Industry Insight

New Tech Company to Address Value-Based Care

agilon health, a health care services and technology company aiming to accelerate the conversion to value-based health care, recently announced its formation. The company brings together established value-based health care delivery systems, physician risk enabling infrastructure, and proven operating talent from across health care. The combination of these capabilities and a unique partnership-centric approach offers providers on a national basis the opportunity to successfully transition to risk-based business models.

agilon health empowers physicians and other providers with the clinical, technological, and administrative capabilities to function effectively in a health care system undergoing a structural shift to a compensation model based on outcomes, rather than traditional fee-for-service, and to capture the inherent opportunity in bearing global financial risk associated with improving patient outcomes and lowering system costs. agilon health, through its value-based delivery systems, has a strong track record operating in multiple capitated markets, currently managing more than 475,000 patients through a network of more than 1,500 primary care physicians and 8,000 specialists. agilon health’s partnership solution includes information and support systems, data analytics, and sophisticated medical management infrastructure to support physicians across the risk spectrum, from professional capitation to full capitation. Ronald A. Williams, former chairman and CEO of Aetna, is agilon health’s chairman.

“Our mission is to be a great partner with physicians, whose pivotal role in improving care quality and efficiency puts them on the front lines of the transition to value-centric health care,” Williams says. “We have the specialized capabilities and clinical, administrative, and technological infrastructure necessary to help providers navigate this transition.”

“We believe our innovative model improves quality, reduces cost, satisfies providers, and engages patients, adding up to a system of care that any of us would want for our family and friends, all while transforming the physician economic model,” says Stuart Levine, MD, chief medical and innovation officer for agilon health.

“In a very real way, agilon health is helping to revive the joy of practicing medicine by providing physicians with the opportunity to participate in a next-generation care delivery system that allows them to focus more on quality of care and less on volume of activity,” says Manoj Mathew, MD, agilon health’s national medical director.

Core to the company’s relationships with physicians are its integrated clinical, administrative, and financial solutions, specifically built for the delegated physician risk market. Initially developed in 1996 by Gerry Ibanez, who remains a senior executive at agilon health, the company’s proprietary technology platform currently includes products for Medicare’s stars program, burden of illness management, pay for performance, care management, and a fully integrated administrative platform that includes claims payment. It’s also particularly tailored for managing the growing Medicaid, Medicare, Expansion, and Duals populations, which agilon health currently serves directly in California and Hawaii. The technology platform, which is highly portable to new markets, also supports the management of more than 1.3 million patients for numerous well-known third-party providers and health plans across the country.

In California, agilon health has made a significant investment in supporting and enhancing the quality of care delivery in the rapidly growing Medi-Cal market (California’s version of Medicaid). agilon health operates a management services organization that, along with its affiliated independent provider associations (IPAs), services a patient base of more than 450,000 primarily Medi-Cal members in Riverside, San Bernardino, San Diego, Fresno, and Los Angeles. agilon health’s largest affiliated IPA, Vantage Medical Group (formed in 1993), is the largest independent Medi-Cal IPA in the Inland Empire (Riverside and San Bernardino counties), one of the largest and fastest growing Medicaid communities in the country.

In Hawaii, agilon health is delegated for professional and institutional risk, taking full risk for the management of approximately 24,000 Medicare Advantage patients in exchange for a percentage of the Centers for Medicare & Medicaid Services premium. The full risk model developed by agilon health is the first of its kind in the Hawaii market, which has historically been defined by traditional, fragmented, and more expensive fee-for-service health care. agilon health has been operating in Hawaii since 2003, and, as of today, more than 800 primary care physicians and 2,000 specialists are a part of the agilon health network in Hawaii. agilon health’s unique management services organization model relies on its own proprietary clinical and administrative technology applications to support its management of delegated risk.

“I am excited to team up with a strong financial partner like Clayton, Dubilier & Rice and a growing group of operating talent to accelerate investment in the technology platform and unique physician risk infrastructure we have developed to expand our footprint and help transform care delivery nationally at a critical time in health care,” Ibanez says.

“We are in the process of expanding to other geographies based on agilon health’s unique physician-centric partnership model tailored for local market needs. The growth in risk-based models driven by reimbursement changes, growth in government lives, and growing physician dissatisfaction is creating an opportunity to reinvent local health care delivery markets through creative strategic partnerships with providers,” Williams says.

— Source: agilon health

Health Navigator Partners With Find-A-Code

Health Navigator recently announced that it has partnered with Find-A-Code, the most complete medical coding and billing resource library available, to improve productivity and efficiency for professionals who process billing and payment of medical services. As part of the collaboration, Find-A-Code users will have access to an additional 14,000 medical search terms and codes.

“Find-A-Code makes medical coding easier by providing extensive search terms that are linked to medical codes, which makes them a natural partner for Health Navigator,” says Patty Maynard, senior vice president of business development at Health Navigator. “In the same spirit as Find-A-Code, our system of coded chief complaints is always being updated to keep up with changes in medical coding and trends in patient calls and inquiries. And our Natural Language Processing technology connects the plain language of patient symptoms to these industry codes.”

Users and subscribers of Find-A-Code’s online resources use search terms to help identify appropriate codes more efficiently. Customers range from small clinics to large medical practices, hospitals, teaching colleges, health insurance companies, and the federal government. Find-A-Code data aligns with codes from major health organizations, such as Medicare, Medicaid, Centers for Disease Control and Prevention, health plans, the American Medical Association, American Hospital Association, and the American Dental Association.

“Find-A-Code customers need to quickly identify relevant codes, which is why we are laser-focused on gathering the most appropriate search terms for each code,” says David Berky, CIO of Find-A-Code. “Our partnership with Health Navigator significantly expands our library of search terms, so users can find what they’re looking for faster.”

— Source: Health Navigator

Case Study Examines the Role of HIM Professionals
in Facility Closure

The Fall issue of Perspectives in Health Information Management, the online research journal of AHIMA, features the latest research on topics such as implications for radio frequency technology on the pharmaceutical industry as well as an evaluation of health information exchange (HIE) systems in nursing homes.

The case study, “Facility Closure: How to Get In, Get Out, and Get What Is Important,” examines HIM’s role in the closing of a health care facility as well as the impact on revenue cycle operations. Using the closure of an acute care hospital in 2015 as an example, the authors emphasize that HIM professionals are uniquely positioned to assist an organization in closure efforts because of their knowledge of revenue cycle operations, ability to work with the software products used to generate and store patient information, and solid understanding of the process of care and treatment of the patient. The authors recorded their experiences through the facility closure process so they could offer them to other HIM professionals to provide a basic primer to ensure that all requirements are addressed. “HIM professionals and revenue cycle experts should know and understand what is involved with a facility closure because they will most likely be involved in this process at some point in the near future, either directly or indirectly,” the authors wrote.

“This study emphasizes the value that HIM professionals bring to their jobs every day,” says AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. “HIM professionals will liaise with the compliance, legal, risk management, and information technology departments to determine what legal requirements are tied to the facility closure so they can act accordingly. This study should spark ideas or discussions that could help HIM professionals further identify areas that need to be addressed during the closure process.”

— Source: AHIMA