Ep 118 – A New Primary Care Model for the Future, with Steve Sell

Primary Care in the United States is flawed, especially for our most complex patients in the Medicare program.  We have built this incredibly expensive primary care model around a fee-for-service system that is incredibly fragmented and uncoordinated.  There is now a need for a new model – one that yields a much better experience for patients and physicians.  We now stand at the threshold a great dawning. An era is ending, and we are at the core of creation in reimagining a more idealized, value-based model for primary care – one that untaps a massive reservoir of healing capacity. This vision for “A New Primary Care Model” will transform community health for our most clinically complex and vulnerable populations.  And it all starts with payment model innovation which, in turn, spawns care delivery innovation. Although we are in early days of full-risk Medicare Advantage and global capitation models in Medicare, there are leading indicators that show promise for the future of health. What exactly does a reimagined primary care model look like and how can it scale?  Look no further than agilon health – a company that partners with independent primary care practices that are leaders in their markets and helps them transition to value-based care success in the Medicare program.

On the Race to Value this week, we are joined by Steve Sell, the Chief Executive Officer and a member of the board at agilon health.  Steve leads agilon health as an experienced, mission-based CEO known for transforming organizations through partnerships, product innovations and talented, collaborative teams. With over 25 years of experience in value-based care in the health plan environment, Steve Sell is building a new model of primary care for the future. Under Steve’s leadership and guidance, agilon health is transforming health care delivery through a technology enabled, full risk value-based care model that places the primary-care physician as the quarterback of patient care. And they are doing this at scale, in geographies that have operated in a fee-for-service environment. If you are want to know more about how we can transform primary care at scale, this week’s podcast episode is a must-listen!

Episode Bookmarks:

01:30 Introduction to Steve Sell and agilon health

04:00 agilon’s growth to over 250k Medicare Advantage members and over 90k attributed Direct Contracting beneficiaries

06:30 “Primary Care in this country is really flawed. It’s been built around a FFS system that is incredibly fragmented and uncoordinated.”

07:00 The vision for “A New Primary Care Model” to transform community health that is empowered by payment model and care delivery innovation

08:00 Steve discusses the rapid growth of agilon health since its founding in 2016 (1% of all PCPs in the country, 23 communities in 12 states) and how PCP trust is built over time

09:00 Partnering with physicians to support scale and alignment in markets that have been historically dominated by FFS

09:45 “We believe that full-risk, value-based care is the best way to organize an entire community. PCPs can then move to the top of the overall delivery of care.”

10:15 The Speed of Transformation — agilon’s intensive 12-month implementation period

10:45 Win/Win/Win (Patients, Doctors, Communities) – transformed health outcomes, satisfied primary care providers, high industry-leading Net Promoter Scores

12:00 The consumer-centric innovation opportunity in fully-delegated, capitated Medicare Advantage plans

13:30 How changing demographics and an aging population fuels Medicare Advantage Growth

14:00 The economic challenges of a shifting payer mix in primary care, i.e. less concentration of commercial business when a population ages

14:45 “The reform of payment models are the key to starts the process of transformation in primary care practices.”

15:00 The early days of full-risk MA and global capitation models in Medicare as an indicator for future success

16:00 Recent study showing the association of full-risk value-based care and improved acute care utilization outcomes (e.g. 5-8% reduction in hospitalizations, 11-13% in ER visits per 1000)

18:00 Steve discusses agilon’s medical margin experience in impacting client success and primary care reinvestment

18:45 “This year, as a result of driving positive improvements in medical margin, agilon will reinvest over $100M into primary care in our communities.”

19:30 Creating a “flywheel effect” by capitalizing on the waste in the healthcare delivery system

20:00 Reestablishing a primary care visit cadence (i.e. frequency and regularity of visits) for the most complex patients

20:30 PCP visit within 48 hours of being discharged can reduce hospital readmission rates by >20%

21:00 The importance of medication adherence in high-touch, chronic care management

22:00 Amazon’s acquisition of One Medical for $3.9B — how will this impact the value-based, primary care landscape?

24:00 “There is need for a new primary care model – one that yields a much better experience for patients and physicians than what we’ve seen historically.”

25:00 Universal recognition of the broken nature of primary care as a driver of capital investment

26:00 Steve differentiates agilon’s primary care model with what we may see from Amazon Care/One Medical model

27:30 “The Amazon decision on One Medical is the latest indicator that a number of competitors have identified primary care as a place to invest.”

29:00 The scarcity of primary care physicians (only 200K nationwide): “We must treat them well.  Competition is a good thing.”

30:00 PCP Shortage: only 20% of young doctors are going into primary care, and the percentage of PCPs in the physician workforce has fallen to 32%

31:45 The need to slow the attrition rate of primary care doctors leaving the profession (and how value-based primary care can make this happen!)

34:00 “My dream is that we are going to look like the rest of the world, where adult primary care becomes one of the top 5 medical specialties in the next 5-10 years.”

34:30 Steve discusses the significance of primary care physician compensation models in realigning incentives to “do the right things”

36:30 “The elegance and simplicity of our compensation model is that it aligns with better outcomes for patients, and that allows our physicians to win.”

38:00 The agilon vision “to transform the future of health care in 100+ communities across the country by empowering patient-physician relationships.”

40:00 Driving success through scalability and how that enables agilon’s mission and vision

41:00 How a scalable partnership model and VBC support platform integrates with local health care markets to achieve success

45:00 Steve discusses the impact of the COVID-19 on the value movement and how it will reshape the primary care landscape

46:00 How telehealth innovation and amplified access further strengthened patient-provider relationships during the pandemic (with net promoter scores actually increasing!)

47:30 Partnering with practices to address staffing shortages in clinical care teams

48:30 “The macro effects of COVID-19 have pushed us more towards value.”

49:30 Eric provides brief overview of the new ACO REACH model

51:00 Steve discusses the important opportunity of ACO REACH with agilon’s physician partners

53:00 The scale and concentration benefits of ACO REACH as a tipping point for risk-based value transformation

54:00 Perspectives on how ACO REACH will impact health equity outcomes for agilon’s communities

56:00 Steve describes how agilon’s partner practices are taking upstream actions to address social determinants of health

58:30 Steve discusses agilon’s recent IPO and why a publicly traded primary care company should have a long-term focus on positively impacting health care

63:30 Learn more about agilon health through online resources (website, Twitter, LinkedIn, Instagram) and by talking to their existing partners