Agilon Health (AGL) came out with a quarterly loss of $0.41 per share versus the Zacks Consensus Estimate of a loss of $0.28. This compares to loss of $0.14 per share a year ago. These figures are adjusted for non-recurring items.This quarterly report represents an earnings surprise of -46.43%. A quarter ago, it was expected that this senior-focused health care company would post a loss of $0.05 per share when it actually produced a loss of $0.06, delivering a surprise of -20%.Over the last four quarters, t ...

Business Model and Partnerships - The company operates under a Total Care Model, which is a value-based care reimbursement model, allowing physicians to focus on improving care quality and sharing in financial surpluses when premiums exceed medical costs[24]. - The company has long-term partnerships with community-based physician groups, typically lasting 20 years, resulting in a growing and recurring revenue stream with over 90% visibility into projected annual revenue[20]. - As of January 1, 2024, the company has relationships with 29 health plan payors across 32 geographies, enhancing access to value-based care reimbursement structures[31]. - The global capitation fees from health plan payor contracts are based on a defined percentage of monthly premium payments received from CMS for attributed members[30]. - The company has entered into risk-bearing, global capitation agreements with payors, which typically require risk-bearing capital averaging between 1.0-3.0% of projected annual gross revenue[32]. - The ACO REACH Model involves eight approved ACOs, with each ACO selecting the Global risk-sharing option, assuming accountability for the total cost of care for aligned beneficiaries[36]. - Each ACO under the ACO REACH Model will transition to compensating physician partners on a per Medicare beneficiary per month (PBPM) basis by 2025, moving away from fee-for-service compensation[37]. - The company aims to expand its geographic reach by partnering with community-based physician groups across the United States, supported by a dedicated business development team[41]. - The enterprise marketing team develops local branding strategies to support the growth of physician partners and their Medicare patient populations[42]. Regulatory Compliance and Legal Risks - The healthcare industry is subject to extensive regulation, and the company must comply with numerous federal, state, and local laws[57]. - The company has structured its business arrangements with healthcare providers to comply with the Anti-Kickback Statute (AKS) and fit within safe harbors, ensuring that payments for healthcare services do not incentivize marketing or member enrollment[71]. - Violations of the federal and state False Claims Acts (FCAs) can result in treble damages, substantial penalties for each false claim, and exclusion from federal healthcare programs[68]. - The Stark Law prohibits physicians from referring Medicare and Medicaid patients to entities with which they have a financial relationship unless specific exceptions apply, with penalties including civil fines of up to $15,000 per service[76][77]. - The company has sought to comply with the ACO REACH Model by ensuring that protected arrangements align with quality, care coordination, and cost-reduction goals[75]. - The Civil Monetary Penalties Law allows for significant penalties for presenting false claims, with potential assessments of up to three times the total amount claimed for each item or service[82][83]. - The company is subject to scrutiny under state laws that may differ from federal regulations regarding kickbacks and self-referrals, which can vary significantly across states[73][84]. - The Regulatory Sprint initiative aims to facilitate the transition to value-based care by amending the AKS to include new safe harbors for value-based arrangements[74]. - The company performs monthly checks on employees and affiliated providers to ensure compliance with federal healthcare program exclusions[82]. - The Health Care Fraud Statute prohibits schemes to defraud healthcare benefit programs, with violations potentially resulting in felony charges and significant penalties[81]. Financial Performance and Risks - The company has a history of net losses and anticipates increasing expenses in the future, which may hinder profitability[117]. - Medical expenses incurred on behalf of members may exceed the revenues received, potentially leading to financial losses[124]. - The company relies on a limited number of physician partners and payors, which poses risks to its operational scalability and growth initiatives[118]. - Expansion into new geographies may face challenges in securing contracts with MA payors, impacting financial targets[126]. - Startup costs for developing physician partner relationships may not be recoverable if partnerships do not mature as expected[127]. - The company expects that fluctuations in medical costs and service utilization could adversely affect its financial condition[125]. - A significant reduction in membership could adversely affect the company's financial condition, as payor contracts compensate on a per-member basis[133]. - The company may incur significant losses if healthcare service expenses exceed revenues from payors under capitation contracts[169]. - Changes in reimbursement rates from CMS could adversely impact revenue, with potential volatility in MA revenues affecting financial results[186]. - The company may face repayment requests from health plans if CMS adjusts payments based on audits, which could lead to significant financial liabilities[174]. Technology and Data Security - The company relies on proprietary technology, including the "CORE" technology platform and HCC Manager risk adjustment software, to support operational programs and clinical insights[48]. - The company is highly dependent on information technology networks and systems for secure data management, which may be vulnerable to cyberattacks and breaches[150]. - Cybersecurity risks have increased due to geopolitical events, including Russia's invasion of Ukraine, potentially leading to retaliatory cyberattacks[152]. - Breaches of data security could result in significant liabilities under laws like HIPAA, potentially leading to damages and regulatory penalties[153]. - The company faces significant risks related to cybersecurity, data breaches, and the protection of proprietary information[110]. Market Competition and Economic Factors - The healthcare industry is highly competitive, with the company facing competition from various entities providing value-based care services[43]. - Increased competition in the healthcare industry could hinder the company's ability to attract payors and physician partners, potentially affecting profitability and market share[193]. - The company faces competition from well-financed payors that may offer managed services at discounted prices, increasing challenges to achieve projected growth rates[194]. - Economic downturns or reduced government expenditures could have a material adverse effect on the company's financial condition and operations[189]. - Unfavorable economic conditions may lead to reduced benefits for members, resulting in decreased overall membership, premiums, and fee revenues, adversely affecting the financial position of physician practice groups[191]. - The current macroeconomic environment includes high inflation, supply chain challenges, and labor shortages, which may impact the operations and financial condition of physician partners and payors[192]. Employee and Organizational Health - As of December 31, 2023, the company had 1,117 employees, with none being members of a labor union[56]. - The company emphasizes a strong commitment to employee health, safety, and wellness, which are vital to its success[56]. - The company has implemented measures to promote pay equity, including benchmarking roles against market comparables and increasing pay transparency[53]. Intellectual Property and Compliance - The company maintains its intellectual property through a combination of trademark law and confidentiality procedures[45]. - The company has significant intangible assets that may not be fully realized, leading to potential impairments affecting financial condition[149]. - The company maintains a compliance program to monitor adherence to federal and state laws, which includes conducting periodic audits and mandatory educational programs for employees[105].

AUSTIN, Texas--(BUSINESS WIRE)--agilon health, inc. (NYSE: AGL), the trusted partner empowering physicians to transform health care in our communities, announced that it will participate in the 44th Annual Cowen Health Care Conference including a fireside chat on Tuesday, March 5 at 12:50 PM Eastern Time. Interested investors and other parties may listen to a simultaneous webcast of the presentation by visiting the “Events & Presentations” section of agilon health’s investor relations website at https://in ...

AUSTIN, Texas--(BUSINESS WIRE)--agilon health, inc. (NYSE: AGL), the trusted partner empowering physicians to transform health care in our communities, announced that it will release its financial results for the fourth quarter and full year 2023 after the market closes on Tuesday, February 27, 2023, and host a conference call at 4:30 PM Eastern Time the same day to discuss the results. The conference call can be accessed by dialing (833) 470-1428 for U.S. participants and +1 (929) 526-1599 for internation ...

AUSTIN, Texas--(BUSINESS WIRE)--agilon health, inc. (NYSE: AGL), the trusted partner empowering physicians to transform health care in our communities, announced today that Benjamin Kornitzer, M.D., will assume a strategic role as special advisor to the company and will transition from his role as chief medical officer (CMO) effective March 1, 2024. agilon health has initiated a comprehensive search process to identify a new CMO. Until a successor is named, Karthik Rao, M.D., senior medical director and vic ...

This year is going to offer a lot of opportunities for risk seeking investors. The world of penny stocks is well known to be speculative and is usually the domain of investors possessing a risk seeking profile.The year is shaping up to be a strong one for speculative investment. The Federal Reserve is slated to cut interest rates multiple times this year, which should cause a flood of liquidity in the markets as lending rates fall. Cheaper lending will lead to increased risk appetites overall, benefiting sp ...

In the investment space, uncovering stocks to sell with potential pitfalls is as crucial as identifying opportunities. This comprehensive review zooms in on the recent moves of three prominent companies that have sent ripples through the market. These aren’t just fluctuations, but indicators of underlying operational vulnerabilities, providing essential insights for investors seeking portfolio resilience.Each of these stocks to sell has a tale of challenges impacting profitability and investor sentiment. Un ...

BOSTON, Jan. 05, 2024 (GLOBE NEWSWIRE) -- Block & Leviton is investigating Agilon Health, Inc. (NYSE:AGL) for potential securities law violations. Investors who have lost money in their Agilon Health investment should contact the firm to learn more about how they might recover those losses. For more details, visit https://www.blockleviton.com/cases/agl. What is this all about? Before the market opened on January 5, 2024, Agilon Health announced it had reduced its guidance for fiscal year 2024, citing higher ...

Shares of Agilon Health Inc. AGL, -0.25% were indicated down more than 1% in Friday’s premarket, after the health care services company lowered its 2023 margin outlook, citing higher costs, but provided an upbeat 2024 outlook. “Higher-than-expected costs became visible to us in mid-December during the November close process given updated data from health plans and will impact our FY2023 medical margins,” said Chief Executive Steve Sell. While the company raised its guidance range for Medicare Advantage mem ...

AUSTIN, Texas--(BUSINESS WIRE)--agilon health, Inc. (NYSE: AGL), the trusted partner empowering physicians to transform health care in our communities, today announced that Timothy Bensley has informed the company of his intent to retire from his position as Chief Financial Officer (CFO) during 2024, which agilon expects to take place within the next nine months. The search for a new CFO has been initiated, and Bensley has agreed to remain as CFO through this process and serve in a consulting role through t ...