The Keys to Healthcare Sustainability for Seniors

“The nice thing about being partnered with agilon health is that we have support, both financially and professionally, but also our physicians feel like they’re doing something and they’re empowered and actually have an opportunity to transform care within the healthcare system.”
Dr. Frank Civitarese, Preferred Primary Care Physicians

Over the past decade, more and more of America’s seniors are enrolling in Medicare Advantage, with the program taking on an increasingly larger role within the overall Medicare landscape. Today, more than 26 million seniors are enrolled in a Medicare Advantage plan. agilon health has been keeping pace and doing its part by helping transform healthcare for seniors with Medicare Advantage. But how? Through partnerships with independently-owned physician groups, agilon health is able to offer our Total Care Model, which allows community physicians to focus on the entire health of their Medicare patients – one that is built on value of care (also called “value-based care”), not volume of services.

agilon health convened an expert panel of independent physicians from across the U.S. – with experience in delivering value-based care through our Total Care Model – to discuss Medicare Advantage, the role of independent primary care and this new way of caring for seniors. Moderated by Mara McDermott, Vice President of McDermott+Consulting, the panel covered six key areas:

1. What value does Medicare Advantage bring to the healthcare system? Why is value-based care important to seniors?

Medicare Advantage is “leading the movement” of value-based care and is a “unique and exciting opportunity to change the way we deliver care to seniors,” says Dr. Frank Civitarese, President of Preferred Primary Care Physicians (PPCP), located in Pennsylvania’s greater Pittsburgh area. Through its partnership with agilon health, PPCP physicians can focus on the entire health of patients by managing them in a value-based care model. And results are impressive. Patients “have readily recognized that there is value in Medicare Advantage” and are saving money compared to original Medicare; they are even using inpatient services less frequently (47% less, in fact) – a “remarkable number,” Dr. Civitarese notes.

2. What is a “global risk” model and what does that mean for patients?

With the “global risk” model, Medicare Advantage allows physician groups to access pre-payments for their patients with Medicare Advantage. Instead of being reimbursed for each patient visit, the physician group gets a fixed monthly payment from Medicare Advantage plans to cover virtually all of the member’s health needs. “We manage the entire cost of care in our model,” explains Dr. Kevin Spencer, CEO of Premier Family Physicians, based in Austin, Texas. Any money left over – the savings associated with keeping patients healthier and out of the hospital – is used to fund clinical programs, cover operating expenses as well as help primary care and multispecialty groups with incentives in payment equity within the practice.

As far as results, we’ve consistently observed “better experiences and outcomes,” says Dr. Spencer. For example, 90% of members reported being satisfied with their care and 95% strongly agree that they’re getting comprehensive care. He adds, “On the outcome side, we’re seeing 42% lower ER utilization, and that was pre-COVID.”

3. What capabilities have you been able to build as a result of offering value-based care?

Dr. Bill Wulf, CEO for Central Ohio Primary Care Physicians, headquartered in Westerville, Ohio, says they’ve been able to add extensive programs that provide “better and safer care for our patients.” Visualize a pyramid, with low-risk patients needing primary care at the bottom, then patients requiring specialty care, then those requiring hospital care and finally those needing end-of-life care at the top. “What the funding allows us to do is develop programs and capabilities that enable us to deliver comprehensive care to patients, and essentially bubble wrap our patients and especially those that are high risk.” Some programs that have been added as a result of its partnership with agilon health include:

• same day (urgent care) centers
• preferred skilled nursing facilities
• 24/7 call support center to manage hospital admissions and floor calls
• centralized referral management
• home visiting physicians
• multiple care coordination programs for chronic patients
• dedicated high-risk patient clinic and ER diversion programs

He concludes, “We’d like to see more independent physicians in every market because of what we can provide for our patients.”

4. How has the “global risk” model and value-based care created more access for patients?

Thanks to its partnership with agilon health, Premier Family Physicians (Texas) was able to strengthen its business, especially for senior patients, by adding new offices (that are “convenient” and “close to where people live”) and hiring new physicians. In the past, Dr. Spencer says that it took a “couple months or more for a new Medicare patient to be seen….we now can see a new Medicare member in less than two weeks.” Dr. Spencer also has observed improvement in preventative services, including well visits and immunization rates. “Access is key,” says Dr. Spencer.

5. How has the agilon health partnership helped your practice reach underserved communities and achieve health equity?

Dr. Keisha Jarrett, a family medicine physician with Wilmington Health in North Carolina, shared some interesting stats: 59 million people in the United States live in areas where there is a shortage of healthcare providers, and 43% of the agilon health partner practices are in some of those areas. “We are constantly growing,” she says, noting the increasing retiree population in the area. “We’re providing a lot of after-hours care” and are “trying to reach as many of those patients as we can.”

Other examples:

• Wulf (Ohio): “agilon has provided us the opportunity to invest in our own community to provide better care for those in need,” noting that they established two clinics in low income, high-need areas.
• Spencer (Texas): A struggling rural practice of seven providers in two impoverished locations was integrated into Premier Family Physicians. “They didn’t have any of the infrastructure to provide telemedicine care management, transition of care, ER diversion….and so now those patients are in that community are now getting care.”
• Civitarese (Pennsylvania): During the COVID-19 pandemic, a drive-up clinic was opened for patients who did not have access to computers or smartphones. When a patient arrives, a staff member brings an iPad to their car, allowing them to virtually connect with their physician.

6. Why is independent primary care so important and how can independent practices be supported?

“The nice thing about being partnered with agilon health is that we have support, both financially and professionally, but also our physicians feel like they’re doing something and they’re empowered and actually have an opportunity to transform care within the healthcare system,” says Dr. Civitarese (Pennsylvania). He explains that physicians may only see patients three or four times a year for 20-30 minutes, but the rest of their lives are outside of the exam room.

“That’s the beauty of this model…we now can reach out to them with programs that are outside the four walls of our exam room, and we ultimately believe will improve and impact the care that they’re being delivered and also their outcomes.” It’s been an “exhilarating experience,” he adds.

To view the full webinar, click here.