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

What this episode covers

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