Study Shows 35% Jump in Medicare Patient Access Under Value-Based Care Model

Study also sheds light on how agilon health’s VBC model can enable primary care physicians to provide high-quality care for all seniors, including those with Traditional Medicare

WESTERVILLE, Ohio--(BUSINESS WIRE)-- agilon health (NYSE: AGL), the trusted partner empowering physicians to transform health care in our communities, today announced new research demonstrating the promising role of value-based care (VBC) in maintaining primary care for senior patients when supported by agilon health, a VBC-enablement company. The study was published in the May 2025 issue of Health Affairs Scholar.

“Primary care is foundational for Medicare beneficiaries, especially those with chronic conditions. Despite its importance, many senior patients, particularly ones with Traditional Medicare (TM), have difficulties finding a primary care provider (PCP) and establishing this enormously critical longitudinal relationship,” said Karthik Rao, MD, chief medical officer, agilon health. “As PCPs play a key role in providing comprehensive care to patients, we wanted to examine the role of VBC in improving primary care access in this population.”

Using claims data, researchers compared two groups of PCPs with TM patients in their panels: one group that received support from agilon health to adopt a VBC model and one group that maintained prevailing payment structures, primarily fee-for-service (FFS). Unlike FFS models that reward volume, VBC incentivizes PCPs to spend more time with patients and focus on their quality of care. The following results were observed in the study:

After shifting to VBC, PCPs saw eight more new TM patients per year compared to the matched cohort of physicians who did not transition to the full-risk model, representing an approximate 35% relative increase in new TM patient volume, a statistically significant finding (P < 0.001).

PCPs shifting to VBC kept their practices open to new TM patients for 0.7 more months per year on average – nearly one full month annually – compared to the other group (P < 0.001), a statistically meaningful increase in availability in the context of shrinking access and PCP workforce shortages nationally.

“This study provides timely, independent validation of agilon health’s VBC approach, confirming its role in increasing availability of primary care access for Medicare patients, including TM patients who historically face more limited options,” added Dr. Rao. “While agilon’s model is built around supporting physicians in full-risk arrangements through Medicare Advantage (MA) and ACO REACH contracts, this study shows that our model can have an even greater impact on communities by helping PCPs improve access to care across all of their Medicare patients.”

Study design

Using FFS claims data from 2019 to 2023, researchers compared two groups of PCPs with at least 50 TM patients in their panels: 208 PCPs who received support to adopt a VBC model for TM and MA patients in 2022 (“adopters”), and 3,657 similar PCPs who maintained their existing payment models (FFS) (“nonadopters”).

Researchers evaluated changes in two key outcomes between the two groups each year before, during and after VBC adoption. These outcomes included the number of new TM patients seen annually and the number of months each year that physician panels remained open to new TM patients. Researchers used difference-in-differences statistical methods to isolate the effect of joining the VBC model while accounting for other time-based trends. The primary study limitation was the nonexperimental design with a self-selected group of VBC-adopting PCPs.

National trends in primary care and the promising role of VBC

Access to primary care remains insufficient, despite its critical role in the U.S. healthcare system. Many areas are at risk of becoming “primary care deserts,” and even well-resourced health systems have started restricting the acceptance of new patients, regardless of insurance type. Additionally, a national shortage of PCPs is projected to reach 57,000 by 2040. Compounding the issue, Medicare payments have dropped by 29% since 2001 after adjusting for physician practice costs. In response, some PCPs have been limiting new patient intake for TM beneficiaries.

VBC models offer a promising path forward, leading to high-quality, cost-effective care. The Center for Medicare & Medicaid Innovation (CMMI) recently announced its goal to increase the share of Medicare beneficiaries in two-sided risk models. Unlike traditional FFS models, full-risk VBC arrangements provide PCPs with fixed payments based on patient demographics and complexity. In exchange, PCPs are held accountable for total medical spending and quality of care. These arrangements incentivize PCPs to proactively manage healthcare needs through efficient team-based approaches. By supporting care delivery transformation, it may also expand PCPs' capacity to serve more patients while maintaining high-quality care.

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.