MaineHealth, the largest health care network in the state, is entering a partnership with agilon health for the network’s Medicare Advantage patients.
The partnership will work on payment reforms, moving from a fee-for-service primary care model to a “value-based care model,” the health network announced. The agreement does not include any upfront costs for MaineHealth, the parent organizations of Maine Medical Center in Portland, seven other Maine hospitals and a network of primary care and specialized health services.
Value-based care prioritizes keeping patients healthy through prevention and caring for chronic illness rather than merely treating them when they fall ill. The insurer benefits because it is cheaper to keep patients healthy than to wait until they have serious illnesses that are expensive to treat.
MaineHealth and agilon health, based in Austin, Texas, will share in the cost savings of the payment reforms, said John Porter, MaineHealth spokesman.
Medicare Advantage is supplemental insurance for Medicare patients – typically those age 65 and older – to fill in the gaps for health care services that Medicare doesn’t pay for. Nearly 40,000 Maine residents have a Medicare Advantage plan through MaineHealth.
Under the new value-based care model, payments are made “based on the health outcomes” of patients and the “quality of services delivered,” compared to the current model, which pays based on the quantity of services provided.
“Through the partnership with agilon health, we will be accelerating the transition to a payment model defined by value and investing more deeply in our primary care delivery system. The depth of patient need, especially among our growing senior population, necessitates us to think very differently about what the primary care delivery system in our community needs to look like today and in the future,” said Dr. Andy Mueller, CEO of MaineHealth.
Agilon will help MaineHealth by “identifying patient conditions and mapping out care plans” for Medicare Advantage patients to help them get preventive care and to help manage chronic conditions.
The agreement is expected to be finalized in the coming months.