Scripps ACO - Accountable Care Organization

A Scripps physician talks with a mature male patient in a clinic hallway.

A Medicare Shared Savings Program participant

ACO name and location

Scripps Accountable Care Organization, LLC

Previous names: N/A

10140 Campus Point Drive

San Diego, California 92121

ACO primary contact

Primary contact name	Cindy Gipson
Primary contact phone number	858-678-7478
Primary contact email address	gipson.cynthia@scrippshealth.org

Organizational information

ACO participants
ACO governing body
Key ACO clinical and administrative leadership
Associated committees and committee leadership
Shared savings and losses
Quality performance results
Payment rule waivers

ACO Participants

ACO participants	ACO participant in joint venture (Y/N)
Acute Care Associates, INC.	N
Adema Family Medicine Inc	N
Ali Salami	N
Alisa L Williams, Md, Facog, Inc.	N
ASIM GUHA ROY	N
Balboa Park Internal Medicine, Medical Associates Inc	N
Billie Green, Medical Corporation	N
Bradley L. Spitz, MD Inc	N
BRETT J. BERMAN, MD, PROFESSIONAL CORPORATION	N
Bruce Kimura	N
Cardiac Arrhythmia Associates A Medical Corporation	N
Catharine Marshall MD	N
Chia-Lin Charles Liu,DO,Inc	N
Clara Lucy Polak, MD Inc.	N
Coastal Cardiovascular Care Inc	N
Coastal Pain & Spinal Diagnostics Medical Group, Inc.	N
CRAIG SCLAR	N
Dan I Giurgiu M D Professional Corporation	N
Dana P. Launer, MD and M.Jonathan Worsey, MD, A Professional Corp.	N
Daniel Michaels, MD, INC	N
Dennis Costello	N
Edward Kocharian MD APC	N
Elahe Toulouie, Md, Inc	N
Enlightened Healthcare Alliance Medical Corporation	N
Francisco S. Pardo MD PC	N
Frank E. Mayer, MD, A Professional Corporation	N
Frederick J De La Vega Md	N
Gregory P Ranches MD ACP	N
Gregory Ranches	N
Hanh M Bui Md Apmc	N
HOUMAN DAHI MD, APC	N
INTERNAL MEDICINE ASSOCIATES MEDICAL GROUP OF SAN DIEGO, INC.	N
James Santiago Grisolia, MD Inc	N
Jay Berenter	N
Jean Rizkallah, MD, Inc	N
Jeffry A Mullvain Md Inc	N
Jerrold Glassman, MD, A Medical Corporation	N
JOSE R PENA MD PC	N
JOSEPH CAPERNA MD A PROFESSIONAL CORPORATION	N
Joseph Resnikoff MD	N
Julian Lichter Md A Professional Corporation	N
Kelly S. Keefe MD, Inc	N
KESHAV R NAYAK MD AMC	N
Kiyon Chung, MD	N
La Jolla Cardiovascular Medical Assoc Inc	N
La Jolla Pulmonary And Critical Care Inc	N
Lars R Newsome Md Inc.	N
Leila Rhodes MD Inc	N
Leticia Uwedjojevwe Md Medical Corporation	N
Luis M Marquez,MD Inc	N
Luis Sanchez	N
Maria Lourdes S Mara Md - A Medical Corp	N
Medicus M D Inc A Deleware Corporation	N
Michael Sise	N
Michael T Couris, MD, Inc.	N
Naira Kocharian MD APC	N
Ngocbich Nguyen, MD, Inc.	N
North County Gastroenterology Medical Group Inc	N
North County Oncology Medical Clinic, Inc	N
Olde Del Mar Surgical Medical Group Inc	N
Pain Management Consultants A Professional Medical Corporation	N
Pamela Resnikoff	N
Paul Phillips	N
Perry W. Sexton, Md Professional Corporation	N
Richard Friedman	N
Ritvik Mehta Md, Pc	N
Robert Houghton Md Inc	N
Salami Nuclear Cardiology Medical Group Inc	N
San Diego Arrhythmia Associates, A Medical Corporation	N
San Diego Cardiovascular Associates Medical Group Inc	N
San Diego Gastroenterology Medical Associates	N
SAN DIEGO HEART ARRHYTHMIA CENTER, AMC	N
San Diego Heart Rhythm Center, A Medical Corporation	N
San Dieguito Orthopedic Medical Center, PC	N
Scott A Eisman Md Inc	N
Scott Mercer, Md, Inc	N
Scripps Health	N
Southern California Health Providers Medical Grp Inc	N
Spinezone Medical Fitness INC	N
Steven C. Wong MD, Apc	N
Stewart L Frank, MD, Inc.	N
Sudhir Malik, A Professional Medical Corporation	N
SUNIL RAYAN, MD, INC.	N
Surgical Associates Of La Jolla Medical Group, Inc.	N
Suzanne P Handler Md Inc	N
Szmidt A Professional Medical Corp	N
Thomas Diggs	N
Tram Le	N
Vg Cardiac Associates, A Medical Corporation	N
Vitali Aizin Md Inc	N
Wayne Whitwam	N
Wun-Ling Chang, MD, Inc.	N

ACO governing body

First name	Last name	TItle/Position	Voting power	Membership type	ACO participant TIN legal business name
Kevin	Hirsch	MD, Chair	12.5%	ACO Participant Representative	Scripps Health
Dan	Dworsky	MD	12.5%	ACO Participant Representative	Scripps Health
Scott	Eisman	MD	12.5%	ACO Participant Representative	Acute Care Associates, Inc. and Scott A Eisman MD Inc.
Andrew	King	MD	12.5%	ACO Participant Representative	Scripps Health
Clara	Polak	MD	12.5%	ACO Participant Representative	Clara Lucy Polak, MD
Robert	Tjosvold		12.5%	Medicare Beneficiary Representative	N/A
Chris	Van Gorder		12.5%	ACO Participant Representative	Scripps Health
Michael	Worsey	MD	12.5%	ACO Participant Representative	Dana P. Launer, MD, and M. Jonathan Worsey, MD, A Professional Corp.

Key ACO clinical and administrative leadership

Tracy Chu	ACO Executive
Anil Keswani, MD	Medical Director
Taunya Juliano	Compliance Officer
Karen Patel	Quality Assurance/Improvement Officer

Associated committees and committee leadership

Committee name	Committee leader name and position
Network Alignment	Michael Worsey, MD, Network Alignment Committee Chair
Utilization Management	Anil Keswani, MD, ACO Medical Director
Credentialing	Dan Dworsky, MD, Committee Chair
Communications	Cindy Gipson, Growth and Accountable Care Assistant Vice President
Clinical Care Line Council	Anil Keswani, MD, ACO Medical Director
Quality Committee	Dan Dworsky, MD, Committee Chair

Types of ACO participants, or combinations of participants, that formed the ACO:

Hospital employing ACO professionals
Partnerships or joint venture arrangements 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, $0
Performance year 2021, $0
Performance year 2020, $7,758,213.65

First agreement period

Performance year 2019, -$8,726,114.79
Performance year 2018, $0
Performance year 2017, $0

Shared savings distribution

Second agreement period

Performance Year 2022

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 2021

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 2020

Proportion invested in infrastructure: 44%
Proportion invested in redesigned care processes/resources: 29%
Proportion of distribution to ACO participants: 27%

First agreement period

Performance Year 2019

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 2018

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: N/A
Proportion invested in redesigned care processes/resources: N/A
Proportion of distribution to ACO participants: N/A

2022 Quality Performance Results

Quality performance results are based on CMS Web Interface.

Measure#	Measure name	Collection Type	Rate	ACO Mean
001	Diabetes: Hemoglobin A1c (HbA1c) Poor Control	CMS Web Interface	9.63	10.71
134	Preventative Care and Screening: Screening for Depression and Follow-up Plan	CMS Web Interface	69.29	76.97
236	Controlling High Blood Pressure	CMS Web Interface	72.91	76.16
318	Falls: Screening for Future Fall Risk	CMS Web Interface	72.61	87.83
110	Preventative Care and Screening: Influenza Immunization	CMS Web Interface	86.27	77.34
226	Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention	CMS Web Interface	77.78	79.27
113	Colorectal Cancer Screening	CMS Web Interface	82.79	75.32
112	Breast Cancer Screening	CMS Web Interface	86.64	78.07
438	Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	CMS Web Interface	84.23	86.37
370	Depression Remission at Twelve Months	CMS Web Interface	19.51	16.03
479	Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups	Administrative Claims	0.1505	0.151
484	Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions	Administrative Claims	31.1997	30.97
CAHPS-1	Getting Timely Care, Appointments, and Information	CAHPS	74.42	83.96
CAHPS-2	How Well Providers Communicate	CAHPS	93.48	93.47
CAHPS-3	Patient’s Rating of Provider	CAHPS	93.65	92.06
CAHPS-4	Access to Specialists	CAHPS	71.67	77.00
CAHPS-5	Health Promotion and Education	CAHPS	60.57	62.68
CAHPS-6	Shared Decision Making	CAHPS	57.88	60.97
CAHPS-7	Health Status and Functional Status	CAHPS	71.94	73.06
CAHPS-8	Care Coordination	CAHPS	85.72	85.46
CAHPS-9	Courteous and Helpful Office Staff	CAHPS	91.94	91.97
CAHPS-11	Stewardship of Patient Resources	CAHPS	20.38	25.62

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 uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR §425.612.

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.

Arrangement #1

Parties to the arrangement: Scripps ACO and ACO Participants
Date of arrangement: December 8, 2017
Items, services, goods, or facility provided: Scripps Health EpicCare EHR
Date and nature of any amendments to the arrangement, if applicable: N/A

Arrangement #2

Parties to the arrangement: Scripps ACO and ACO Participants
Date of arrangement: May 30, 2018
Items, services, goods, or facility provided: Chronic Disease Care Management services
Date and nature of any amendments to the arrangement, if applicable: N/A

Arrangement #3

Parties to the arrangement: Scripps ACO and ACO Participants
Date of arrangement: September 26, 2018
Items, services, goods, or facility provided: Clinical and hospital facilities for coordinated oncology services
Date and nature of any amendments to the arrangement, if applicable: N/A

Arrangement #4

Parties to the arrangement: Scripps ACO and ACO Participants
Date of arrangement: January 23, 2020
Items, services, goods, or facility provided: Home-based care management services
Date and nature of any amendments to the arrangement, if applicable: N/A

Arrangement #5

Parties to the arrangement: Scripps ACO and ACO Participants
Date of arrangement: January 23, 2020
Items, services, goods, or facility provided: Advance care planning services
Date and nature of any amendments to the arrangement, if applicable: N/A

Arrangement #6

Parties to the arrangement: Scripps ACO and ACO Participants
Date of arrangement: February 24, 2021
Items, services, goods, or facility provided: Remote monitoring devices to assist in management and care of chronic and/or acute conditions
Date and nature of any amendments to the arrangement, if applicable: N/A