logo
New Study Finds Senior Patients Managed by Women Physicians in a Value-Based Care (VBC) Model Have Equal or Better Clinical and Quality Outcomes and Less Healthcare Utilization

New Study Finds Senior Patients Managed by Women Physicians in a Value-Based Care (VBC) Model Have Equal or Better Clinical and Quality Outcomes and Less Healthcare Utilization

Business Wire5 days ago

WESTERVILLE, Ohio--(BUSINESS WIRE)--agilon health (NYSE: AGL), the trusted partner empowering physicians to transform health care in our communities, today announced the publication of new peer-reviewed data examining the impact of gender differences of primary care physicians (PCPs) on patient outcomes, healthcare utilization and revenue using different Medicare payment models, specifically value-based care (VBC) and fee-for-service (FFS). Research was published in the May 16, 2025, issue of the JAMA Health Forum.
In the study, researchers identified nearly 900 PCPs, of whom 40% were women, at 15 practice groups across seven states who deliver care through agilon's VBC model. Researchers then examined claims data from approximately 225,000 Medicare Advantage (MA) patients who were treated by these physicians, as well as the corresponding Stars quality data from national and regional payors. When comparing men and women PCPs in the same practice groups, researchers found that patients managed by women PCPs in a VBC model experience equal or better clinical and quality outcomes and less healthcare utilization, and the women physicians earned more per patient.
'The reversal of the gender gap under value-based payment implies that these models may be better aligned with desirable practice patterns that are more common in women, like spending more face-to-face time with patients in office visits,' said study author Ishani Ganguli, MD, MPH, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Specifically, researchers observed the following:
Outcomes: Senior patients managed by women PCPs experienced better key clinical outcomes, as evidenced by better hemoglobin A1C control and receipt of more eye exams for those with diabetes, compared to patients seen by men PCPs. Of note, similar patient outcomes were observed for blood pressure control and adherence to statin medication for cholesterol management between the two groups. In terms of quality scores, women PCPs had higher composite Stars quality scores, but lower provider rating scores than their men counterparts.
Utilization: While the number of primary care visits were similar between the two groups, visits to the emergency room (ER) and hospitalizations were substantially lower for patients seeing women PCPs compared to those seeing men PCPs.
Revenue: Compared to men PCPs in their own practice groups, women PCPs earned more per patient in the VBC model and similar amounts under the FFS model.
'As a woman physician, I believe VBC allows us the opportunity to leverage the relationships we develop with our patients, which correlates to improved outcomes, and the ability to be paid because of those important connections,' said study author Victoria DiGennaro, DO, Pioneer Physicians Network, Akron, OH. 'Our partnership with agilon health and implementation of its VBC model have been instrumental in enabling both of those to happen.'
agilon's VBC model, which puts the physician at the center, is known as the Total Care Model. The Total Care Model takes the same physicians, the same patients and the same payors, and moves them from the challenges of FFS into a total care relationship, which results in high-quality care and improved patient clinical and quality outcomes, lower healthcare costs and healthier communities. It encompasses long-term partnerships, a purpose-built platform and a Physician Network that helps physicians overcome obstacles and transition to VBC.
'In addition to agilon's Physician Network, another benefit of our partnership has been the focus on women physicians, which includes a Women Physician Leadership Council,' added Dr. DiGennaro. 'Many women physicians want to practice medicine as they were trained, while finding that critical work-life balance, and I'm proud to be a voice for them through my involvement on the Council.'
Study design
In this cross-sectional study, researchers examined PCPs with primary care specialties who participated in agilon's Total Care Model. A total of 872 PCPs (352 of whom were women) working in 15 practice groups in seven states (Ohio, Texas, New York, Pennsylvania, Connecticut, North Carolina and Michigan) were included, along with 223,810 MA patients. Women and men PCPs had similar education, years of experience and specialties.
There are several limitations to the study. First, results may not generalize beyond physicians who participate in risk arrangements. Second, MA patients represent only a portion of doctors' patient panels. And, finally, researchers cannot observe how individual practice groups translated MA payments to take-home wages (though comparing PCPs within the same practice groups mitigates this concern).
About agilon health
agilon health is the trusted partner empowering physicians to transform health care in our communities. Through our partnerships and purpose-built platform, agilon is accelerating at scale how physician groups and health systems transition to a value-based Total Care Model for their senior patients. agilon provides the technology, people, capital, process and access to a peer network of 2,200+ primary care physicians that allow its physician partners to maintain their independence and focus on the total health of their most vulnerable patients. Together, agilon and its physician partners are creating the healthcare system we need – one built on the value of care, not the volume of fees. The result: healthier communities and empowered doctors. agilon is the trusted partner in 30 diverse communities and is here to help more of our nation's leading physician groups and health systems have a sustained, thriving future. For more information, visit agilonhealth.com and connect with us on LinkedIn.

Orange background

Try Our AI Features

Explore what Daily8 AI can do for you:

Comments

No comments yet...

Related Articles

‘Having Medicaid keeps me alive': Illinois residents anxiously watch as Congress considers Medicaid cuts
‘Having Medicaid keeps me alive': Illinois residents anxiously watch as Congress considers Medicaid cuts

Chicago Tribune

time10 hours ago

  • Chicago Tribune

‘Having Medicaid keeps me alive': Illinois residents anxiously watch as Congress considers Medicaid cuts

Across Illinois, millions of people are anxiously awaiting the next move on a bill that would cut hundreds of billions of dollars from Medicaid across the country. The 'One Big Beautiful Bill Act' would slash the program, which provides health care coverage to people with low incomes, in order to help pay for tax cuts and border and national security. President Donald Trump and congressional Republicans say the bill would cut waste, fraud and abuse from Medicaid, providing coverage only to those who truly need it. But Democrats, health care leaders and patients say it would devastate those who rely on the program, and the hospitals that serve all patients. Across Illinois, 3.4 million people are on Medicaid — about one-fourth of the state's population. Depending on which proposals are adopted, Illinois could lose billions of dollars — a loss that could force the state to make difficult decisions about who gets coverage and what kind of coverage they get. Though the bill was still in flux as of Friday afternoon, multiple proposals in recent weeks have included work requirements for some people who receive Medicaid, changes to rules surrounding so-called provider taxes, and have threatened coverage for more than 770,000 Illinois residents who receive Medicaid as part of the Affordable Care Act's expansion of the program. 'No state, including Illinois, can backfill cuts in federal funding for Medicaid,' said the Illinois Department of Healthcare and Family Services, in response to Tribune questions. 'Cuts in federal funding will lead to reduced services and enrollment, putting the full range of Medicaid services at risk.' The Tribune spoke with three Illinois residents on Medicaid about what the cuts could mean to their lives. It's difficult to survive on $1,077 a month. That's how much Kristina Lewis receives in monthly Social Security disability payments. She gets disability payments from the federal government because she can't work due to mental health issues, heart failure and Type 1 diabetes, she said. The 64-year-old Alsip woman, however, has been able to stretch her small income, largely because she receives rental assistance from a local charity and because Medicare and Medicaid pay for her health care needs. She's one of nearly 400,000 people in Illinois who receive both Medicare and Medicaid because of disability, low income and/or age, according to KFF, a nonprofit organization focused on health policy. She's scared of what might happen if Medicaid, a state and federally funded program, is cut. She's on five different medications for heart failure alone. 'They do those cuts and I don't know how people like me on certain medications, how we're supposed to survive and live,' Lewis said. 'I know I'm not the only person out there that's terrified of what's going to happen.' House and Senate versions of the bill have included provisions that could make it more difficult for people who are enrolled in both Medicare and Medicaid to keep their Medicaid coverage, according to KFF. Lewis is also one of millions of people in Illinois who may end up dealing with the fallout of Illinois receiving fewer federal dollars overall, if certain proposals become law. Both the House and Senate have proposed changes that could limit the amount of money Illinois and many other states collect in so-called provider taxes, which help boost the amount of money states receive from the federal government for Medicaid. Proponents of provider taxes say they're a necessary way of funding Medicaid, while critics say provider taxes are a way for states to inflate how much money they receive from the federal government. Republican Rep. Chip Roy of Texas recently called provider taxes a 'Medicaid money laundering scam.' Though the concept of provider taxes may seem obscure and bureaucratic, in Illinois, they account for about $11 billion a year spent on Medicaid — about 25% of the state's spending for medical services, according to the Illinois Department of Healthcare and Family Services. Senate Republicans' proposal to reduce provider taxes suffered a major setback Thursday, after the Senate parliamentarian shot it down, saying it didn't follow procedural rules, according to The Associated Press. It was not yet clear Friday afternoon if changes to provider taxes would still be part of the final bill. Limiting provider taxes is a 'backdoor' way of cutting federal Medicaid funding for Illinois, said Kathy Waligora, a spokesperson for EverThrive Illinois, a nonprofit advocacy organization working to achieve reproductive justice. 'The provider tax is absolutely going to shrink the size of the Medicaid program in Illinois,' Waligora said of proposed cuts. 'Exactly what benefits are cut, what provider rates are cut, what eligibility will be cut remains to be seen, but it will be across Medicaid.' Lewis is worried about any kind of reduction to her Medicaid benefits. She said she first got on Medicaid about 10 to 15 years ago when she was living in a nursing home because of health issues. Eventually, her health improved to the point where she could live independently. She worries that if her health issues again become unmanageable, she might have to one day return to living in a nursing home. 'I would really, really struggle,' she said of if her Medicaid benefits were cut. 'My biggest fear is to end up in another nursing home. You lose your independence.' If she did have to live in a nursing home again, Medicaid may end up footing the substantial bill. In Illinois, Medicaid pays for about 68% of all nursing home care, according to the state Department of Healthcare and Family Services. Cornelia Simms, 60, of Auburn Gresham, fears work requirements could make it difficult for her to stay on Medicaid — even though she has a job. Under the bill, childless, able-bodied adults ages 19 to 64 would be required to spend at least 80 hours a month working, doing community service or going to school, in order to stay on Medicaid. Simms already works about 80 hours a month as a home health care aide — a profession she got into after spending years caring for her ailing mother. She discovered that she enjoys helping elderly people and stuck with it after her mom passed away. About 70% of Illinois residents on Medicaid already work, according to KFF. But Simms worries about the paperwork, and the potential problems it could create if she's subject to work requirements. The bill would require states to verify at least twice a year that Medicaid beneficiaries are meeting work requirements. Simms is concerned about being asked to prove that she's eligible twice a year, especially because she said she prefers to verify her eligibility in person, which can require time away from work. It can be tough for her to take days off from work because the person she cares for relies on her help, Simms said. 'I'm mainly her sole person to take her to the hospital, grocery stores and do all those things with her,' Simms said. 'If I have to take off work to see about my Medicaid then she will be lacking the daily things that she needs.' The extra paperwork can also create administrative complications. Once, Simms said she forgot to submit paperwork to verify her continued eligibility for Medicaid. Simms lost her coverage, and it took more than six months to get it back, she said. During that time, she canceled doctor appointments and generally tried not to get medical care. 'I tried not to catch a cold,' Simms said. 'I just prayed and held out.' In Illinois, anywhere from 270,000 to 500,000 people on Medicaid may end up losing coverage for administrative reasons, if work requirements proposed by House Republicans went into effect, according to the Illinois Department of Healthcare and Family Services. 'What we see in other states where there are work requirements is that having the hoops to jump through, the red tape and the administrative burden keep people from accessing and enrolling in health care,' said Anusha Thotakura, executive director of Citizen Action/Illinois, a public interest coalition that's been working with partners across the state to hold events and drive action to fight Medicaid cuts. 'Many eligible people who are working will still lose access if these requirements are put into place,' Thotakura said. Without Medicaid, Simms said it would be difficult for her to afford health care. She's in the process now of getting about $4,000 worth of dental work, most of which is being paid for by Medicaid, she said. 'No person, unless you've got some money, can afford it, not on a 9-5 (job), not the lower class or middle class,' Simms said of health care. 'It's impossible.' Isaiah Rogers was up in a tree, wielding a chain saw when his vision began to blur. He didn't know what was wrong with him, but he knew he couldn't continue his work trimming trees. Dizzy and in pain, Rogers went home, rested and popped ibuprofen. Eventually, Rogers' son convinced him to go to the hospital. There, he was diagnosed with Type 2 diabetes and told that if he had waited a couple of more days to seek care, he might have died. The hospital helped sign Rogers up for Medicaid, he said. Since that scare several years ago, Rogers has faithfully been going to his doctor appointments and taking insulin and other medications, he said. He has not been able to return to his job trimming trees, and has been working small side jobs. He and his son have been staying with a friend to help them get by. The 61-year-old West Pullman man relies on Medicaid to pay for his doctors' visits and the medications that 'keep me above water.' Rogers is now worried about losing that lifeline. A recent version of the bill proposed work requirements not only for childless able-bodied Medicaid recipients, but also for adults with children older than 14. Rogers' son is 12. The single father is concerned that there might come a point when he would be subject to the proposed requirement to work 80 hours a week or lose his Medicaid coverage. Between his health issues and caring for his son, as well as his lack of a high school diploma, Rogers doesn't think it would be possible for him get a job working 80 hours a month. Rogers drops his son off and picks him up from school each day, taking city buses with him to and from the school. He doesn't envision letting his son take the buses himself. 'At 14, no, not in Chicago,' Rogers said of his son taking the bus alone. 'People who don't ride the bus and don't live in our 'hood, they don't know what's going on. I'm not going to subject my son to that danger.' He knows the dangers all too well. Rogers was incarcerated when he was younger, saying he was once a 'destroyer' of his community. He's since tried to turn his life around, working with Community Organizing and Family Issues to create positive change. But his life now, as he knows it, depends on having Medicaid. He's confident he'll lose Medicaid if he's required to work 80 hours a month. He worries that if he loses Medicaid, he'll no longer be able to afford insulin and his other medications, and he may slip into a diabetic coma or suffer a stroke. 'Having Medicaid keeps me alive,' Rogers said. 'It keeps me going, with the consistent doctors appointments, with the different types of medications. 'Having Medicaid helps me stay healthy to let me take care of my son,' Rogers said.

CVS Health Corporation (CVS) Outpaces Broader Market with Strong 2025 Rally
CVS Health Corporation (CVS) Outpaces Broader Market with Strong 2025 Rally

Yahoo

time14 hours ago

  • Yahoo

CVS Health Corporation (CVS) Outpaces Broader Market with Strong 2025 Rally

CVS Health Corporation (NYSE:CVS) is one of the Best Dividend Stocks of 2025. A row of shelves in a retail pharmacy, demonstrating the variety of drugs and over-the-counter products. Following a challenging year in 2024, CVS Health Corporation (NYSE:CVS) appears to be making progress toward a recovery. The company remains committed to becoming the most trusted healthcare provider in the United States by delivering improved care, value, and service through its integrated and industry-leading operations. The stock has surged by over 50% since the start of 2025. With a strong focus on customer needs, CVS Health Corporation (NYSE:CVS) reported positive results across its Health Care Benefits, Health Services, and Pharmacy and Consumer Wellness segments. The company continues working toward its goal of building a healthier future for the 185 million individuals it serves. CVS Health Corporation (NYSE:CVS) also updated its full-year 2025 guidance for GAAP diluted earnings per share, adjusted earnings per share, and operating cash flow to reflect strong performance across all business areas. However, the company is maintaining a cautious outlook for the rest of the year due to ongoing elevated cost trends and potential broader economic challenges. CVS Health Corporation (NYSE:CVS) has paid regular dividends to shareholders since 1997. The company's quarterly dividend comes in at $0.665 per share for a dividend yield of 3.90%, as of June 26. While we acknowledge the potential of CVS as an investment, we believe certain AI stocks offer greater upside potential and carry less downside risk. If you're looking for an extremely undervalued AI stock that also stands to benefit significantly from Trump-era tariffs and the onshoring trend, see our free report on the best short-term AI stock. READ NEXT: and . Disclosure. None. Sign in to access your portfolio

Traditional Medicare to add prior authorizations
Traditional Medicare to add prior authorizations

Axios

time20 hours ago

  • Axios

Traditional Medicare to add prior authorizations

Medicare is requiring more pre-treatment approvals in its fee-for-service program in a bid to root out unnecessary care, federal regulators announced Friday. The big picture: Traditional Medicare historically hasn't required prior authorizations to access most drugs or services, a major perk for enrollees. Prior authorization in privately-run Medicare Advantage plans has become a hot-button issue, with Congress and federal regulators working to rein in the practice. Federal inspectors found in 2022 that prior authorization in MA prevented some seniors from getting medically necessary care. Major health insurers this week made a voluntary pledge to streamline and improve the prior authorization process across all health insurance markets. State of play: Medicare's innovation center announced that it will solicit applications from companies to run the prior authorization program. Medicare is looking for companies with experience using AI and other tools to manage pre-approvals for other payers, and with clinicians who can conduct medical reviews to check coverage determinations. The program will start Jan. 1, 2026 and run through the end of 2031. It will only apply to providers and patients in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. The change will apply to 17 items and services, including skin substitutes, deep brain stimulation for Parkinson's Disease, impotence treatment and arthroscopy for knee osteoarthritis. CMS selected the services based on previous reports and evidence of fraud, waste and abuse, as well as what's already subject to prior authorization in Medicare Advantage. Overuse of skin substitutes to help heal wounds has especially come under fire in recent years. Medicare spent more than $10 billion on the products in 2024 — more than double what was spent the year before, according to the New York Times. CMS noted that it may make other services subject to the prior authorization program in future years. Providers in the geographic areas can choose whether or not they want to submit an authorization request before delivering a service. But if they decide not to, they'll be subject to post-claim review and risk not getting paid for a service that was already delivered. "In general, this model will require the same information and clinical documentation that is already required to support Medicare FFS payment but earlier in the process, namely, prior to the service being furnished," the notice reads. Zoom in: The companies hired to manage the program will be paid based on how much they saved the government by stopping payments for unnecessary services. "Under the model, we will work to avoid any adverse impact on beneficiaries or providers/suppliers," CMS wrote in the notice.

DOWNLOAD THE APP

Get Started Now: Download the App

Ready to dive into a world of global content with local flavor? Download Daily8 app today from your preferred app store and start exploring.
app-storeplay-store