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Capital Gains: Attracting Investors Without Losing Independence By Sean Price Texas Medicine December 2018

When Austin Regional Clinic (ARC) went looking for an investor to help the large group change its payment model in 2016, the practice had a lot going for it: more than 300 physicians, a patient base of 450,000, and a strong financial track record.

Despite these advantages, ARC quickly found that the pool of potential investors resembled a bad dating scene. Lots of investors wanted to woo ARC, but most of them were either too controlling or just didn’t share ARC’s vision.

“We had to kiss a lot of frogs to find the right [investor],” ARC Chief Medical Officer Jay Zdunek, DO, told a crowded room at the Dawn Duster presentation on venture capital in medicine at the Texas Medical Association’s 2018 Fall Conference in September.

But better to kiss a lot of frogs than to settle for the first one that comes along, Dr. Zdunek says. That, unfortunately, is a common experience for physicians and physician groups looking to line up venture capital. It’s easy for medical practices to be tempted by business agreements that appear lucrative in the short term, without realizing the extent to which they may sacrifice long-term independence, he warns.

That’s especially true for physician groups with an increasing financial burden. Many practices urgently need to acquire more capital because operating costs have been on a steep rise since 2001 while Medicare payments — which set the pace for commercial payers — have not kept up with practice expenses, says Dr. Zdunek, who also has a master’s degree in business administration.

The need for outside capital “is not unique to Texas. I have not met a physician group that has not been struggling with this for some period of time,” he told Texas Medicine in a separate interview.

There are many types of investors, including private investors, hospital groups, and insurance companies. Most of them look to buy or control practices to create broader networks, says Kevin Wood, a lawyer with the Austin law firm Clark Hill Strasburger who specializes in business deals for health care organizations and who also spoke at Fall Conference.

Physician practices, in general, are hot investments, but some specialties are hotter than others. The most popular are dermatology, ophthalmology, orthopedics, gastroenterology, and urology, according to Becker’s ASC Review, an online health care business publication. Each specialty is popular for different reasons, but many ties back to the United States’ rapidly aging population and expectations for increasing health care demands. Transactions involving dermatology practices alone rose about 46 percent between 2016 and 2017, according to Irving Levin Associates, a publisher of investor newsletters.

Before beginning an investor search, physicians should have a clear idea of what they want out of the deal, Mr. Wood says. They also should focus on how any agreement will affect their organizational structure, governance rights, and contract rights. Because once everything is signed, it will be too late for second-guessing.

“Knowing who you are and where you want to go are the key pieces,” he said. “What you do with your partner and what you do going forward is going to be key. You want to make sure the culture of who you’re partnering with marries up with the culture of your practice.”

Who needs capital? 

The past 40 years have brought several waves of financial consolidation and increased investment activity among physician practices, Mr. Wood says. These waves typically occur because some regulatory shift makes practicing medicine more expensive or changes payment.

In the 1980s, major changes in Medicare payment prompted consolidation; in the 1990s, it was the advent of health maintenance organizations. In both cases, hospitals typically bought out or partnered with physician practices. The latest round, triggered by federal health care reforms under President Barack Obama, prompted more private investors to buy or partner with physician practices.

For instance, the American Recovery and Reinvestment Act of 2009 mandated the use of electronic health records (EHRs). The transition cost practices on average $80,000 to $85,000 per physician upfront, plus maintenance fees, says Dr. Zdunek. It also slowed physicians’ productivity because their workload increased.

Given these and other changes, some practices need investment capital just to keep up with normal expenses, Dr. Zdunek says. Others might try to upgrade their quality reporting tools to comply with the Medicare Access and CHIP Reauthorization Act (MACRA) and its Merit-Based Incentive Payment System (MIPS). (See www.texmed.org/MACRA and “The Results Are In: Physicians Finally See How They Fared In First Year of MIPS,” September 2018 Texas Medicine, pages 36-39, www.texmed.org/FirstYearMIPS.)

Practices looking to expand also face significant costs. At ARC, hiring just one physician runs anywhere from $250,000 to $500,000 in the first year of employment when counting the costs of recruitment, salary, benefits, support staff, and other related expenses, Dr. Zdunek says. That new physician, in time, will make money for the practice, but the upfront costs must be met first.

Most investors are looking to buy physician practices outright, and most of these purchasers are hospital groups or insurance companies.

In 2016, about 42 percent of U.S. physicians worked for hospitals, up from about 26 percent in 2012, according to health care consulting firm Avalere Health. Not all of this physician employment is a result of acquisitions, but hospitals have been aggressive buyers of medical practices, Mr. Wood told Texas Medicine in a separate interview.

Another aggressive investor is OptumCare, a subsidiary of UnitedHealth Group, the biggest U.S. health insurer. It’s most recent blockbuster deal came in 2017 with the purchase of DaVita Medical Group, which employed 17,000 physicians. But its own website makes clear it is on the lookout to buy out or partner with physician groups. Even before the DaVita purchase, OptumCare had employed or partnered with 30,000 physicians across the country, compared with the 37,000 working for HCA Healthcare Inc., the largest for-profit U.S. hospital system, according to Bloomberg.

Texas can be a more difficult investment market because it has strict “corporate practice of medicine” laws, which, among other things, forbid businesses from practicing medicine or employing physicians to provide medical services here, Mr. Wood says. (See “Corporate Encroachment,” July 2018 Texas Medicine, pages 36-41, www.texmed.org/CorporateEncroachment.) The laws are designed to preserve doctors’ independent medical judgment. However, certain legal agreements can give nonphysicians effective control over physician practices, and that frequently happens when doctors don’t guard their rights to make practice-related decisions, says Mr. Wood.

“When [capital groups] are throwing around their money they expect to have the control,” Mr. Wood said. “It’s a rare instance where the physician group maintains total control or even majority control. For decisions that you’re making, be sure that the physician group keeps a seat at the table,” even after negotiations end.

Getting to yes

ARC Chief Medical Officer, Jay Zdunek, DO

Having clear goals is key, Dr. Zdunek says. For instance, a practice made up of older physicians may be more interested in maximizing financial return so those physicians can retire sooner; maintaining self-governance might be less important. A practice of younger physicians might want to guard self-governance and instead give in on cash value.

Practices that give up too much control can quickly find investors dictating medical policy, Mr. Wood warns. In some cases he’s represented and researched, the physicians thought they’d found an investor who respected their independence, but that investor turned around and sold the practice to a third party. The physicians had no say in the new arrangement.

The most successful business deals he’s seen are ones where physicians held firm on what they wanted and actively negotiated to maintain their independence.

“[Investors] are coming to you for a reason,” he said. “Whatever size group, whatever size market, whatever size patient base you have, you’re the one bringing value to the table. The key to remember in those negotiations is — that’s why you’re there. … If [the proposed deal] is not what you want, it’s OK to walk away from the negotiations.”

In 2016, ARC did just that. The practice made the strategic decision to switch from fee-for-service payments to global capitation with Medicare Advantage plans, which entails a fixed per-patient (or “capitated”) payment for all care as an incentive for the practice to control costs.

To transition, ARC needed a large influx of capital to brace for longer patient appointments and administrative changes under the new payment model. Its physicians were determined to preserve their independence, so finding the right investor was difficult, Dr. Zdunek says. One investor waited until late in the negotiations to inform ARC that it wanted total control of the practice in order to invest, apparently assuming the doctors would cave into this demand. Instead, ARC turned them down. But that meant ARC had to start over in its investor search.

“I got to tell you — there are a lot of people who want to talk to you, but there aren’t a lot who want to give you the things that you want,” Dr. Zdunek said. “It’s a labor-intensive endeavor looking for that right partner.”

At roughly the same time, Premier Family Physicians, an Austin practice of about 30 physicians and a 90,000 patient base, also was looking for investment money to hire more physicians to make the switch to a capitation payment model. Unlike ARC, Premier was willing to consider a buyout, but it ultimately decided that remaining independent made better business sense, says Kevin Spencer, MD, Premier’s CEO.

Eventually, ARC and Premier found the right partner in Agilon Health. The company boosts practices with the technology and funding to switch to global capitation. Its business model is to partner with, not buy, medical practices, says Ravi Sachdev, a partner at Clayton, Dubilier and Rice, the private equity firm that owns Agilon.

“The future is letting physicians remain independent, maintain their culture, maintain their brand, maintain their relationship as a group,” Mr. Sachdev told Texas Medicine. He acknowledges the approach does not work for all practices. “In a partnership, you don’t have control. It’s about trust. It’s about transparency. It’s about shared decisionmaking.”

ARC, Premier, and Agilon created a three-way partnership in which the two practices get 50-percent control and Agilon gets 50 percent. The arrangement covers only Medicare Advantage patients, which make up a minority of both practices’ patient base — about 20,000 out of 540,000 total, Dr. Spencer says.

Agilon’s desire to partner with doctors is unusual for an investor, Dr. Spencer says. It allows physicians to participate fully in the financial side while being left alone to practice medicine.

“We don’t think independence exists in the real world,” he said. “You need to be interdependent with the right people.”

Dr. Zdunek says he understands physicians’ resistance to outside authority. The appeal of being a doctor traditionally has been working in a small business and controlling your own destiny. But the economic pressures physicians face today make that increasingly difficult.

“As an independent physician group or an independent physician, you’re constantly trying to play in a land of giants and not get squashed,” he said. “The only way you can do that sometimes is to find outside capital.”

The original article was published in the December 2018 issue of the Texas Medicine by Texas Medical Association. To view the original article, click here

2018-12-05T22:18:41+00:00 December 5th, 2018|

COPC CEO, William Wulf, MD, and agilon health CEO, Ron Kuerbitz recently spoke with Becker’s Healthcare about net promoter scores and shifting practice culture to adapt to value-based care

The original article appeared in the Becker’s Spine Review and the Becker’s Hospital Review.  Becker’s Spine Review and Becker’s Hosptial Review are the original producers of the content.

 

Columbus-based Central Ohio Primary Care is the nation’s largest independent primary care physician group and an industry leader in physician engagement.

COPC partnered with agilon health, which aims to help physician groups implement programs to spend less time on business administration and more time with patients. COPC CEO William Wulf, MD, and agilon health CEO Ron Kuerbitz recently spoke with Becker’s Spine Review about net promoter scores and shifting practice culture to adapt to value-based care.

Question: What is the importance of a high net promoter score for physician practices?

Dr. William Wulf: Net promoter score is a common metric for physician engagement and patient experience. We believe there is a connection between the two — physicians who are satisfied with their practice environment deliver better patient care.

We are extremely proud that our NPS from physicians is an industry-leading 85, which basically means there are 85 percent more physician promoters within our practice than detractors. When you bring 350 physicians together under one common clinical vision and governance structure, achieving that level of satisfaction doesn’t happen on its own. Many of our strategies and initiatives are designed to improve the lives of our physicians.

We also measure how satisfied our patients are with the care and service they receive from our physicians. For example, we recently surveyed patients that participate in our COPC Senior Care Advantage program, and more than 95 percent of them attend their annual wellness visits. and many of them say they love the focused time and attention from their COPC physician.

As a result of our partnership with agilon health, we were able to launch a global risk program in 2017 for our Medicare Advantage patients, and today, more than 25,0000 COPC patients are benefitting from it. agilon health’s platform, which delivers an integrated people, process and technology solution through a deeply-aligned partnership with our physician group, has allowed us to develop a Medicare Advantage-focused service line without sacrificing our independence and practice culture.

Question: What were the key contributors to your high score? What makes the difference?

WW: While COPC’s philosophy has always been to include our physicians in the practice’s decision-making process, we are now involving them even more. One physician representative from each of the 67 clinics attends a monthly advisory committee meeting. Today, more than 80 percent of COPC physicians are shareholders, and, therefore, are financially rewarded for contributing to the success of the practice. Also, all COPC physicians are incentivized for their ability to deliver quality patient care.

In addition to our governance model, we believe that our commitment as a practice to value-based care is a significant contributor to physician satisfaction. Working with the leadership of agilon health, we have implemented new strategies, such as centralized referral management; new sites of care, including a high-risk clinic; increased clinical assistance from nurse practitioners and other healthcare professionals and improved patient engagement, to name a few. These strategies allow our physicians to spend more quality time with their patients and provide them with even more comprehensive healthcare.

Q: How does this raise the bar for other physician groups?

Ron Kuerbitz: The U.S. healthcare system is in the midst of systematic change for primary care physicians. Physician burnout is becoming endemic, the patient mix is quickly shifting to Medicare and Medicare Advantage, payer mix is shifting to risk-based payment, and the demands for quality care coordination systems are greater than ever. However, from our perspective, the market does not offer primary care physicians an effective model to capture the emerging opportunity.

With agilon health’s help, the COPC model is paying off. This year, the organization has added 10 new physicians, and the practice’s Medicare Advantage patient population has grown more than 10 percent. COPC is thriving as a result of this growth and enhancing its position of the ‘practice of choice,’ which makes it attractive to new physician talent and further strengthens its competitive position in the marketplace.

Besides COPC, agilon health is assisting other U.S. physician practices to stay ahead of the curve by providing them with a platform to leap from fee-for-service to value-based care. We are beginning to see this virtuous cycle with our other partner practices, including primary care groups in Austin, [Texas], and Akron, [Ohio]. Within the next two years, we expect to provide our technology-enabled risk services to a total of 15 markets across the U.S.

Q: Do you think the net promoter scores will become part of a national trend?

RK: Yes. The continued commitment to measuring physician engagement underlines its importance in the success and sustainability of our healthcare system. And the net promoter score is an excellent tool for measuring the overall satisfaction rate of physicians.

Shortages of primary care physicians, aging populations, and the complexity of changing reimbursement systems and the program put a tremendous amount of strain on many physician practices. On a daily basis, physicians find themselves on the front lines of this transition from fee-for-service to high-quality, value-based care, often without a partner to help or a business model to use as a guide. It’s important for physician groups to seek outside help during this difficult transitional time.

Personally, I think the deep commitment we make to our partner practices not only engages them at the organization level but also touches each individual physician. Our physician leaders and the agilon health team agree with those tenets and we’ve built a company to cultivate that.

Q: How did the practice have to shift its culture to get this score?

WW: We realize that physicians want to work in an environment where they are appreciated, and their time and input are valued. At COPC, physicians continue to be more involved in the decision making and are financially rewarded and incentivized. COPC is leading the way nationally through its adoption of a successful value-based care model, but we know that our practice must continue to evolve with the changes in the marketplace. We want to provide our physicians with complete transparency for the quality and cost of the care we manage and the utilization trends of all providers in the network. We strive to give them the opportunity to spend the right amount of time with the right patient. And most of all, we want them to remain independent. Physicians who feel they contribute and are engaged in the practice are one of the main reasons that COPC continues to be an industry leader, offering high-quality and accountable care for patients.

To read the original post, click here

2018-12-05T01:29:49+00:00 November 12th, 2018|

agilon health Partners with Market-Leading Independent Physician Groups in Austin, TX, and Akron, OH, Expanding to Leading Positions in Six U.S. Markets

Unique value-based physician partnership model empowers physicians to remain independent by embracing the agilon health integrated operating platform to support the successful transition to a global risk-based business model

LONG BEACH, Calif. –  Oct. 29, 2018 – agilon health, which partners with primary care physicians to unlock the value inherent in the leap from fee-for-service to a global-risk based business model,  today announced that it has entered into a joint venture with leading independent physician practices Austin Regional Clinic (ARC) and Premier Physicians in Austin, Texas, and with Pioneer Physicians Network in Akron, Ohio.  These recent partnerships expand upon agilon health’s efforts to both improve and accelerate the growth of risk-based models of care in key geographies across the country through the introduction of a complete operating platform for integrated payment and delivery.

With today’s announcement, agilon health has successfully entered into seven partnerships with leading physician groups and networks, empowering primary care providers in six markets to influence the continued transformation of their local care delivery systems around the principles of cost and quality.  Across these six markets, agilon health has signed 17 global risk contracts with multiple payors, including Humana and WellCare, that will serve the Medicare Advantage population in 2019.

In 2017, agilon health and Columbus, Ohio based Central Ohio Primary Care (COPC), the largest independent primary care medical group in the U.S. with 375 providers at 67 locations and over 25,000 Medicare Advantage members under its care, formed the first partnership of this kind to support the transition to a global risk-based business model. Through the partnership, COPC has seen more than a 10 percent increase in patients participating in their new Medicare Advantage global risk model, and delivered improvements in patient and physician experience, and clinical outcomes.

“We have been very impressed by the opportunity for transformation across all elements of our business that our partnership with agilon health has created,” said William Wulf, MD, CEO, Central Ohio Primary Care Physicians. “Our partnership-centric operating model focused on integrating payment and delivery in our market has led to significant improvements across our practice – strong physician engagement, the implementation of network management strategies such as centralized referral management, new sites of care such as a high-risk clinic, and robust patient engagement measured by annual wellness visits for over 95% of our patients – to name a few.  Our physicians can dedicate themselves to the care of their patients with the knowledge that our practice’s new Medicare Advantage program, and consequently the practice itself, will grow and thrive through the partnership with agilon health.”

“I am exceptionally proud of the work done by our team over the past two years to establish truly collaborative partnerships with physicians that are fundamentally changing the way health care is provided to seniors and vulnerable populations across the country,” said Ron Kuerbitz, CEO of agilon health. “On a daily basis, physicians find themselves on the front lines of the transition from fee-for-service to high-quality value-based care, and often without a partner, business model, or the capabilities to capture the opportunity being created by the transition to value-based care. At agilon health, we have created a business model and an operating platform for physicians, to successfully drive change, allowing our partners to provide the right care for each patient at the right time and allowing physicians to rediscover the joy of practicing medicine. We see tremendous opportunity to continue growing, and we expect to provide our technology-enabled risk services to over 15 markets across the U.S. in the next two years.”

 

About Austin Regional Clinic

Austin Regional Clinic is a multispecialty medical group committed to providing comprehensive health care services throughout the greater Austin area. Founded by three physicians in 1980, ARC now provides health care to over 471,000 area residents in 24 locations in ten cities, including both primary and specialty care. It is unique to the Austin area because of the widespread locations, convenient services, and quality assurance programs. ARC patients enjoy access to such conveniences as same-day appointments, 24/7 online or phone scheduling, after hours clinics, nursing services through the night, and access to their providers through the MyChart patient portal. Most ARC locations also offer on-site radiology and lab services, and some clinics offer specialty programs such as a travel clinic and weight loss programs. For more information, visit www.austinregionalclinic.com.

 About Pioneer Physicians Network

Pioneer Physicians Network has 50 board-certified primary care providers practicing at 16 locations with specialties of Family Practice, Podiatry, Pediatrics, and Internal Medicine. We are proud to be one of the largest primary care independent physician groups in Northeast Ohio and recognized and accredited by the National Committee on Quality Assurance as a Level 3 Patient-Centered Medical Home.  As a physician-owned and physician-led organization, our providers’ promise is to serve our community with cutting-edge medical initiatives and superior medical staff and services.

 About Central Ohio Primary Care

Central Ohio Primary Care (COPC) is the largest physician-owned primary care medical group in the United States. COPC was established in 1996 when a group of 33 physicians chose to focus more on the quality of patient care they were providing and less on the administrative paperwork. Today, they have over 375 providers and 67 practice locations throughout central Ohio, along with a full-service laboratory, radiology, cardiac testing, physical therapy and hospitalist services, and several first-rate disease management programs.

 About agilon health

agilon health of Long Beach, California, a company founded in 2016 by world-class health care leaders, is helping U.S. physicians manage the leap from fee for service to global risk-based health care.  Recognizing the increasing pressure on physicians caused by the existing healthcare system, agilon health has created a complete operating platform for managing global risk-based health care 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 six U.S. markets.   For more information visit www.agilonhealth.com.

2018-11-01T19:37:50+00:00 November 1st, 2018|

agilon health’s Innovative Interventions and Achievement in Closing Care Gaps Featured in “Case Studies in Excellence 2018”

“Case Studies in Excellence 2018” Spotlights the Value of Coordinated Care

WASHINGTONOct.  10, 2018 /PRNewswire/ — A computer app reduced hospital readmissions by 26 percent. A 24-hour house call practice showed 34 percent lower patient mortality rates. Innovative interventions improved care in hypertension, depression, and diabetes.

These are just a few of the outstanding results featured in Case Studies in Excellence 2018, a new volume from America’s Physician Groups (APG) that highlights how value-based delivery models are improving patient care while lowering healthcare costs. APG releases the collection at its Colloquium 2018, which is taking place October 10-12 in Washington, DC.

“These stories of coordinated and patient-centric care are truly compelling and exemplify what value-based care is all about: keeping patients healthier while lowering costs and boosting patient and physician satisfaction,” said Dr. Amy Nguyen Howell, APG’s Chief Medical Officer.

Each of the seven case studies highlights a specific challenge faced by a physician group, along with the solution and results. The studies were selected from APG members across the country, including top honorees from APG’s nationally recognized Standards of Excellence™ (SOE®) program—a voluntary program that measures physician groups’ capabilities to deliver high-quality, risk-based care.

Featured medical groups are agilon health, Long Beach, California; Landmark Health, Huntington Beach, California; Marshfield Clinic Health System, Marshfield, Wisconsin; Oak Street Health, Chicago; Prospect Medical Systems, Johnston, Rhode Island; Tandigm Health, West Conshohocken, Pennsylvania; and Vancouver Clinic, Vancouver, Washington.

“Our members have repeatedly demonstrated that a risk-based, coordinated delivery model results in the best quality of care for patients,” Nguyen said. “Sharing these case studies is one more way APG is working to support physician groups across the country as they move away from traditional fee-for-service payment models to innovative, value-based care that puts patients first.”

To download a free copy of Case Studies in Excellence 2018, visit www.apg.org/casestudies.

About America’s Physician Groups  
America’s Physician Groups (APG) is the nation’s leading professional association for accountable physician groups, composed of over 300 medical groups and independent practice associations (IPAs) across 43 states, the District of Columbia and Puerto Rico. America’s Physician Groups’ members operate under a capitated, coordinated care model that is the essence of the nation’s health reform movement from volume to value.

2018-12-05T01:27:54+00:00 October 10th, 2018|

WellCare Partners with agilon health to Form Value-Based Care Agreement

TAMPA, Fla.Oct. 8, 2018 /PRNewswire/ — WellCare Health Plans, Inc. (NYSE: WCG) announced today it has expanded its network of providers by signing a new value-based care agreement with agilon health, a leading national organization which brings a complete operating platform for global risk to primary care physicians, to help improve access to care and drive greater health outcomes for its members in Texas.

Value-based programs reward healthcare providers with incentive payments based on the quality of care provided rather than the services delivered. The aim is to provide better care for individuals, improve population health management and reduce healthcare costs.

“We’re thrilled to partner with agilon health to help provide our members with access to high-quality, coordinated health care,” said Sue Podbielski, WellCare’s vice president, network performance. “Working together, we can collectively deliver improved health outcomes and an enhanced experience for our members. Our goal is to move to more value-based care agreements that incentivize positive health outcomes.”

“We’re excited to partner with WellCare,” said Ron Kuerbitz, agilon health’s chief executive officer. “We are committed to providing quality, value-based, preventive and personalized care and look forward to bringing our proven model to WellCare members.”

Across the country, agilon health manages care for more than 300,000 patients through a network of more than 14,000 physicians across four states. For more information about agilon health, visit www.agilonhealth.com.

About WellCare Health Plans, Inc. 
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services to families, children, seniors, and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 1, 2018. For more information about WellCare, please visit the company’s website at www.wellcare.com.

2018-10-09T19:32:38+00:00 October 9th, 2018|

New Survey Shows Central Ohio Primary Care Physician Satisfaction Rivals Consumer Loyalty to Beloved Corporate Brands

 

Columbus, OH — At a time when substantial numbers of primary care physicians are disgruntled about their work environment and physician burnout reaches an all-time high, the physicians at Central Ohio Primary Care (COPC) are more satisfied and loyal than customers of some of the nation’s most beloved corporations.

A recent survey of COPC physicians showed their Net Promoter Score* of 85 is higher than Apple and Southwest Airlines.  In fact, the only constituents who appear to be more loyal than COPC physicians are the owners of a Tesla automobile.

“Every physician wants to work in an environment where his or her time and input is valued” commented David Neiger, MD, COPC primary care physician.  “COPC provides that and more.  Physicians are active participants in decision making regarding the practice and are financially rewarded as shareholders.  COPC also offers a delivery system specifically built for seniors through partnerships with local Medicare Advantage plans.  These value-based care programs allow me to spend more quality time with my patients.”

WCMH- TV Columbus interviews Dr. Wulf about the recent survey of COPC physicians where their Net Promoter Score of 85 is higher than Apple and Southwest Airlines. Click the image to watch the interview.

But for most primary care physicians the picture isn’t so rosy.  An editorial published in the Journal of General Internal Medicine reported burnout rates ranging from 30 to 65 percent across specialties, with the highest rates incurred by physicians at the front line of care, such as emergency medicine and primary care.  And a survey of 950 primary care physicians conducted by MDVIP revealed 83 percent of doctors say they wish they had more time with their patients.

COPC’s journey to creating happier physicians started with a culture shifting from fee-for-service to value-based care, a model used in every aspect of their practice.  To add to this initiative, the physician group executed a plan focusing on the quadruple aim: quality of care, physician satisfaction, patient experience, and efficiency of care.

In addition, COPC management, including hands-on CEO Bill Wulf, MD, points to the other reasons why this group’s physicians are happier at work:

  • Physicians have always been involved in COPC’s decision-making process. One physician representative from each of the 67 offices attends a monthly advisory committee meeting.
  • The company follows a shareholder model. Physicians are financially incentivized for their involvement as a shareholder and their ability to deliver quality patient care. Over 80% of COPC physicians are shareholders.
  • COPC physicians are less stressed at work because their overall compensation is increasingly tied to the quality of care scores instead of the number of patients they manage. Furthermore, COPC patients adhere to recommended preventive care screenings and immunizations at industry-leading rates.
  • They are also taking advantage of ancillary staff, such as nurse practitioners, to provide important preventive care to patients.
  • COPC has also entered into a long-term partnership with agilon health to enable the growth and development of a purpose-built care delivery program for Medicare Advantage patients.

And happy doctors go hand in hand with happy patients.  A recent survey of COPC patients who recently underwent an annual wellness visit confirms their satisfaction.

Vicki Spencer has been getting regular exams from Henry Sleesman, MD, a COPC internist at Riverside Medical Group, for more than 30 years.  “He is a wonderful man.  Not only is he an excellent doctor, but he also spends quality time with me,” Vicki admits.  “He remembers everything about my family and I feel like I can talk to him about anything.  And when I do my yearly health exams, he calls me back with the results of my blood tests, which are usually negative.  He always goes the extra mile.”

COPC has also been widely recognized for its commitment to quality and efficiency of care.  This physician group created an award-winning program that has significantly reduced the number of patients utilizing emergency care.  Their patients have also benefited from a reduction in skilled nursing facility (SNF) utilization, as COPC hospitalists have effectively discharged more patients directly to their homes.  These results clearly demonstrate that COPC is keeping quality patient care at the forefront of all their initiatives.

“The promise of value-based care is reflected in the satisfaction of COPC physicians,” said Amy Nguyen Howell, MD, chief medical officer at America’s Physician Groups.  “It provides them with the tools they need to increase time at the bedside while reducing the burden of paperwork.  By embracing this model, COPC has invested not only in its physicians but also in the patients and communities they serve.”

 

About Central Ohio Primary Care (COPC)

Central Ohio Primary Care (COPC) is the largest physician-owned primary care medical group in the United States.  COPC was established in 1996 when a group of 33 physicians chose to focus more on the quality of patient care they were providing and less on the administrative paperwork.  Today, they have over 375 providers and 67 practice locations throughout central Ohio, along with a full-service laboratory, radiology, cardiac testing, physical therapy and hospitalist services, and several first-rate disease management programs.

About agilon health

agilon health of Long Beach, California, a company founded in 2016 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 six U.S. markets.

*Net Promoter Score (NPS) is a management tool that can be used to gauge the loyalty of a firm’s customer relationships and is also used to gauge employee satisfaction.  It serves as an alternative to traditional customer satisfaction research and is a tool that correlates loyalty and satisfaction with business performance.  NPS has been widely adopted with more than two-thirds of Fortune 1000 companies using the metric.  NPS scores greater than 50 are generally considered excellent.

COPC Medicare Advantage patient NPS survey

In Q1 2018, nearly 500 COPC patients covered by a Medicare Advantage plan were surveyed after undergoing an Annual Wellness Visit with a COPC primary care physician.  Of the 17% who responded, they resoundingly expressed their satisfaction with the Annual Wellness Visit experience with their COPC physician, awarding an NPS score of 55.  NPS scores greater than 50 are considered excellent and in fact, a 55 NPS for an Annual Wellness Visit exceeds the NPS reported by Apple customers.  Respondents shared that they especially valued the time their primary care physician spent reviewing their medications and evaluating their physical and cognitive capabilities.

 

2018-12-05T01:20:15+00:00 October 1st, 2018|

agilon health achieves a 20 percent boost in closing care gaps by using physician and member incentives for preventive care

LONG BEACH, Calif. (August 29, 2018) – agilon health, which helps physicians and medical groups manage the leap from fee-for-service to value-based care by providing financial, organizational and operational tools, has released its 2017 outcomes report that revealed it closed about 20 percent more gaps in care with a partner IPA in the Inland Empire that serves Medicaid enrollees.

By implementing teams of member quality specialists to increase participation in preventive services such as screenings and annual health checks, agilon health closed more than 65,000 gaps in care during 2017 for its Inland Empire-based Medicaid patients, the report highlights.   Based upon this initial success, the most effective tactics have now been implemented across agilon health’s entire Medi-Cal population, which extends into the Central Valley.

“Gaps in care push up costs for Medicaid patients,” said Ronald Kuerbitz, chief executive officer, agilon health. “If patients do not get preventive services, they will more likely need costlier specialty or acute care down the road.  More importantly, preventive care saves lives.”

By using unique incentives, improved communications and proprietary data collection tools for both the participating physicians and members to improve adherence with preventive services, agilon health achieved remarkable outcomes for Medicaid members, which traditionally have been reluctant to participate in preventive care services.  More than $1 million was distributed as bonuses to participating agilon physicians that closed care gaps, and more than $60,000 was spent on gift cards which were used as an incentive for members.

“The fact is, incentives are quite effective in engaging both the physicians and members in preventive care compliance,” said Manoj Mathew, MD, National Medical Director, agilon health.  “If all it takes is offering a $25 Target gift card to incentivize a woman to come in and get her mammogram, we can influence health care behavior that can save lives. It is a small investment to ensure long-term quality of care and a better quality of life for our members, the majority of whom are from underserved communities.”

The screening and health check performance for 2017 highlights the outcomes for breast cancer screening, diabetic eye screening, cervical cancer, childhood immunizations, adolescent immunizations, diabetic glucose monitoring, medication management, timely prenatal care, timely postpartum care and well-child visits.

Among the more notable outcomes for 2017 included agilon health’s quality performance for its diabetic members.  Eye screening adherence increased from 38 percent in 2016 to more than 50 percent for 2017. Glucose level screening increased from 42 percent to more than 50 percent during the same period.  In November of 2017, agilon health invested in two RetinaVue imaging devices.  By using telehealth resources with trained ophthalmologists, they were able to bring retinal eye screenings directly to its members through local IPA physician offices.  Through this service, eye diseases, such as macular degeneration and glaucoma, were identified early and members have been referred for further evaluation.

Besides introducing a new proprietary technology platform in 2017 that improved workflow, quality data collection, and reporting, agilon health increased its quality care team to nine professionals who work daily on member engagement and care coordination.

To review the details of agilon health’s quality outcome report for 2017, please visit https://agilonhealth.com/outcomes.

 

2018-08-29T19:35:07+00:00 August 29th, 2018|

agilon health to Leverage HMS Essette Care Management Technology for its Care Delivery Networks

agilon health to Leverage HMS Essette Care Management Technology for its Care Delivery Networks

 Industry leaders collaborate to offer customized workflows and business intelligence capabilities to physicians through integrated, SaaS-based platform

 IRVING, Texas (PRWEB) July 26, 2018 — HMS (NASDAQ: HMSY), a provider of industry-leading technology, analytics and engagement solutions for healthcare, today announced that agilon health, a healthcare

services and technology company dedicated to partnering with physicians to create value-based healthcare delivery systems will leverage the HMS Essette software to provide a unique care management technology offering to primary care physician groups and care delivery networks.

Leveraging HMS Essette care management technology, agilon health will provide robust care management technology to their provider market customers, enabling them to create and manage care plans that focus on improving health outcomes and reducing costs. Essette creates efficiencies through automation while allowing each physician group or delivery network to customize workflows to their individual business needs.

“The HMS Total Population Management product portfolio has broad applications to multiple healthcare markets,” said Emmet O’Gara, HMS’ executive vice president, Total Population Management. “Working with agilon health enables us to further our reach and strengthen our impact on improving health outcomes and reducing system costs.”

“We are committed to consistently improving the comprehensiveness and value of our Operating System, and the Essette technology modules empower us to offer a new set of business intelligence analytics and workflows that will help our partners achieve their care management goals,” said Ron Kuerbitz, agilon health’s chief executive officer.

About HMS

HMS advances the healthcare system by helping payers reduce costs and improve health outcomes. Through our industry-leading technology, analytics and engagement solutions, we save billions of dollars annually while

helping health plan members lead healthier lives. HMS provides a broad range of coordination of benefits, payment integrity, care management and member engagement solutions that help move the healthcare system forward. Visit us at www.hms.com or follow us on Twitter at @HMSHealthcare.

About agilon health

agilon health partners with primary care physicians to define a new standard of quality, efficiency and patient experience. We bring the people, solutions, capital, and technology necessary to ensure their long-term success and to bring back the joy of practicing medicine. Visit www.agilonhealth.com for more information.

 

2018-07-31T00:08:13+00:00 July 30th, 2018|

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|

New Year’s Message from Ron Kuerbitz, CEO

“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:

  1. Successfully serving a growing number of primary care physicians across four states;
  2. Enabling them to better care for more than 750,000 patients;
  3. 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);
  4. 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;
  5. 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.

 

2018-03-03T01:11:45+00:00 February 3rd, 2018|
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