ACO Name and Location

Memorial Hermann Accountable Care Organization
929 Gessner, Suite 2700
Houston, Texas 77024

ACO Primary Contact

Name Nicole Clarke Luck
Phone Number (713) 242-4429
Email Address Nicole.ClarkeLuck@memorialhermann.org

Organizational Information

ACO Participants

Office Name

ACO Participant in Joint Venture

Richard C Lock MD PA

N

Pinewood Medical Clinic

N

Star Primary Care PA

N

Ike Eni MD PA

N

Family Healthcare Affiliates PLLC

N

UT Physicians Family Medicine TMC

Y

Spuhler Medical Associates PA

N

Jimin Wang MD PA

N

Fairfield Family Physicians PA

N

Prompt Care Medical Doctors

N

Westside Medical Clinic

N

Faizun Anwar MD PA

N

Pratibha R Kulkarni

N

Hazem El Zufari MD PA

N

Family Medicine at Sterling Ridge

N

Rosewood Family Physicians PLLC

N

Memorial Hermann Medical Group

N

Southeast Medical Group PA

N

Barker Cypress Family Practice PA

N

Rishi Hingorani DO PA

N

Nibu Mathew MD PA

N

Elite Medical Care

N

Allison Blazek MD PA

N

Murtaza Mussaji DO PA

N

Magnolia Family Medicine

N

Orlando Fonseca MD PLLC

N

Bay Area Total Health Medical Group PA

N

Suparna Chhibber MD PA

N

Thomas Family Practice PLLC

N

Summerwood Family Clinic

N

Trinity Primary Care PA

N

Rios Family Medicine Clinic PA

N

Dr A Family Clinic PLLC

N

Rajnikant Kushwaha MD PA

N

Saleha R Ahmed

N

Zealth Care PLLC

N

Alexandria Clinic

N

Internal Medicine Associates of Houston PA

N

Inpatient Providers of Texas PLLC

N

IMD Healthcare and Imaging

N

Tehmina Sami MD PA

N

North Star Medical

N

Zhengnan Yin MD

N

North Woods Family Medicine PLLC

N

Family Medicine Associates of Conroe PLLC

N

Saint Johns Physician Associates PA

N

JY Family Medicine & Urgent Care PLLC

N

Medical Associates of Katy PLLC

Y

Fuqua Family Practice and Urgent Care

N

First Colony Primary Care PA

N

Gulf Coast Primary Care PLLC

N

Golden Care Medical Center

N

Southeast Houston Medical Clinic

N

Katy Supportive Medicine PA

N

Samuel Gan MD

N

Primecare Medical Group

Y

Genesis Family Care PA

N

High Tech Family Care & Women's Health PA

N

Westchase Health Clinic

N

Moonat Medical Associates

N

Sistla B Krishna

Y

Stuart A Shapiro MD

N

Summerwood Family Clinic

N

Georgina Loya MD PA

N

Virgil C Carandang MD

N

Providence Family Practice PA

N

Northwest Medical Group

N

Southwest Family Physicians PA

N

Mehta Medical Group PLLC

N

Texas Family Practice

N

J Kevin Giglio MD PA

N

Mischer Neuroscience Associates

N

Katy Internal Medicine Associates LLP

N

Medical Colleagues of Texas LLP

Y

Horizon Healthcare Clinic

N

Sheng Kun Yao MD PA

N

Sylvia Wu MD

N

Northeast Primary Care Associates PA

N

Northeast Medical Associates PA

N

Affiliates of Family Medicine PA

N

Campbell Family Practice and Ghebranious Internal Medicine

N

Ella Family Medicine PA

N

Anil A Dara MD PA

N

Southwest Memorial Physician Associates PA

N

Coastal Medical Group

N

Anuradha Kantamani

N

David E Auer MD PA

N

Paramount Medical Associates

N

Tamirisa Renu MD PA

N

Pachie Chan MD PLLC

N

Fulshear Family Medicine

N

ACO Governing Body

Member

Member's Voting Power - Expressed as a Percentage or Number

Membership Type

ACO Participant Legal Business Name / DBA, if Applicable

Last Name

First Name

Title / Position

Callender, MD

David

Serves on Board of Directors; MHHS CEO

1

MHHS CEO

Memorial Hermann Health System

Cannon

Deborah

Serves on Board of Directors

1

MHHS Board Member

Memorial Hermann Health System

King

Alec

Serves on Board of Directors; Treasurer

1

MHHS CFO

Memorial Hermann Health System

Doshi, MD

Ankur

Serves on Board of Directors

1

Participant Representative

Primecare Medical Group, PLLC

Giglio, MD

J. Kevin

Serves on Board of Directors; Medical Director

1

MHHS Board Member/Participant Representative

J. Kevin Giglio, MD, PA

Jackson

Grover

Serves on Board of Directors

1

Medicare Beneficiary Representative

N/A

McCarthy, MD

James J.

Serves on Board of Directors; President

1

MHHS Chief Physician Executive

Memorial Hermann Health System

Salcedo, MD

Christophe C.

Serves on Board of Directors

1

Participant Representative

Christophe C. Salcedo, MD & Associates PA

Key ACO Clinical and Administrative Leadership

James McCarthy, MD ACO Executive
J. Kevin Giglio, MD Medical Director
Robert McStay Chief Compliance Officer
Amanda Gusart Compliance Officer
Joseph Wardlow Compliance Officer

Associated Committees and Committee Leadership

Committee Name Committee Leader Name and Position
ACO Incentive Appeals Committee Nicole Clarke Luck, Senior Vice President

Types of ACO Participants, or Combinations of Participants, That Formed the ACO

  • Hospital employing ACO professionals
  • Partnership or joint venture arrangement between hospitals and ACO professionals
  • Networks of individual practices of ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses

  • Second Agreement Period
    • Performance Year 2019, $10,117,658.93
    • Performance Year 2018, $7,965,918
    • Performance Year 2017, $14,499,448
    • Performance Year 2016, $14,025,212
  • First Agreement Period
    • Performance Year 2015, $41,912,527
    • Performance Year 2014, $22,723,305
    • Performance Year 2013, $28,338,705

“Note: Our ACO participated in multiple performance years during Calendar Year 2019. Shared savings/losses amount reported for Performance Year 2019 therefore represents net shared savings or losses across all performance years in 2019 and is shown under all agreement periods in which the ACO operated during Calendar Year 2019.”

Shared Savings Distribution

  • Second Agreement Period
    • Performance Year 2019
      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesigned care processes/resources: 15%
      • Proportion of distribution to ACO participants: 65%
    • Performance Year 2018
      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesigned care processes/resources: 15%
      • Proportion of distribution to ACO participants: 65%
    • Performance Year 2017
      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesigned care processes/resources: 15%
      • Proportion of distribution to ACO participants: 65%
    • Performance Year 2016
      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesigned care processes/resources: 15%
      • Proportion of distribution to ACO participants: 65%
  • First Agreement Period

      Performance Year 2015

      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesigned care processes/resources: 15%
      • Proportion of distribution to ACO participants: 65%

      Performance Year 2014

      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesigned care processes/resources: 15%
      • Proportion of distribution to ACO participants: 65%

      Performance Year 2013

      • Proportion invested in infrastructure: 15%
      • Proportion invested in redesigned care processes/resources: 10%
      • Proportion of distribution to ACO participants: 75%

“Note: Our ACO participated in multiple performance years during Calendar Year 2019. Shared savings/losses amount reported for Performance Year 2019 therefore represents net shared savings or losses across all performance years in 2019 and is shown under all agreement periods in which the ACO operated during Calendar Year 2019.”

Quality Performance Results

2019 Quality Performance Results

ACO # Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 86.34 85.86
ACO-2 CAHPS: How Well Your Providers Communicate 95.59 94.11
ACO-3 CAHPS: Patients' Rating of Provider 92.90 92.69
ACO-4 CAHPS: Access to Specialists 81.57 81.54
ACO-5 CAHPS: Health Promotion and Education 57.99 60.44
ACO-6 CAHPS: Shared Decision Making 62.67 62.78
ACO-7 CAHPS: Health Status/Functional Status 71.90 73.79
ACO-34 CAHPS: Stewardship of Patient Resources 27.61 26.17
ACO-45 CAHPS: Courteous and Helpful Office Staff 92.93 92.84
ACO-46 CAHPS: Care Coordination 88.63 86.89
ACO-8 Risk Standardized, All Condition Readmission 15.28 14.86
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 56.51 58.15
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 1.68 1.87
ACO-13 Falls: Screening for Future Fall Risk 89.33 84.04
ACO-14 Preventive Care and Screening: Influenza Immunization 81.89 74.77
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 83.78 78.04
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 66.59 70.40
ACO-19 Colorectal Cancer Screening 72.87 70.76
ACO-20 Breast Cancer Screening 75.09 73.84
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 82.35 82.17
ACO-40 Depression Remission at Twelve Months 12.35 13.58
ACO-27 Diabetes: Hemoglobin A1c Poor Control (>9%) 11.89 13.88
ACO-28 Controlling High Blood Pressure 69.03 75.04

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size.


Note: In the Quality Performance Results file(s) above, search for “Memorial Hermann Accountable Care Organization” to view the quality performance results. This ACO can also be found by using the ACO ID A1175 in the public use files on data.cms.gov.

Payment Rule Waivers

  • No, our ACO does not use the SNF 3-Day Rule Waiver.

Participation Waivers

Arrangements Disclosed

The MHACO Board has approved the following arrangements for the waivers authorized by CMS and the OIG pursuant to the “Medicare Program; Final Waivers in Connection with the Shared Savings Program” originally published on November 2, 2011 and finalized on October 29, 2015.

  1. The Memorial Hermann Health System (“MHHS”), a participant in the Memorial Hermann Accountable Care Organization, will engage MHMD, the Memorial Hermann Physician Network, to administer a program to advance evidence-based medicine, increase patient satisfaction, and manage the cost of care for the hospitalist service line of MHHS, and may be extended to intensivists an anesthesiologists. The focus will be inpatients and observation and eligible physicians will be eligible for compensation based upon meeting quality and cost metrics. In September 2015 the program was modified to establish the physician compensation caps, clarify the dates for measurement and other program administrative changes. In March 2016, the program was modified to make the program adaptable as new information becomes available to incentive activities to advance MSSP, while maintaining the overall purposes of the original program. The program was extended for the duration of the new MSSP Renewal Period “Pathways to Success.”
  2. The Memorial Hermann Health System (“MHHS”), a participant in the Memorial Hermann Accountable Care Organization, will engage MHMD, the Memorial Hermann Physician Network, to administer a program to advance evidence-based medicine, increase patient satisfaction, and manage the cost of care for the orthopedic service line of MHHS. The focus will be total joint replacement, and other inpatient services and eligible physicians will be eligible for compensation based upon meeting quality and cost metrics. The program was approved in February 2014. In May of 2014, the program was supplemented to permit MHMD to develop criteria for a physician list eligible to receive referrals from call centers, nurse navigators or other sources using criteria such as geographic proximity, and the physician’s overall level of experience and expertise. In September 2015 the program was modified to establish the physician compensation caps, clarify the dates for measurement and other program administrative changes. In March 2016, the program was modified to make the program adaptable as new information becomes available to incentive activities to advance MSSP, while maintaining the overall purposes of the original program. The program was extended through the end of the MSSP renewal period in 2019. The program was extended for the duration of the new MSSP Renewal Period “Pathways to Success.”
    1. The Memorial Hermann Health System (“MHHS”), a participant in the Memorial Hermann Accountable Care Organization, will engage MHMD, the Memorial Hermann Physician Network, to administer a program to advance evidence-based medicine, increase patient satisfaction, and manage the cost of care for the cardiovascular service line of MHHS. The focus will be inpatient surgeries services and eligible physicians will be eligible for compensation based upon meeting quality and cost metrics. In September 2015 the program was modified to establish the physician compensation caps, clarify the dates for measurement and other program administrative changes. In March 2016, the program was modified to make the program adaptable as new information becomes available to incentive activities to advance MSSP, while maintaining the overall purposes of the original program. The program was extended through the end of the MSSP renewal period in 2019. The program was extended for the duration of the new MSSP Renewal Period “Pathways to Success.”
  3. The Memorial Hermann Accountable Care Organization (“MHACO”) will provide referral coordination service to physicians who participate in MHACO. MHACO will identify preferred providers, utilizing quality, cost and operational efficiency considerations, but will also coordinate referrals to physicians outside the preferred network. The expectation is that this will make the delivery of care more efficient, and will influence patients to utilize physicians with demonstrated quality and efficiency. The program was approved in February 2014.
  4. The Memorial Hermann Health System (“MHHS”), a participant in the Memorial Hermann Accountable Care Organization (“MHACO”) has engaged the University of Texas Health Science Center (“UTHSC”) to provide academic, professional and administrative services, including the configuration of an ambulatory orthopedic network. Additionally, UTHSC will provide clinical and administrative leadership to advance quality and safety metrics of the orthopedic service line inclusive of a regional leadership structure; supplement and support the orthopedics call coverage requirements of the Hospital emergency departments; provide qualified physician leaders to coordinate the medical direction of local campuses and programs; provide guidance on operating room efficiency and operations to ensure the safest environment possible for patient care where requested; provide guidance on strategic sourcing solutions to improve overall quality of care and value to patients; and provide high quality care. The arrangement was approved for a June 1, 2014 start date with a 5 year term. The parties renewed the arrangement for an additional 5 year term, effective January 1, 2019.
  5. The Memorial Hermann Health System (“MHHS”), a participant in the Memorial Hermann Accountable Care Organization (“MHACO”) has engaged the University of Texas Health Science Center (“UTHSC”) to provide academic, professional and administrative services, including the configuration of an ambulatory cardiovascular professional services network. Additionally, UTHSC will provide clinical and administrative leadership to advance quality and safety metrics of the heart & vascular service line inclusive of a regional leadership structure; supplement and support the cardiovascular call coverage requirements of the Hospital emergency departments; provide qualified physician leaders to coordinate the medical direction of local campuses and programs; provide guidance on operating room efficiency and operations to ensure the safest environment possible for patient care where requested; provide guidance on strategic sourcing solutions to improve overall quality of care and value to patients; and provide high quality care. The arrangement was approved for a July 1, 2019 for a five year term.
  6. The Memorial Hermann Health System (“MHHS”), a participant in the Memorial Hermann Accountable Care Organization (“MHACO”) has engaged the University of Texas Health Science Center (“UTHSC”) to provide academic, professional and administrative services, including the configuration of an ambulatory professional services network for neuroscience, heart & vascular, and women & children’s services. Additionally, UTHSC will provide clinical and administrative leadership to advance quality and safety metrics of the service lines inclusive of a regional leadership structure; supplement and support the call coverage requirements of the Hospital emergency departments; provide qualified physician leaders to coordinate the medical direction of local campuses and programs; provide guidance on operating room efficiency and operations to ensure the safest environment possible for patient care where requested; provide guidance on strategic sourcing solutions to improve overall quality of care and value to patients; and provide high quality care. The arrangements were approved for a January 1, 2019 start date for a five year term, except for neurosciences which commenced on September 1, 2019.
  7. The Memorial Hermann Health System (“MHHS”), a participant in the Memorial Hermann Accountable Care Organization (“MHACO”) has engaged the MHS Physicians of Texas (“PhyTex”), a certified nonprofit healthcare corporation of which MHHS is the sole member, to provide academic, professional and administrative services, including the configuration of an ambulatory neuroscience network. Additionally, PhyTex will provide clinical and administrative leadership to advance quality and safety metrics of the neuroscience service line inclusive of a regional leadership structure; supplement and support the neuroscience call coverage requirements of the Hospital emergency departments; provide qualified physician leaders to coordinate the medical direction of local campuses and programs; provide guidance on operating room efficiency and operations to ensure the safest environment possible for patient care where requested; provide guidance on strategic sourcing solutions to improve overall quality of care and value to patients; provide high quality care. An initial component of the program will provide financial incentives to neurosurgeons for meeting defined quality and cost metrics. The arrangement was approved April for April 15, 2014, for a one year automatically renewing term.
  8. The MHACO Board has approved a pilot program to utilize a scribe in certain clinically integrated physician offices to determine whether the program should be expanded and utilized to increase physician productivity, quality and patient satisfaction. The program was approved to commence July 1. The subsidy for the service would be for a 1 year period with staggered start dates after the commencement for the participating physician offices.
  9. The MHACO Board has approved a subsidy to cover part of the cost for its academic affiliated physician group to transition to the EMR platform as Memorial Hermann.
  10. The Memorial Hermann Accountable Care Organization Board has approved a small holdback of the available bonus pool if in-network utilization for the MHACO members remains flat or declines over the baseline. The MHACO Board considered documentation showing evidence that use of the network improved care quality and decreased the overall cost on a per patient basis. The impact on the bonus pool is aggregate, and does not take into account the utilization of physicians at the individual level. The program was approved for the 2016 bonus year.
  11. For purposes of managing covered lives including MSSP, the MHACO Board approved certain network utilization tools for MHACO or MHMD to utilize along with its participants, partners, and affiliated entities. The network tools include the publication and distribution of reports to inform leadership on the various metrics and for the development of care networks for population health management; the publication and distribution of network directories; the development of limited, aggregate financial incentives to align network utilization to the extent that it advances MSSP purposes, and other similar related tools as necessary for these purposes. The network resources would be utilized for the duration of the MSSP renewal period through 2019.
  12. The Memorial Hermann Health System (“MHHS”), a participant in the Memorial Hermann Accountable Care Organization, will engage MHMD, the Memorial Hermann Physician Network, to administer a program to advance evidence-based medicine, increase patient satisfaction, and manage the cost of care for the oncology service line of MHHS. The focus will be quality metrics for inpatient and outpatient services as well as patient satisfaction. Physicians will be eligible for compensation based upon meeting quality and cost metrics. This program is concurrent with the MSSP participation period for MHACO.