Specialist
Former VP at Aledade Inc
Agenda
- Provider VBC (value-based care) software market – recent trends and developments
- Competitive landscape across major players such as Evolent Health (NYSE: EVH) Agilon Health (NYSE: AGL), Aledade and Privia Health Group (NASDAQ: PRVA)
- Platform differentiation and respective value proposition to provider partners
- Breakdown of VBC unit economics and cost containment strategies
- 2023 outlook – long-term industry risks and growth expectations
Questions
1.
What are some major trends and developments you’ve been following in the provider value-based software solutions space that might better inform our Interview around names such as Evolent, Privia and Agilon?
2.
We saw many major Medicare Advantage health plans take significant CMS [Centers for Medicare & Medicaid Services] star rating hits in 2022. What do you think has been the fallout from those reduced quality metrics in terms of membership attrition or plan hopping? What’s the trickle-down impact on provider groups participating in these risk capitation models?
3.
What are your thoughts on the penetration opportunity for health plan partnerships for some of the platforms? We’ve seen Agilon score a major JV with MaineHealth and Privia announce partnerships with OhioHealth system and Novant Health. How are you viewing the remaining addressable revenue opportunity and growth runway there?
4.
Approximately what percentage of large health systems do you think are happy to work with some of the VBC [value-based care] platforms vs more reticent?
5.
What balance do you think groups such as Privia, Agilon and Evolent will strike between independent physician groups, health systems, direct contracting and other avenues in terms of their partnership mix over the longer term, and why?
6.
Could you break out the unit economics in some of these PCP [primary care physician] value-based arrangements, appreciating it will differ considerably by company and patient demographic? How much can the provider partner expect to make in a commercial-based contract vs Medicare Advantage, etc? What’s the expected revenue split of shared savings and/or margin profile in each scenario?
7.
How do you assess the ongoing competitive dynamics among Privia, Aledade, Agilon and Evolent across the independent physician group market? Could you juxtapose the relative value they’re bringing to provider partners, as we look to get a better understanding of which entities might be best-positioned for long-term success in the space?
8.
We discussed contract stickiness dynamics briefly. What happens if another VBC solutions vendor is delivering much higher platform contributions back to the provider? How would that shift the decision rationale and switching costs, and how are you viewing overall stickiness over the next 2-3 years?
9.
How does profitability roughly compare on patients who’ve been in the network for one, two and three-plus years? Is there a notable upward trend in platform contribution from more mature members?
10.
What are your thoughts on how the groups’ relationships with payers will evolve over the next few years? Provider software players still rely on payers for patient health data and access. Do you see increasing competition or friction on the horizon, either from payer consolidation of provider groups, or perhaps even carriers building out VBC capabilities in-house to compete more directly with players such as Privia or Aledade?
11.
How might some of the consolidation dynamics you’ve mentioned materialise over the next few years? Do you think we’ll see VBC groups combining to achieve greater scale or payers getting acquisitive and perhaps purchasing one of these names? What do you think are likely scenarios and why?
12.
Would you like to highlight anything else around the provider VBC software market or any of the companies we’ve discussed?
13.
What’s your 12-18-month outlook for the provider VBC software industry, perhaps emphasising the most important factors for us to monitor over that time frame?
