ACO Name and Location

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

ACO Primary Contact

Primary Contact Name Samuel Fulton
Primary Contact Phone Number (713) 338-5202
Primary Contact Email Address Samuel.Fulton@memorialhermann.org

Organizational Information

ACO Participants

Office Name

ACO Participant in Joint Venture

ANURADHA KANTAMANI MD PA

Y

Affiliates Of Family Medicine Inc

N

Alexandria Medical Association PA

N

Allison Blazek, MD, PA

N

Ambreen Sharaf, MD, PA

N

Aslam Loya MD PA

N

BAY AREA TOTAL HEALTH MEDICAL GRP PA

N

Barker Cypress Family Practice, Pa

N

Berta De Leon Scaglia Md Pa

N

Brian C Castillo, MD PA

N

CAMPBELL GHEBRANIOUS PLLC

Y

Cesario A Castillo MD PA

N

COMMUNITY HEALTH AND LIFE CENTER, PLLC

N

DURGA SUNKARA

N

Dr Saleha Ahmed

N

Dr. A Family Clinic

N

Ella Family Medicine Pa

N

FAIRFIELD FAMILY PHYSICIANS, PA

N

Faizun Anwar, M.D. P.A.

N

First Colony Primary Care, P.A

N

Fulshear Medical Associates PLLC

N

Fuqua Family Practice and Urgent Care PA

Y

Genesis Family Care, P.A.

N

Gulf Coast Primary Care, Pllc

N

HAZEM EL ZUFARI MD PA

Y

HUAIGUANG LI M.D., PLLC

N

High Tech Family Care And Women's Health Pa

N

IMD Healthcare and Imaging

N

INPATIENT PROVIDERS OF TEXAS, PLLC

N

INTERNAL MEDICINE ASSOCIATES OF HOUSTON PA

N

J Kevin Giglio, MD, PA

N

JY Family Medicine & Urgent Care PLLC

N

Jimin Wang, MD, PA

N

KATY SUPPORTIVE MEDICINE PA

Y

Kannappan Krishnaswamy

N

Luis Diaz

N

MA Medical Care PLLC

N

MEDICAL COLLEAGUES OF TEXAS LLP

Y

MEMORIAL HERMANN HEALTH SYSTEM

N

MHS Physicians of Texas

N

MICHAEL Y. CHANG, D.O., P.A.

N

MOONAT MEDICAL ASSOC INC

N

MTL MD PLLC

N

Medical Associates of Katy PLLC

Y

Memorial Hermann Medical Group

Y

Memorial Hermann Rehabilitation Hospital Katy, Llc

Y

NIBU MATHEW, M.D., P.A.

N

NORTHEAST PRIMARY CARE ASSOCIATES P.A.

N

NorthWoodsFamilyMedicinePLLC

N

Orlando Fonseca, MD, PLLC

N

PACHIE S CHAN MD PLLC

N

Pinewood Medical Clinic, PA

N

Premier Internal Medicine Associates Of Houston Pllc

N

Providence Family Practice, PA

N

RAJNIKANT KUSHWAHA MD PA

N

RICHARD C. LOCK, M.D., P.A.

N

Raja Abusharr, MD, PA

N

Rishi Hingorani DO, PA

N

SHENG-KUN YAO

N

SISTLA KRISHNA

N

SYED A GARDEZI

N

SYED V AHMED MD PA

N

Samuel Gan

N

Samuel L Siegler,ii,j.D.,m.D.,p.A.

Y

Southwest Family Physicians, PA

N

Southwest Memorial Physician Associates, PA

N

Spuhler Medical Associates, PA

N

St Johns Physician Associates Pa

N

Stuart A Shapiro, MD

N

Suparna Chhibber MD PA

N

Sylvia Wu, Md, Pa

Y

Tanveer F. Syed, M.D., P.A.

N

Tehmina Sami MD PA

N

Thanh K. Hoang, M.D., P.A,

N

Thomas FP, PLLC

N

Tran & Thomas, PA

N

Trinity Primary Care Pa

N

UT Physicians Specialty Services

Y

WESTLAKE MEDICAL SERVICES LLLP

N

Wang & Jiang MD PA

N

ZHENGNAN YIN, MD, PLLC

N

Zealth Care Pllc

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

Aronson, DO

Laura

MHACO Primary Care Physician

1

Participant Representative

Memorial Hermann Health System

Callender, MD

David

Serves on Board of Directors; MHHS CEO

1

Participant Representative

Memorial Hermann Health System

Cannon

Deborah

Serves on Board of Directors

1

At-Large member

Memorial Hermann Health System

Chang, MD

Phillip

MHHS Chief Medical and Quality Officer

1

Participant Representative

Memorial Hermann Health System

Esquivel

John

Serves on Board of Directors

1

Participant Representative

Memorial Hermann Health System

Flax, MD

Ira L.

Serves on Board of Directors

1

Participant Representative

Memorial Hermann Health System

Heaps, MD

Brian

MHMD Board Chair

1

Participant Representative

Memorial Hermann Health System

Jackson

Grover

Serves on Board of Directors

1

Medical Beneficiary

Memorial Hermann Health System

King

Alec

Serves on Board of Directors; Treasurer

1

Participant Representative

Memorial Hermann Health System

McCarthy, MD

James J.

Serves on Board of Directors; President

1

Participant Representative

Memorial Hermann Health System

Key ACO Clinical and Administrative Leadership

James McCarthy, MD ACO Executive, Quality Assurance/Improvement Officer
Tiffany Albritton, MD Medical Director
Robert McStay Chief Compliance Officer

Associated Committees and Committee Leadership

Committee Name Committee Leader Name and Position
ACO Incentive Appeals Committee Samuel Fulton, 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 2022, $6,957,179
    • Performance Year 2021, $0
    • Performance Year 2020, $11,491,733
    • Performance Year 2019, $10,117,659
    • 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 2022
      • Proportion invested in infrastructure: 19%
      • Proportion invested in redesigned care processes/resources: 16%
      • Proportion of distribution to ACO participants: 65%
    • Performance Year 2021 - N/A
    • Performance Year 2020
      • Proportion invested in infrastructure: 20%
      • Proportion invested in redesigned care processes/resources: 15%
      • Proportion of distribution to ACO participants: 65%

    Quality Performance Results

    2022 Quality Performance Results

    Quality performance results are based on CMS Web Interface

    Measure Number Measure Name Rate ACO Mean
    001 Diabetes: Hemoglobin A1c (HbA1c) Poor Control1 6.61 10.71
    134 Preventative Care and Screening: Screening for Depression and Follow-up Plan 78.06 76.97
    236 Controlling High Blood Pressure 71.78 76.16
    318 Falls: Screening for Future Fall Risk 95.78 87.83
    110 Preventative Care and Screening: Influenza Immunization 79.35 77.34
    226 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention 84.21 79.27
    113 Colorectal Cancer Screening 81.73 75.32
    112 Breast Cancer Screening 76.94 78.07
    438 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 88.17 86.37
    370 Depression Remission at Twelve Months 17.19 10.03
    479 Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups1 0.1503 0.1510
    MCC1 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions for ACOs (MCC)1 26.64 30.97

    [1] A lower performance rate corresponds to higher quality.

    Payment Rule Waivers

    • Skilled Nursing Facility (SNF) 3-Day Rule Waiver:
      • Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.612.
    • Waiver for Payment for Telehealth Services:
      • Our ACO clinicians provide telehealth services using the flexibilities under 42 CFR § 425.612(f) and 42 CFR § 425.613.

    Medicare Shared Savings Program Fraud and Abuse 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.”
    3. 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.”
    4. 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.
    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 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.
    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 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.
    7. 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.
    8. 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 health care 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.
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. THE MH ACO Board approved on June 27, 2018 a subsidized cost structure for electronic health records for primary care physicians participating in the MH Accountable Care Organization for the benefit of care coordination purposes.
    14. 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.
    15. The MH ACO Board approved in June 2020 the establishment of a general surgery incentive program based on metrics that promote accountability for quality cost and over all care for patients. 
    16. The MH ACO Board approved on December 12, 2022 the provision of interoperability EMR integration support for MHMD clinically integrated providers to establish a bi-directional interface through the Digital Front Door Initiative to advance efficiencies in various care coordination efforts.
    17. The MH ACO Board approved on June 7, 2021 the provision of EMR interoperability support for MHMD clinically integrated providers through EcW EMR Direct Access, a solution for the digital endpoint and care coordination advancements under the CMS Interoperability and Patient Access final rule. 
    18. The MH ACO Board approved on December 12, 2022 the provision of financial support to support care coordination and value-based activities for clinically integrated providers specializing in both surgical and non-surgical medical weight management in order to improve quality and lower cost through reduction of unwanted variability.
    19. On July 19, 2023, the MHACO Board approved subsidy to cover part of the MHHS EMR implementation costs for MHMD clinically integrated providers effective August 1, 2023 through July 31, 2024.
Memorial Hermann Accountable Care Organization (ACO)