ACO Name and Location
agilon health Michigan ACO, Inc.
440 Polaris Parkway, Suite 550
Westerville, OH 43082
ACO Primary Contact
Eric Becker
510-206-5719
[email protected]
8am – 5pm PST
Organizational Information
ACO Participants:
| ACO Participants | ACO Participant in Joint Venture |
| SHEILA P MEFTAH, MD, PLLC | N |
| DANIEL S HADDAD MD PC | N |
| SOMERSET HEMATOLOGY ONCOLOGY PC | N |
| PREMIER VASCULAR CARE PC | N |
| Klein Md, Hug MD, Sabin MD, Maddens MD, Khogali-Jakary DO PC | N |
| ENDOCRINE AND METABOLIC DISORDERS CENTER PC | N |
| ALTERNACARE PC | N |
| ZANA SOTIROV MD PC | N |
| THOMAS C HOSEY DPM & ASSOCIATES PC | N |
| SUDHA NANNAPANENI MD PLLC | N |
| STEVEN S. ZELDES MD PC | N |
| SMITA BIJLANI, M.D., P. C. | N |
| DAVID V SPURLIN, M.D., P.L.L.C. | N |
| SHEHADA MD PLLC | N |
| ROSS FEINMAN | N |
| ROLANDO M ESTUPIGAN DO PC | N |
| ROCHESTER GENERAL SURGERY PLC | N |
| ROBERT OH GO P.C. | N |
| RIVERBEND HEALTH CARE PC | N |
| PULMONARY CRITICAL CARE AND SLEEP PC | N |
| PREMIER HEMATOLOGY ONCOLOGY CARE INC | N |
| OAKLAND MACOMB OBSTETRICS & GYNECOLOGY, P.C. | N |
| MOHAMMED WAEL AL-AMERI MD PC | N |
| FD FARAH MI PLLC | N |
| VASCULAR & ENDOVASCULAR ASSOCIATES PLC | N |
| ROCHESTER COLON & RECTAL, P.C. | N |
| PANKAJ HUKKU, MD PC | N |
| RODOLFO D FARHY, MD, FACC, FAHA, PLLC | N |
| MATTHEW A ZIEGLER MD PLLC | N |
| JASON SHELLNUT MD PC | N |
| CLAIRE PEEPLES MD PLLC | N |
| MARK S FRIEDLAND MD PC | N |
| SOMERSET OPHTHALMOLOGY PC | N |
| GANESH DESHMUKH | N |
| MICHIGAN EAR INSTITUTE PLLC | N |
| ALLAN SCHWARTZ DO PC | N |
| ARTHUR ROSNER MD PLLC | N |
| MENDELSON ORTHOPEDICS PC | N |
| LINDA C HONET, MD DERMATOLOGY PC | N |
| ROYAL OAK SURGICAL ASSOCIATES PC | N |
| MILLMAN DERR CENTER FOR EYE CARE PC | N |
| PREMIER SURGICAL SPECIALISTS PC | N |
| ENDOSCOPIC SOLUTIONS PC | N |
| MICHIGAN ORTHOPAEDIC SURGEONS PLLC | N |
| TROY GASTROENTEROLOGY PC | N |
| DAVID W CALTON MD PC | N |
| A BAHJAT SHAHBANDAR MD PC | N |
| AARON YON MD PC | N |
| CHANGHEE KIM MD PHD PLC | N |
| GRACE FAMILY CARE PC | N |
| STEPHEN M SWETECH DO MEDICAL CENTER PC | N |
| SCHLABACH FAMILY PRACTICE PC | N |
| JAMES BAUER MD PC | N |
| WILLIAM P BOWMAN MD PC | N |
| KEITH C MCKENZIE MD PLLC | N |
| STONY CREEK INTERNAL MEDICINE PLC | N |
| ACADEMIC CARDIOLOGY ASSOCIATES, PC | N |
| BRADFORD MERRELLI MD PC | N |
| STONEBROOKE FAMILY PHYSICIANS | N |
| NANCY F MANSOUR-HABIB M.D. P,C, | N |
| YOUR PHYSICIANS P.C. | N |
| SKYWALK INTERNAL MEDICINE PC | N |
| FORUM MEDICAL CLINIC, PC | N |
| HALLER & HUG PC | N |
| WEST BLOOMFIELD INTERNAL MEDICINE PLLC | N |
| RICHARDS & RICHARDSON PC | N |
| KARLE MEDICAL GROUP PC | N |
| CLINTON WOMENS HEALTHCARE PC | N |
| MAZEN SABBAQ MD PC | N |
| MARGARET ECKEL | N |
| LMT REHABILITATION ASSOCIATES,PC | N |
| LAWRENCE GREENBERG DO | N |
| JOHN D ARSEN DPM INC | N |
| HEART AND VASCULAR SPECIALISTS PC | N |
| GRUNBERGER DIABETES MEDICAL CENTER PC | N |
| GREENBERGER WU DUNN & FIELDS PLLC | N |
| GHABSHA MD PLLC | N |
| ELITE FAMILY MEDICINE PLLC | N |
| TROY FAMILY PRACTICE PLLC | N |
| CLINICAL NEUROPHYSIOLOGY SERVICES, PC | N |
| CHARLES H. GREENBERG, M.D.P.C | N |
| CHARLES G KISSEL DPM PC | N |
| CHARLES CHRISTOPHER STROUD MD PC | N |
| CHANDA J CORBIN PLLC | N |
| CENTER FOR PREVENTIVE MEDICINE PC | N |
| CARDIOLOGY AND ARRYTHMIA CONSULTANTS P.C. | N |
| ANTHONY L CACCO MD PC | N |
| ALLERGY ASTHMA CARE, PC | N |
| ALLERGY & ASTHMA CENTER OF ROCHESTER PC | N |
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 |
| Michael | Maddens | Voting Member | 25% | ACO Participant Representative | Klein Md, Hug MD, Sabin MD, Maddens MD, Khogali-Jakary DO PC |
| Martin | McGough | Voting Member | 25% | ACO Participant Representative | ACADEMIC CARDIOLOGY ASSOCIATES, PC |
| Frank | Martilotti | Voting Member | 25% | ACO Participant Representative | HALLER & HUG PC |
| Michael | Williams | Voting Member | 4.166% | Other | N/A |
| Diane | Slon | Voting Member | 4.166% | Other | N/A |
| Ravi | Sachdev | Voting Member | 4.167% | Other | N/A |
| Trip | Cothren | Voting Member | 4.167% | Other | N/A |
| Ben | Shaker | Voting Member | 4.167% | Other | N/A |
| Michael | Frank | Voting Member | 4.167% | Medicare Beneficiary Representative | N/A |
Key ACO Clinical and Administrative Leadership:
ACO Executive: Eric Becker
Medical Director: Kimberlee Coleman, MD
Compliance Officer: Kimberly Busenbark
Quality Assurance/Improvement Officer: Adina Guthrie
Associated Committees and Committee Leadership:
| Committee Name | Committee Leader Name and Position |
| ACO Compliance Committee | Kimberly Busenbark, Chief Compliance Officer, Chair |
Types of ACO Participants, or Combinations of Participants, That Formed the ACO:
- ACO professionals in group practice arrangements.
Shared Savings and Losses
Amount of Shared Savings/Losses:
- First Agreement Period
- Performance Year 2024, N/A
Shared Savings Distribution:
- First Agreement Period
- Performance Year 2024
- 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 2024
Quality Performance Results
2023 Quality Performance Results:
Our ACO did not participate in the Shared Savings Program in Performance Year 2023; therefore, this section is not applicable at this time.
Fraud and Abuse Waivers
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.
agilon health Michigan ACO, Inc.
ACO Participation Waiver Documentation – BOI Program
Parties to the arrangement: agilon health Management, Inc., agilon health Michigan ACO, Inc., United Physicians
Date of arrangement: 01/01/24
Items, services, goods, or facility provided:
agilon health Michigan ACO, Inc. (the ACO) a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO), is actively engaged in fulfilling the purposes of the MSSP through improvements in patient and provider engagement, clinical documentation and quality, as well as cost savings. The ACO has partnered with agilon health management, inc. (agilon health) to develop the BOI Program. This program is designed to assist and encourage ACO participating providers in completely and accurately capturing beneficiaries’ conditions.
The ACO recognizes the importance of Medicare Annual Wellness Visits (AWVs) and Chronic Care Visits (CCV). Medicare AWVs and CCVs serve as an opportunity to engage patients in their healthcare, improve patient satisfaction, and increase the clinician’s understanding of the patient’s overall health. Beyond fostering the clinician-patient relationship, the AWV or CCV is an excellent way for providers to identify and close gaps in quality, capture a complete and accurate account of a patient’s historical and chronic conditions, and prepare a meaningful personalized prevention and care plan. Therefore, the BOI Program was built around the clinical documentation leading up to and after an AWV or CCV, though it may be utilized during any relevant visit. A Relevant Visit is defined as an AWV or other eligible visit for a Covered Beneficiary—represented by the applicable professional service codes and the applicable telehealth codes—that is conducted between the start and end dates of this Program.
The BOI Program was created to incentivize complete and accurate coding to the highest level of specificity. Under this program, providers are given information related to known chronic and suspect conditions, based on a medical record review completed prior to a Relevant Visit. The ACO has contracted with agilon health Chart Reviewers who are tasked with reviewing beneficiary medical records based on disease states and chronic conditions (e.g., CHF, COPD) prior to and after a Relevant Visit.
For each BOI Assessment completed during the Term of the BOI Program, the provider who billed for the underlying Relevant Visit will be eligible to receive a BOI Assessment Protocol Fee, intended to compensate the provider for the time and effort required to complete the Assessment.
In addition to this Protocol Fee, each provider is eligible to receive Assessment Incentive Payments based on their Chronic Condition Assessment Rate. In order for a provider to qualify for the incentive, they must document a minimum percentage of chronic conditions in a complete and compliant fashion, with higher incentive payments made for accuracy levels of 93% and 97% respectively.
The purpose of the arrangement is to support and encourage ACO participating providers to meet quality metrics, capture a complete and accurate picture of beneficiaries’ historical and suspect chronic conditions, increase preventive care for beneficiaries, and meet documentation requirements for Relevant Visits.
All medical decisions will continue to be made based on the preferences of the beneficiary and medical judgement of the treating provider.
Prior to a scheduled AWV or CCV, the applicable provider will be given information related to known chronic and suspect conditions, based on a medical record review performed by agilon Chart Reviewers. The provider will be eligible to receive an incentive payment only if both of the following standards are met:
- The BOI Assessment is completed, and
- The Chronic Condition Assessment Rate meets the minimum threshold for accuracy.
Eligibility for incentive payments based on these thresholds will be determined by the ACO pursuant to a post-visit audit conducted by a clinical coder. The outgoing claims file and the patient’s information profile are analyzed by a certified coder using agilon health proprietary software to calculate the threshold per visit. The incentive is paid on a quarterly basis and is only available once per beneficiary each calendar year.
A5387_PY24PublicRpt_IA 020624