Care Transformation: Partnerships, Global Capitation, and Achieving the Quadruple Aim

The movement toward value-based care is something in which all professionals in the healthcare industry should be involved. While there might be different paths and strategies to transforming care into a truly value-based system, the main goal is to achieve the quadruple aim – high-quality care, lower total cost of care, higher patient satisfaction, and improved physician engagement and joy in practicing medicine.

But, how do we get there? What are the challenges that exist to taking on risk, and how can partnerships help share the load? These are important questions, and I’m looking forward to leading a discussion on care transformation alongside a few of Agilon’s leading partner groups at AMGA’s 2020 Conference in March.

Agilon Health was established as a healthcare platform to partner with medical groups that wanted to accelerate the journey to value-based care around specific lines of business in a partnership model. Our focus is on establishing a true 50/50-owned and –governed, risk-bearing entity for a region of the United States where the medical group is located and contracting with all willing health plans around global capitation for Medicare Advantage and other government programs.

One of the benefits of global capitation, and the transition to value-based care in general, is the increased efficiency (and resultant ease) of administrative and financial tasks associated with the cost of health care. As part of our partnerships with medical groups, we provide both the administrative infrastructure and financial investments necessary to create a strong foundation, allowing the medical group to keep focused on their physicians and patients as well as hone their focus on active participation in the provision of population health. Agilon contributes all MSO services and enables collaboration within and between markets in order to design a system of standardized care for individualized physicians, medical groups, patients, and the community as a whole. All of these services allow the medical group to focus on increasing the quality of patient care.

Before and throughout the creation of a partnership between Agilon and a medical group, initiatives are evaluated to ensure success in achieving the quadruple aim. These initiatives include burden of illness program, medical management infrastructure, clinical structure and identification of the gaps in care programs, and quality-focused compliance programs that meet all of the demands of health plans and government oversight. Additionally, administrative structures—such as health plan and provider contracting, clinical operations, informatics and reporting, IT, local leadership, and MSO services—are evaluated by both Agilon and the medical group to ensure that efficiency and quality are continuously improved.

Dr. Bill Wulf, CEO of Central Ohio Primary Care, Dr. Anas Daghastani, CEO of Austin Regional Medical Clinic, and Dr. John Notaro, Medical Director of Buffalo Medical Group, will join me at AMGA’s Conference to discuss our partnership journey, the challenges, and the resulting clinical outcomes.

During the panel, we’ll explore our clinical vision for state-of-the-art medical management infrastructure, as well as the different obstacles we (Agilon and our partner groups) have dealt with along the road to sharing risk. We will share how experience has shown us that medical groups’ transition from fee-for-service to value-based care, and eventually to global capitation and holistic care, has a definitive impact on patient and physician satisfaction. The benefits of the transition are also clear to us when we evaluate the clinical outcomes resulting from our various partnerships (e.g., reduced hospital admissions and readmissions, improvement in star ratings in Medicare advantage patients, and the improvement in NPS scores).

By sharing our experiences and findings, my hope is to spark a meaningful conversation about the challenges, clinical evolution, and administrative infrastructure needed to transition to value and achieve the quadruple aim. We believe this transition not only will be to the benefit and joy of providers, but will also lead to the increased quality of care that all patients deserve.