Empowered PCP: Dr. John Notaro on the Importance of Palliative Care and Leveraging Specialists in VBC

As part of our blog series, The Empowered PCP, agilon health is sharing what we learn from influential voices in the primary care physician (PCP) community about how they’re creating healthier communities through value-based care (VBC) and their perspectives on empowering other PCPs.

Dr. John Notaro, a primary care physician with the Buffalo Medical Group in Western New York, began his relationship with agilon in November 2019. He made the move to value-based care because he felt it was important to provide a higher level of care for senior patients, something that wasn’t always feasible under the fee-for-service model. “Our partnership with agilon helped us transition from fee-for-service to value-based care because we learned about the concept of investing before the result to get to a place that we wanted to be for our patients.” Dr. Notaro says.

Filling a Need for Palliative Care

That investment in patients extends to a palliative care clinic wouldn’t be possible without the support of the agilon model.

As the baby-boom generation ages, palliative care programs have expanded to offer serious illness care to more patients. Many senior patients reach a point in their illness when symptoms start to impact their quality of life in ways they did not anticipate. Palliative care, through comprehensive care conversations and symptom management, sets goals that better align with patients’ wishes as their illness progresses. “We knew that with an effective palliative care program, we could give those patients and their families back the control that they needed to reach the end of life in a manner that was consistent with their values,” Dr. Notaro says.

“We built something that we call an extensivist clinic,” he continues, “which is really like an urgent care clinic on steroids.” The clinic is IV-capable, allowing the care team to administer IV medications in the office, something that is usually only done in the emergency room or the hospital.

To further enhance palliative care, the clinic hired a nurse practitioner palliative care coordinator, a clinical pharmacist, and established a partnership with a pre-hospice palliative care service that provides nurse practitioners who can deliver care to patients in their homes.

In this video, Dr. John Notaro, an agilon health physician partner at Buffalo Medical Group, discusses how their partnership with agilon expanded their vision of what a palliative care program could be and how they deliver better care for their patients in a more efficient manner.

Strengthening the Physician-Patient Relationship

Partnering with agilon has not only transformed care delivery in Dr. Notaro’s practice but has also redefined the relationship between doctor and patient. “The VBC model asks the PCP to delegate and act more like a head coach crafting strategies and managing assets,” Dr. Notaro says. “Where we do want the PCP to be more active is in building the relationship with the patient in the most delicate part of their lives. We’re asking the PCP to delegate a lot of functions to other team members so they can have the time to deepen those relationships, particularly with older patients with comorbidities.”

Leveraging Specialists in VBC

While primary care is the basis of VBC, the agilon model has empowered PCPs to leverage specialists to improve care for senior patients. “In our practice, we’re beginning to define a few roles for specialists and how they fit into the VBC model,” Dr. Notaro says. He highlights the pivotal contributions specialists make, particularly in fields such as oncology, nephrology, cardiology, and orthopedic surgery. Specialists assist PCPs in framing the right questions and providing insights to help patients make decisions consistent with their values. For example, an oncologist can offer information about cancer therapies, side effects, and prognoses, empowering patients to make informed choices.

“In our group, we have a couple of oncologists and we’ve started calling it the navigation role,” Dr. Notaro explains. “This is a new role for the oncologist that’s distinct from their traditional role, which is to treat patients with chemotherapy.”

Driving Efficiency and Precision

Specialists play a vital role in enhancing efficiency and precision within the VBC model. Dr. Notaro emphasizes their contribution, stating, “The early stages of moving to VBC are about defining risk, and specialists can help the PCP do this with more precision.”

Informing specialists about the importance of effectively communicating with Medicare and the patient’s PCP is crucial. Dr. Notaro highlights the significance of accurately coding all diagnoses for Medicare patients. By educating specialists about coding accuracy, PCPs can develop a complete picture of a patient’s health, ensuring that all health risks are identified and addressed by the PCP or other appropriate provider.

Dr. Notaro further explains, “You can also teach specialists to make utilization more efficient.” Specialists contribute to utilization practices in various ways. For some specialists, it revolves around the place of service. “For example, it makes a difference if a surgeon does a knee replacement in a hospital versus an ambulatory surgical center,” he says. “If specialists like orthopedic surgeons are thinking about place of service, that’s helpful.”

In terms of utilization, high-cost drugs can be a significant factor for certain specialists. Dr. Notaro elaborates, “If you’re an ophthalmologist and you’re treating wet macular degeneration, there’s a very expensive name-brand ocular injection and another generic option. Knowing these options matters.” By equipping specialists with knowledge about cost-effective alternatives, PCPs can optimize resource utilization without compromising patient outcomes.

Partnering for Success

When asked what excites him the most about his partnership with agilon, Dr. Notaro said this: “agilon has provided the capital to make investments in programs for our patients and also the business rigor that they put around process, which has really allowed us to operationalize the kinds of things that we envision for patients. The exciting part of the agilon partnership is that what we can build together brings the PCP back to the center as the architect of the delivery system.”

The agilon Difference

At agilon, we’re daring to reimagine primary care. By prioritizing trusted physician-patient relationships and empowering PCPs with time and resources, agilon is revolutionizing health care for seniors. Learn more about what agilon health can offer.