support our provider partners in developing care management guidelines, adherence policies and processes rooted in evidence-based medical practices. Through our proprietary technology, we’re able to draw on both centralized and local resources to operationalize these capabilities more efficiently.
Claims Processing and Adjudication: Access to timely, granular data is critical to making informed decisions about referrals, sites of service and care management. By assuming the responsibility for claims processing and adjudication for all the healthcare services provided in the network, agilon health is able to provide access to a deeper level of data and analytics for more optimized patient care.
Chronic Disease Identification
A cornerstone of our health contracting approach is the delegation of complex case management and disease management services to agilon health and our primary care partner. This allows for an integrated approach to patient care that thoroughly documents a patient’s burden of illness on an annual basis, and identifies and addresses gaps in care through engagement with our clinical services. From there programs can be designed and operationalized across care teams to ensure all the patient’s needs are addressed by a seamless experience.
The IT & Analytics Backbone
The backbone of our Operating System is our proprietary technology platform. Built with the insight that comes from years of industry experience, our platform integrates best of breed niche technology products with proprietary agilon health technology for a broad range of functionality. And because we fully control our own technology, developing interfaces and workflows that connect with local provider partners is seamless. Our IT team is led by industry veterans who have developed IT solutions for health plan pioneers and leading physician organizations alike.
Like our technology, our best-in-class analytics support every aspect of our Operating System. Whether it’s using data to critically review clinical quality, evaluate the effectiveness of interventions, or measure the scalability and reliability of our operational processes, analytics play an important role in everything we do. These insights are helping us and our partners redefine with good care looks like.