ACO Name and Location

Accountable Care Coalition of Southeast Texas, Inc.
4888 Loop Central Drive, Suite 300
Houston, TX 77081

ACO Primary Contact

Karen Holt
Karen.Holt@wellcare.com
855-236-9820

ORGANIZATIONAL INFORMATION

ACO Participants


 

ACO Preferred Providers

 

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

 

Accountable Care Coalition of Southeast Texas, Inc. Governing Body

  • Clive Fields, M.D., Chair, Voting Member, ACO Participant, Village Family Practice
  • Louis Roddy, M.D., Voting Member, ACO Participant, Louis Roddy, M.D. FCCP
  • Todd Youngblood, M.D., Voting Member, ACO Participant, Northwest Diagnostic Clinic, PA
  • Laurel Tucker, M.D., Voting Member, ACO Participant, Town & Country Family Physicians, PLLP
  • Fanny Elena Ramirez, M.D., Voting Member, ACO Participant, MediCorp, P.A.
  • Raul Rivera, M.D., Voting Member, ACO Participant, Raul Rivera & Associates, PA
  • Harold Fields, M.D., Voting Member, Medicare Beneficiary Representative, Village Family Practice
  • Meggin Boreno, Non-Voting Member, Consumer Advocate


 

Accountable Care Coalition of Southeast Texas, Inc. Key ACO Clinical and Administrative Leadership

  • ACO Executive: Karen Holt, Collaborative Health Systems, A WellCare Company
  • Medical Director, Central Region: Louis Roddy, M.D., FCCP
  • Medical Director, SE Region: Raul Rivera, M.D.
  • Compliance Official: Michael Yount, WellCare Health Plans, Inc.
  • Quality Assurance/Improvement Officer: Trevor Rabie, M.D., WellCare Health Plans, Inc. and Village Family Practice
  • VP ACO Operations: Karen Holt, Collaborative Health Systems


 

Accountable Care Coalition of Southeast Texas, Inc. Associated Committees and Committee Leadership

  • Quality and Innovations Committee: Troy Fiesinger, M.D., Chair
  • Transitions of Care Committee: Trevor Rabie, M.D., Chair


 

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

  • A network of individual practices of ACO professionals


 

SHARED SAVINGS AND LOSSES

Amount of Shared Savings/Losses

  • Performance Year 2016: -$2,119,595
  • Performance Year 2017: $9,171,046
  • Performance Year 2018: Not Yet Determined


 

Shared Savings Distribution

Performance Year 2016
  • Proportion invested in infrastructure: N/A
  • Proportion invested in redesigned care processes/resources: N/A
  • Proportion of distribution to ACO participants: N/A

 

Performance Year 2017
  • Proportion invested in infrastructure: 26%
  • Proportion invested in redesigned care processes/resources: 48%
  • Proportion of distribution to ACO participants: 26%


 

Quality Performance Results


 


Arrangements Disclosed

REQUIRED PUBLIC DISCLOSURE FOR THE ACO PARTICIPATION WAIVER

The Accountable Care Coalition of Southeast Texas, Inc. (the “ACO”) participates in the Next Generation Model Accountable Care Organization (“NGACO”) under a contract with the Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation (“CMS“). The Secretary of the Department of Health and Human Services by and through CMS has provided certain waivers of federal fraud and abuse laws in connection with the NGACO pursuant to a Notice of Waiver of Certain Fraud and Abuse Laws in Connection with the Next Generation ACO Model dated December 9, 2015 (“Waivers”). On October 21, 2016, the Board of Directors of the ACO met at a duly called meeting to discuss an arrangement with Curant Health Georgia, LLC and Curant Health Florida, LLC (collectively “Curant”) under which Curant will provide a grant of funds to assist the ACO’s efforts with respect to the NGACO. Consistent with the Waivers, after discussing the proposed arrangement with Curant, the Board of Directors made a bona fide determination that an arrangement with Curant as described below is reasonably related to the purpose of the NGACO and authorized such arrangement. The collaboration is related to the purposes of the NGACO as it augments the ACO’s ability to:

•    Promote evidence-based medicine and patient engagement;
•    Meet the requirements for reporting quality and cost measures coordinating care;
•    Establish clinical and administrative systems;
•    Meet the clinical integration requirements of the Medicare Shared Savings Program;
•    Evaluate the health needs of the ACO’s aligned population;
•    Communicate clinical knowledge and evidence based medicine to Medicare beneficiaries; and
•    Develop standards for beneficiary access and communication, including beneficiary access to medical records.


Arrangements Disclosed

REQUIRED PUBLIC DISCLOSURE FOR USE OF AN ARRANGEMENT ENTERED INTO UNDER THE ACO PARTICIPATION WAIVER

The Accountable Care Coalition of Southeast Texas, Inc. (the “ACO”) participates in the Next Generation Model Accountable Care Organization (“NGACO”) under a contract with the Centers for Medicare & Medicaid Services (“CMS") Center for Medicare and Medicaid Innovation (“CMMI“). The Secretary of the Department of Health and Human Services by and through CMS has provided certain waivers of federal fraud and abuse laws deemed necessary by CMMI to test the NGACO pursuant to a Notice of Waiver of Certain Fraud and Abuse Laws in Connection with the Next Generation ACO Model dated December 9, 2015, as amended December 29, 2016, including the Next Generation ACO Participation Waiver (“Participation Waiver”). On December 15, 2017, the Governing Body of the ACO after previous discussions authorized, via unanimous written consent, an arrangement with Laboratory Corporation of America Holdings (“LabCorp”) under which LabCorp will collaborate with ACO to provide ACO with laboratory data and test result values for ACO’s assigned beneficiaries, and jointly develop an outreach program to ACO’s providers/suppliers to provide educational services and information concerning. In addition to educational services, ACO will provide ACO providers/suppliers with, among other things, their applicable test result values and an analysis of such laboratory data so they can improve their patients’ care. Finally, LabCorp will provide a grant of funds to allow ACO to defray a portion of the costs to further develop and implement the program, including investment or modification of ACO’s administrative and clinical systems, and otherwise assisting the ACO’s efforts with respect to the NGACO. Consistent with the requirements of the Participation Waiver, after discussing the proposed arrangement with LabCorp, the Board of Directors of the ACO made a bona fide determination that an arrangement with LabCorp as described below is reasonably related to the purpose of the NGACO and authorized such arrangement. The collaboration is related to the purposes of the NGACO as it augments ACO’s ability to:

•    Promote evidence-based medicine and patient engagement;
•    Meet the requirements for reporting quality and cost measures coordinating care;
•    Establish clinical and administrative systems;
•    Meet the clinical integration requirements of the NGACO;
•    Evaluate the health needs of ACO’s aligned population;
•    Communicate clinical knowledge and evidence based medicine to Medicare beneficiaries; and
•    Develop standards for beneficiary access and communication, including beneficiary access to medical records.

Accordingly, ACO entered into this arrangement having determined that it meets all conditions to enable ACO to avail itself of the Participation Waiver.
 

V124_PubDiscv14_0719_IA Approved 7/19/2019

Terms of Use | Privacy Policy | Public Disclosures
 

ACO_WebV124_0317_File and Use_Approved 4/25/2017