MSSP
The Medicare Shared Savings Program (MSSP) is an alternative payment model established by the Centers for Medicare & Medicaid Services (CMS) to encourage eligible providers, hospitals, and skilled nursing facilities to collaborate and deliver high-quality, coordinated care that improves outcomes and reduces costs and are rewarded for achieving better health for individuals, improving population health, and lowering growth in healthcare expenditures.
Through this collaboration, MSSP seeks to shift the focus from volume-based care to value-based care, where providers are incentivized to deliver efficient and effective healthcare services.
To participate, care providers must be part of an Accountable Care Organization (ACO), which is a patient-centered network that shares medical and financial responsibilities with the goal of improving patient care while limiting unnecessary spending. The MSSP requires ACOs to promote evidence-based medicine, report internally on quality and cost metrics, engage beneficiaries, and provide coordinated care across primary care physicians, specialists, and acute and post-acute providers. In the ACO, everyone works together to improve quality, streamline processes, reduce duplication, and everyone shares in the financial savings as well as potential risks that ensue.
By participating in MSSP, providers can share in cost savings generated by the ACO while meeting quality performance measures. This program transforms healthcare delivery by promoting better care coordination, reducing unnecessary costs, and ultimately improving patient outcomes.
ACO Name & Location
Care Partners ACO, LLC
Address: 3090 Bristol Street, Suite 200, Costa Mesa, CA 92626
ACO Primary Contact
Kim Phan
Phone: (855) 229-2988 or (714) 308-5288
Email: kphan@careconnectmd.com
ORGANIZATIONAL INFORMATION
ACO Participants:
| ACO Participants | Participant in Joint Venture |
|---|---|
| 360 Family Clinic, Inc. | No |
| Andres Smith MD, a Professional Medical Corporation | No |
| Careline Palliative Care LLC | No |
| Careline Pin100 LLC | No |
| Careline POH100 LLC | No |
| Claris Health PLLC | No |
| Dat Nguyen, M.D., Inc. | No |
| Fresno Long Term Care Medical Group Inc. | No |
| Gaps Health CA | No |
| Gaps Health IL, S.C. | No |
| Gaps Health NC | No |
| Gaps Health OR PC | No |
| Gaps Health WI LTD | No |
| Genesis Medical Health PC | No |
| Geriatric Consultants PLLC | No |
| HDC Care Solutions, LLC | No |
| Homaha Senior Care LLC | No |
| Hospital Internists of Texas LLC | No |
| Housecall MD, Inc. | No |
| Housecall Physicians of Southwest Michigan PLC | No |
| Northview Health Specialists, PLLC | No |
| Northview Medical House Calls PLC | No |
| Parker Jewish Institute for Health Care and Rehabilitation | No |
| Physician Services Group of Florida, LLC | No |
| Physician Services Group PC | No |
| ProHealth Physician Group LLC | No |
| Travis Ptacek MD PLLC | No |
ACO Governing Body:
| Member First Name | Member Last Name | Member Title/Position | Member's Voting Power (Expressed as a percentage) | Membership Type | ACO Participant Legal Business Name, if applicable |
|---|---|---|---|---|---|
| Dan | Baker | MSSP ACO Governing Body Member | 12.5% | Participant Provider or Representative of Participant Provider | HDC Care Solutions LLC |
| Joseph | Mead | MSSP ACO Governing Body Member | 12.5% | Participant Provider or Representative of Participant Provider | Careline POH 100 LLC |
| Luke | Redman | MSSP ACO Governing Body Member | 12.5% | Participant Provider or Representative of Participant Provider | Hospital Internists of Texas LLC |
| Kim | Phan | MSSP ACO Governing Body Member | 20% | Other | CareConnectMD Inc. |
| Asha | Sidhum, M.D. | MSSP ACO Governing Body Member | 12.5% | Participant Provider or Representative of Participant Provider | Fresno Long Term Care Medical Group Inc. |
| Brad | Markowitz | MSSP ACO Governing Body Member | 12.5% | Participant Provider or Representative of Participant Provider | Geriatric Consultants PLLC |
| Frank | Newlands | MSSP ACO Governing Body Member | 12.5% | Participant Provider or Representative of Participant Provider | Physician Services Group P.C. |
| Richard | Weidman | MSSP ACO Governing Body Member | 5% | Medicare Beneficiary | MSSP ACO Beneficiary |
Key ACO Clinical & Administrative Leadership:
ACO Executive: Kim Phan
Medical Director: Kerry Weiner, M.D.
Compliance Officer: Rashed Behroz
Quality Assurance/Improvement Officer: Nghia Pham
Associated Committees & Committee Leadership:
| Committee Name | Committee Leader Name & Position |
|---|---|
| Quality of Care and Utilization Committee | Kerry Weiner, M.D. |
| Finance and Contracting Committee | William Simson, CFO |
| Compliance and Training Committee | Rashed Behroz, Compliance Officer |
Types of ACO participants, or combinations of participants, that formed the ACO:
ACO professionals in a group practice arrangement
SHARED SAVINGS & LOSSES
Amount of Shared Savings/Losses:
Fourth Agreement Period
Performance Year 2024, N/A
Third Agreement Period
Performance Year 2025, N/A
Second Agreement Period
Performance Year 2026, N/A
First Agreement Period
Performance Year 2027, N/A
Shared Savings Distribution:
Fourth Agreement Period
Performance Year N/A
Proportion invested in infrastructure: N/A
Proportion invested in redesigned care processes/resources: N/A
Proportion of distribution to ACO participants: N/A
Third Agreement Period
Performance Year N/A
Proportion invested in infrastructure: N/A
Proportion invested in redesigned care processes/resources: N/A
Proportion of distribution to ACO participants: N/A
Second Agreement Period
Performance Year N/A
Proportion invested in infrastructure: N/A
Proportion invested in redesigned care processes/resources: N/A
Proportion of distribution to ACO participants: N/A
First Agreement Period
Performance Year 2024
Proportion invested in infrastructure: Pending
Proportion invested in redesigned care processes/resources: Pending
Proportion of distribution to ACO participants: Pending
QUALITY PERFORMANCE RESULTS
2024 Quality Performance Results:
Quality performance results are based on the N/A collection type.
| Measure # | Measure Name | Collection Type | Reported Performance Rate | Current Year Mean Performance Rate (SSP ACOs) |
|---|---|---|---|---|
| N/A | N/A | N/A | N/A | N/A |
For previous years’ financial and quality performance results, please visit: Data.cms.gov
PAYMENT RULE WAIVERS
Skilled Nursing Facility (SNF) 3-Day Rule Waiver:
Our ACO does not use 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.
ADVANCE INVESTMENT PAYMENTS (AIP)
Spend Plan:
| Payment Use | General Spend Category | General Spend Subcategory | Projected Spending 2024 | Actual Spending 2024 | Projected Spending 2025 | Actual Spending 2025 | Projected Spending 2026 | Actual Spending 2026 | Projected Spending 2027 | Actual Spending 2027 | Projected Spending 2028 | Actual Spending 2028 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hire Physician in MSSP Medical Director role to review the overall quality of patient care and consult with primary care physician partners on findings. | Increase Staffing | Physician | $307,000.00 | $0.00 | $307,000.00 | $0.00 | $307,000.00 | $0.00 | $307,000.00 | $0.00 | $307,000.00 | $0.00 |
| Hire Health Equity Officer to launch and coordinate case management program, including infrastructure related to SDOH. | Increase Staffing | Health Equity Officer | $106,000.00 | $0.00 | $106,000.00 | $0.00 | $106,000.00 | $0.00 | $106,000.00 | $0.00 | $106,000.00 | $0.00 |
| HIE- Collective Medical value-based care solution and access to live continuity of care information via ADT feed. | Health I.T. | Health Information exchange and Health Information Network Participation | $12,500.00 | $0.00 | $12,500.00 | $0.00 | $12,500.00 | $0.00 | $12,500.00 | $0.00 | $12,500.00 | $0.00 |
| Subtotals | $425,500.00 | $0.00 | $425,500.00 | $0.00 | $425,500.00 | $0.00 | $425,500.00 | $0.00 | $425,500.00 | $0.00 |
Spend Plan Summary:
| Projected Total Advance Investment Payments | $2,128,488.00 |
| Actual Spending | $0.00 |
| Future Projected Spending | $2,128,488.00 |
| Remaining Funding to Allocate | $0.00 |
Our ACO has established a separate designated account for the deposit and expenditure of all advance investment payments in accordance with 42 CFR 425.630(e)(4).
FRAUD AND ABUSE WAIVERS
ACO Pre-Participation Waiver:
The following information describes each arrangement for which our ACO seeks protection under the ACO Pre-Participation Waiver, including any material amendment or modification to a disclosed arrangement.
For each arrangement, provide the following information:
Parties to the arrangement: N/A
Date of arrangement: N/A
Items, services, goods, or facility provided: N/A
Date and nature of any amendments to the arrangement, if applicable: N/A
ACO Participation Waiver
The following information describes each arrangement for which our ACO seeks protection under the ACO Participation Waiver, including any material amendment or modification to a disclosed arrangement.
For each arrangement, provide the following information:
Parties to the arrangement: N/A
Date of arrangement: N/A
Items, services, goods, or facility provided: N/A
Date and nature of any amendments to the arrangement, if applicable: N/A