Reinventing primary care for older Americans with value-based care: Lessons learned from agilon health and MaineHealth's partnership

Primary care is the front door to the healthcare system — and it's ripe for disruption.

New market entrants like Amazon and Walgreens have already made several investments in this space. What the future holds for health systems, however, is unclear. 

At a session sponsored by agilon health at the Becker's Virtual CEO + CFO Roundtable, Erica Carbajal, editor at Becker's Healthcare, facilitated a discussion with three primary care experts about the challenges and opportunities in primary care, including increased adoption of value-based care models. The panelists were:

  • Eric Klein, partner, Sheppard Mullin
  • Andrew Mueller, MD, CEO, MaineHealth in Portland
  • Steve Sell, CEO, agilon health

Four key takeaways were: 

1. There is a huge acceleration away from traditional fee-for-service care, especially for seniors. The Kaiser Family Foundation anticipates that in the next year or two, more than half of all Medicare beneficiaries will be enrolled in Medicare Advantage plans. "The national average in Medicare Advantage for bed days per 1,000 seniors is about 1,700 bed days per year," Mr. Klein said. "The best-performing groups, when under a risk-based system, can reduce that to 600 to 900 bed days per 1,000 seniors. That's a huge difference that translates into trillions of dollars in savings." 

2. Value-based care enables primary care physicians to spend more time with complex patients. People recognize the value that primary care physicians bring in terms of organizing care, but fee-for-service business models don't allow doctors to spend additional time with the most complex patients. "The over-65 Medicare population with complex conditions puts tremendous strain on primary care physicians. agilon health creates partnerships that provide primary care doctors with resources like social workers, care managers and pharmacists in the office," Mr. Sell said. 

This team-based care model enables physicians to spend more time with complex patients and yields exceptional outcomes in terms of both the patient experience and reduced costs. agilon health moves existing doctors, patients and health plans to a coordinated, full-risk world where the primary care physician and care team are responsible for the total care and costs for senior patients. 

3. Successful partnerships depend on alignment and trusting relationships. As health systems navigate new partnerships and move to value-based care models, one key to success is keeping an eye on the organization's goals. "At MaineHealth, our vision is working together so our communities are the healthiest in America," Dr. Mueller said. "Our vision is so aspirational, we know we can't achieve it alone. We must partner with others. agilon health's bi-directional communication and willingness to partner are ultimately what will help us achieve success together." 

Trusting relationships between patients and physicians are essential because those drive behavior and ultimately improves outcomes. "Ensuring that our care delivery teams, including advanced practice providers, nurses, medical assistants and front office staff, can build trust with patients will be critical," Dr. Mueller said.

4. agilon health's business model accelerates the journey to value-based care for healthcare systems. "The pace at which we move doctors, patients and health plans away from a fee-for-service world is unique," Mr. Sell said. agilon health uses a structured, 12-month implementation schedule. The company surrounds primary care doctors with care team resources in their offices and invests in resources outside the office to round at critical junctures like the ER, hospital floor and within skilled nursing facilities. 

"We organize all the health plans in the community and move them into a full-risk relationship. The payment model changes, but we get an agreement that there will be one approach to quality and access, regardless of which health insurance card a senior patient brings in," Mr. Sell said. One of the biggest challenges in healthcare is variation, so treating all senior patients using the same approach can drive improvements in cost, quality and the experience for physicians and patients. 

As health systems make the shift to value-based care, Medicare is a logical place to start, but success requires a holistic view. "Historically, primary care has been under-resourced. When physicians work smarter, with better data and with a care team wrapped around them with the right kind of IT and processes, they can spend more time with patients and that makes a huge difference," Mr. Klein said.

agilon health agrees and its alliance with MaineHealth is already showing positive results. "Our true partnership allows for investment back into the community," Mr. Sell said. "We're live in 17 markets with physicians who have worked in their communities for decades and we're reinvesting about $10 million per month into local primary care. For the first time, we are seeing primary care stabilize and grow."

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