What is an ACO?

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.

The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

How Our Allied Physicians ACO Operates

Types of ACO Participants

ALLIED PHYSICIANS ACO LLC was formed as a new
entity in 2014 and is comprised of professionals in a group practice
arrangement and network of individual practices of ACO professionals.

Allied Physicians ACO Amount of Shared Savings/Losses

  • Agreement Period beginning 2014, Performance Year 2014:   $0
    • Proportion invested in infrastructure: $0
    • Proportion invested in redesigned care processes/resources: $0
    • Proportion of distribution to ACO Participants: $0
  • Agreement Period beginning 2015, Performance Year 2015:   $0
    • Proportion invested in infrastructure: $0
    • Proportion invested in redesigned care processes/resources: $0
    • Proportion of distribution to ACO Participants: $0

Allied Physicians ACO "How Shared Savings are Distributed"

The Shared Savings will be distributed as follows:

  • For the ACO Primary Care Physicians: Thirty percent (30%) of the shared saving bonus toward reporting and improving on the 34 quality measures set by CMS.  The ACO will only award this bonus to those primary care Participants who meet or exceed CMS’s benchmark for pay for performance bonus.
  • Equal distribution of thirty (30%) shared savings bonus to each of the contracted primary care Participants.
  • Equal distribution of fifteen (15%) shared savings bonus to contracted specialists and ancillary Participants.
  • Fifteen percent (15%) of the shared savings bonus will be allocated to investing in data systems allow for tracking quality measures and giving feedback to Participants.  In addition, the ACO will assist contracted primary care Participants to install or supplement their Electronic Health Records (EHRs) and encourage patients to communicate with their physicians over the Web or by e-mail, create a blended patient registry for all chronic conditions that identifies patients with multiple chronic conditions, focus case management by diagnosis and high impact patients and integrate case management with planned visits and point-of-care information  from disease registries.

The remaining ten percent (10%) will be reserved to allow the ACO to transition to Track 2 or 3 (risk sharing of both savings and losses) in the following contract period.

The bonus to be paid to the Non-Investor Participants will be based on performance metrics which will be determined by Allied Performance Committee.  Such performance metrics will be designed to encourage Non-Investor Participants to adhere to quality assurance and improvement programs, and evidence based clinical guidelines.

Allied Physicians ACO Outreach to Beneficiaries

PCP participant providers will have the capability of speaking to the beneficiary/family/significant other/caregiver in the beneficiary’s primary or preferred language;

Beneficiary may be given brochures, handouts or other printed materials as appropriate;

Beneficiaries/family/significant other/caregiver will be given all opportunities to ask questions and alternatives to treatment explained in order for informed decision making to be done;

The beneficiaries will be engaged in shared decision making, with consideration to the beneficiaries’ individual unique needs, preferences, values and cultural alignment.

Allied Physicians ACO Beneficiary Data Sharing Option

Beneficiaries not wanting to share data can contact Medicare.

If you choose, you can ask Medicare not share your personal health information shared with us by calling Medicare.

Call 1-800-MEDICARE (1-800-633-4227)

TTY users should call 1-877-486-2048

Allied Physicians ACO Care Coordination Process

The ACO’s methods and processes to coordinate care: All provisions of service are provided in a beneficiary centered model. The beneficiary is encouraged to have ownership of their healthcare goals. Beneficiaries are valued for their contributions to their care and are respected as unique individuals. Families and support systems are always welcomed and included when available.

Allied Physicians ACO Individualized Care

CASE MANAGEMENT PROGRAM

The entire program focuses on key diseases and aims to reduce avoidable acute inpatient admissions and unnecessary emergency room utilization.
Participant Providers, Beneficiaries and family may make a referral to Case Management.
Any beneficiary who is identified as requiring assistance in managing an acute or chronic health problem including, but not limited to, frequent hospital admissions or emergency room visits, non-compliance with medical management protocols, catastrophic illnesses or injuries or complicated/complex conditions are appropriate candidates for case management.

The ACO Case Management program consists of the following:

Identification and screening of beneficiaries who are experiencing difficulty or have potential for requiring assistance in managing their health care needs;
Assessments of the clinical, environmental, physical and psychosocial factors that influence the beneficiaries’ ability to comply with a treatment plan or participate in managing a healthy life style;
The beneficiaries will be engaged in shared decision making, with consideration to the beneficiaries’ individual unique needs, preferences, values and cultural alignment;
Development of a care plan that reflects the priority needs of the beneficiary and is coordinated with other participant providers;
Identification and coordination of services that match the needs of the beneficiary with the available and appropriate resources;
Monitoring and reassessment of the care plan based upon the beneficiary’s’ progress towards achievement of established goals;
Maintenance of confidentiality and organization of the beneficiary’s’ case management file

ACCESS TO COMMUNITY RESOURCES

This is to incorporate access to community resources into the care planning of beneficiaries and ensure information about community resources is provided to beneficiaries.
Community Resource Programs provide services such as transportation, meals-on-wheels, nutrition programs, counseling, friendly visitor, telephone re-assurance, legal counseling, etc.
All Case Management staff shall be oriented and have ready access to community resources that can supplement or complement the care programs beneficiaries.
Beneficiaries shall be referred to community resources, if needed, in their area of residence in order to enhance the coordination of services and to ensure continuity of care.

ACUTE CASE MANAGEMENT

Beneficiaries admitted to acute inpatient or secondary facilities will be overseen by the ACO Case Manager in collaboration with the facility based Case Manager. Anticipatory post discharge needs will be planned. Medication reconciliation will be captured at discharge and forwarded to the Case Manager.

DISCHARGE PLANNING AND POST DISCHARGE CASE MANAGEMENT

The Case Management staff will evaluate the acute stay discharge requirements of all beneficiaries and provide telephonic follow up on any beneficiary at risk.
The Case Management staff will contact beneficiaries post hospital discharge to determine if there are care issues or access problems.
The goal of a discharge telephonic interview is to assure that the beneficiary is and will be receiving the care recommended at the time of discharge; prevent re-admissions to the hospital, and early identification of new care requirements.

Of special concern are the following areas that would have been addressed in the beneficiaries’ discharge plan:

Do beneficiaries have their medications?
Did they schedule an appointment to follow up with the attending physician or surgeon?
Do patients have transportation to their appointments?
Are they getting adequate nutrition and fluids?
Are they able to ambulate? Has there been any fall or any other indication of an unsafe environment?
Is a caregiver present or needed?
Was home health or other DME ordered and delivered?
Are there ongoing wound care or other physical care needs?

If during the telephonic interview, the staff member identifies a care issue or social problem, a timely plan and intervention is made. Interventions would include:

A call to the provider or attending physician to acquaint them with the issues and solicit assistance with the care plan;
Follow up with the Home Health agency or DME provider on ordered services, as appropriate;
Calls to the Case Management Department at the discharging facility;
Requests for health education materials;
Intervention by local, regional, or state agencies if there is suspected abuse
Identification of social service resources within the community that may meet needs;
Referral of the beneficiaries’ case to Governing Board if a quality of care issue is suspected

Additional target populations: Beneficiaries with chronic conditions, those at risk for frequent admissions and re admissions, those with mental health issues, those without family support and at risk for falls and injuries are among those that the ACO will follow closely to ensure close monitoring in the home or living facilities. Clinical and social support teams may be assigned to these beneficiaries on an individualized basis, with the Primary Care Physicians as the principal gatekeepers.

Internal assessments of this process: The quality management and case management programs as well as other medical management programs will be continuously evaluated by the ACO through collection of admission and readmission data, emergency room utilization, outcomes data, satisfaction surveys, morbidity and mortality data and other indicators of quality of care. Modifications of the programs and resources will be implemented to correct and improve any areas which may lack efficacy or have low performance. These modifications/improvements will be once again measured against clinical data to assess efficiency and once again be modified and improved continuously. The ACO Governing Board will receive quarterly reports on quality management performance and programs.

Allied Physicians ACO Payment Rule Waivers

Allied Physicians ACO

No, our ACO does not utilize the SNF 3 Day Rule Waiver.

Allied Physicians ACO Participants

First Fountains Medical Center Inc
Marta Mora
Adam Hy, DO
Western Pain And Headache Center
Sunmoon Urgent Care Medical Clinic
Anthony L. Mendoza, M.D A Professional Medical Corporation
Paul T.C. Liu, MD Inc
Thomas Slam A Professional Corporation
Galloni Enterprises Medical Corporation
Surgical Anesthesia Medical Associates
Scott Liang, MD Inc
Yen Doan
Dr. Yong Liang Medical Office Inc
Edward A. Mena, M.D., INC.
Franklin Ho, M.D., Inc
Allergy, Asthma, Respiratory & Sinus Center
Arnold Pang, D.O., Inc
Star Health Medical
Puente Hills Eye Care Center, Inc
California Vision and Visage Medical Group
Clinica Medica Del Sol Group, Inc
Hin Chiu Hung, M.D.
Dik S. Cheung MD
David Kw Lieu
Mark W. Li, M.D.
Kevin Chi-Wun Chen
Shiun T. Ker, M.D.
Vincent D. Ho Inc.
Francisco Rodriguez A Medical Corporation
Samuel KK Chung MD DBA Super Care Medical Group
Winnie K. Pang, MD INC
James Y. Lin, MD Inc
Lars Erik Hanson
James P. Lin, MD, INC
Calvin Eng
Wu Liu
Alethea T Hsu MD
Dennis Chan
Shuo S. Wang
Angela W. Liao, MD, Inc
Ding Lei A Professional Medical Corporation
Luning Chen Medical Corporation
Stephan P. Chen MD Inc
Cheng-Tsung Yeh, M.D.
Alberto Jimeno, M.D.
Juan B. Kaplan, M.D.
Dr Barry A Morguelan Group
James W. Wong MD INC
Arroyo Vista Family Health Foundation
Shi Yin Wong A Medical Corporation
Thomas Chu-Tsen Chiu, M.D.
Colima Medical Clinic
Chung-Ning Pang, MD
John C Lee
Felix Chi-Ming Yip, M.D.
Medical Imaging Partners
Los Angeles Urology Medical Group, Inc
Evergreen Cerritos Medical Group, Inc
AMG A Professional Medical Corp
Simon K. Simonian, MD
Po Long Lew A Medical Professional Corp
Gin-Horn Daniel Lee, D.P.M. Inc.
Garfield Comprehensive Care Medical Corp
Randolph J. Falk, MD
S.K. Medical Group, INC.
Edmund B. Foo, M.D.
Medex Medical Group
Ralph A. Massey, MD INC
Richard A Shubin
Jose R. Pilpa, INC.
Adam M. Sun, MD
Peter C Chi Medical Corporation
Tu Tranvan, MD
Arthur An, M.D., INC
Eric Y. Chen
Susie S.K. Kay, MD, A Professional Corp.
Dianne E Wu M D S C A Professional
Josh Weng Ph D Corp
J.M. Lee, M.D., INC
Phyllis A. Weinstein DPM INC.
Chunyeh Wang Phd A Professional Corp
Pacific Horizon Medical Center
Anthony C Chen MD
Araceli Chanbonpin MD
Dr Jimmy C. Huang, D.O., Apc
Garvey Healthy Family Medical Clinic
Haiping Wang, MD
Hing C Wong, MD
Kenneth T Sim, MD
Lakhi M Sakhrani Medical Corp
Paul T Urrea, M.D. M.P.H., Inc
Sam P. Chia, MD Inc
SCOSI Orthopedics, Inc
Sheng H. Chang MD Inc
Sid Danesh, MD
Wellness Physical Therapy Center

“No participants are involved in a joint venture between ACO professionals and hospitals”

Allied Physicians ACO, LLC. Key Leadership Personnel

Thomas Lam, M.D., President/Chief Executive Officer/Chairman

Su Kin Lee, M.D., Secretary/Medical Director

Jo Espino, R.N., VP, Compliance Official, Health Services

Thomas Lam, M.D., Quality Assurance/Improvement Officer

Kenneth Sim, M.D., Chief Financial Officer

Allied Physicians ACO, LLC. Governing Body

Thomas Lam, M.D.

ACO Participant, Chief Executive Officer and President, Chairman of Board of Directors, Voting Member, Shareholder

Dr. Lam, Solo Practice of Thomas S. Lam, MD A Professional Corp

Dennis Chan, M.D.

ACO Participant, Secretary, Voting Member

Dr. Chan, ACO Provider of S.K. Medical Group Inc.

 

Paul Liu, M.D.

ACO Participant, Voting Member, Shareholder

Dr. Liu, Solo Practice of Paul T.C. Liu, MD Inc.

Su Kin Lee, M.D.

ACO Participant, Medical Director, Voting Member

Dr. Lee, Solo Practice of S.K. Medical Group Inc.

Kenneth Sim, M.D.

Chief Financial Officer, Voting Member, Shareholder

Albert Young, M.D.

Community Stakeholder Representative, Voting Member

Allied Physicians ACO, LLC. Committees and Committees Leadership

Utilization Management Committee:              Thomas Lam, M.D., Chairman

Quality Management Committee:                    Thomas Lam, M.D., Chairman

Beneficiary Engagement Committee:              Thomas Lam, M.D., Chairman

Beneficiary Representative:                               Ausencia Villarreal

Medical Director:                                                  Su Kin Lee, M.D.

VP, Health Services:                                             Jo Espino, RN

Allied Physicians ACO Quality Performance Results

 Quality Performance Results

  • See 2015 Quality Performance Results Table Click Here
  • See 2012-2014 Quality Performance Results Table Click Here

Contact Us

Allied Physicians ACO, LLC
1668 S. Garfield Ave, 2nd Floor
Alhambra, CA 91801

ACO Primary Contact:

Jo Espino, RN

jo.Espino@nmm.cc (626) 943-6266

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