PUBLIC INFORMATION AS OF 2/28/2017
NAME AND LOCATION:

Balance Accountable Care Network, LLC

DBA: Balance ACO

5030 Broadway, Ste. 808

New York, NY 10034

Tel: (212) 567-1104

Fax: (212) 567-1116

BALANCE ACO PRIMARY CONTACT:

Dr. Oscar Fukilman, CEO

ofukilman@balanceaco.com

Tel: (212) 567-1104

ORGANIZATIONAL INFORMATION:
Balance ACO Participants (Performance Year 2017)
  • 1211 WPR Medical Services, P.C.

  • 139 Medical Facility P.C.

  • A.W. Medical Office, P.C

  • Academy Medical Care, PC

  • AguedaMercardo, MD

  • Ajith Kumar Karayil

  • Alberto Comas Espinal, MD

  • Alcedo Cruz, MD

  • Alexander Shapsis, MD

  • America Medical Group PC

  • AMR Nayel MD PC

  • Amr Nayel, MD

  • Amsterdam Medical Practice, PLLC

  • Andres Hernandez-Abreu

  • Arthur R. Dove MD PC

  • Atlantic Gastroenterology PC

  • Babu Patel

  • Babu Patel, MD

  • Babubhai I Patel Physician PC

  • Babubhai I Patel, MD

  • Best Care Ever Med Group, PC

  • Bright Medical PC

  • Broadway Internal Medicine PC

  • BukhmanMd Pc

  • Cardiology Unlimited, PC

  • CCN General Medicine,PLLC

  • Cecilia Calderon, MD

  • Chaudhry Ghumman

  • Cheng Gonjon, MD

  • Christian Belliard Estevez

  • Cluny Lefevre, MD

  • Concourse Village Primary Care PLLC

  • Cruz & Herrera, MDs PC

  • Cuidado Medico Y Geriatrico Of Queens Pc

  • Dario Castellanos, MD

  • Dario Castellanos, MD

  • David Weiss

  • Dominick K. Bioh, M.D. P.C.

  • Eduardo L. Pignanelli, Physician P.C.

  • Eduardo Pignanelli

  • Eliscer Guzman, MD

  • Elsa Reyes

  • Essen Medical Associates, P.C.

  • Fausto Gonzalez, MD

  • Felix Florimon

  • First Medcare, Inc

  • Fort Washington Medical Office

  • Francisco De Lara, MD

  • General Medical Services Of Queens Pc

  • Global Medical Care Associates PLLC

  • Godwin Medical PC

  • Groupo Medico Dominicano PLLC

  • Gustavo Melamedoff

  • Hanna

  • Harrison F Mitchell M D P C

  • Health Development & Restorative Medicine, PC

  • Healthy Living David Ben Meir Mph General Medicine

  • House Call Medical Services of New York, PLLC

  • Imperial Medical PC

  • Isaiah Pinckney

  • Isaiah Pinckney

  • Janny A. Ozuna Mendez MD PLLC

  • Jean D Augustine

  • Jean D Augustine MD

  • Jean Macenat

  • Jerome Medical Office PC

  • JLDH Medical Service PLLC

  • Jose A. Goris, MD PC

  • Jose Batlle, MD

  • Jose Goris

  • Joseph Huang, MD

  • Juan Alba

  • Julio AlbarranMarzan, MD

  • Julio AlbarranMarzan, MD PC

  • Junction Medical Office PC

  • KalidChaughtai, MD

  • Khalid Chaughtai

  • Knickerbocker Medical Care P.C.

  • Le Kiong Huang MDPC

  • Leonid Bukhman

  • Luisa Perez, MD

  • Luz Ares, MD

  • M B Medical Associates PC

  • Mahmood Karimi, NJ MD PA

  • Martha Valdivia, MD

  • Mary Z. Awad MD PC

  • Medinova Physician PLLC

  • Mesbah Medical Pc

  • Michael Correa, MD

  • Michael Correa,MD PC

  • Michael Karimi

  • MihailMedvedovsky Physician PC

  • MihailMedvedovsky, MD

  • Mohammed Rahman

  • Muhammad Haque

  • Muhammed Haque

  • Nadia Martinez De Pimentel

  • New York Primary Care Medicine Pc

  • Night and Day Medical Associates

  • ORG MEDICAL PLLC

  • Oscar Fukilman

  • Provat Das

  • Q-Care Affordable Medical Care PLLC

  • R.R.G. Medical Practice, PC

  • Rafael Guillen, MD

  • Rafael Rodriguez

  • Rajesh Patel, MD

  • Ramon Pimentel, MD

  • Ramon Tallaj, MD

  • Ravi Physician PC

  • Rehana Zaman

  • Roberto Zambon

  • Rodolfo Guzman

  • Ruben U. Carvajal MDPC

  • Ruben U. Carvajal, MD

  • Sixto R. Caro MD

  • Stanley B. Cohen, MD

  • Stanley Cohen

  • Stephan Simons

  • Total Medical, PC

  • Total Neuro Care PC

  • University Medical Office, PLLC

  • Venkata Ravi, MD

  • Vijay Alla, MD

  • Westchester Avenue Family Medicine PC

  • Westside Medical

  • Woodlawn Medical Associates PC

  • Woodside Medical Practice PC

  • YdelfonsoDecoo

  • Yomaris Pena-Pena, MD

  • YPP New Modern Medicine, PLLC

  • Roberto Zambon

  • Rodolfo Guzman

  • Ruben U. Carvajal MDPC

  • Ruben U. Carvajal, MD

  • Sixto R. Caro MD

  • Stanley B. Cohen, MD

  • Stanley Cohen

  • Stephan Simons

  • Total Medical, PC

Balance ACO participants in joint ventures between ACO Professionals and hospitals:

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

Balance ACO Governing Body:
  • Ramon Tallaj, M.D., Voting Member and Chairman, ACO Participant, Academy Medical Care, PC & AW Medical, PC

  • Oscar Fukilman, M.D., Voting Member and Chief Executive Officer, ACO Participant, Oscar J. Fukilman, MD

  • Sumir Sahgal, MD, Voting Member, Chief Medical Officer& Medical Director, ACO Participant, Essen Medical Associates, P.C. and House Call Medical Services of New York, PLLC

  • Jose A. Goris, MD, Voting Member and Treasurer, ACO Participant,Jose A. Goris, MD PC and Best Care Ever Med Group, PC

  • Ramon Anibal Ramos, Voting Member, Medicare Beneficiary Representative

  • Emilio Villegas, M.D., Non-Voting Member and Secretary

  • Patricia Tobon, Non-Voting Member and Chief Operating Officer

Key Balance ACO Clinical and Administrative Leadership
  • ACO Executive: Oscar Fukilman, M.D.

  • Chief Medical Officer & Medical Director: Sumir Sahgal, M.D

  • Chief Operations Officer: Patricia Tobon

  • Compliance Official: Liz Webb

  • Quality Assurance/Improvement Officer: Dara Grieger, M.D.

Balance ACO Committees and Committee Leaderships
  • Quality Improvement and Patient Centeredness and Care Coordination Committee: Sumir Sahgal, M.D., Chair

  • Finance and Operations Committee: Emilio Villegas, Chair

  • Compliance Committee:Liz Webb, Chair

  • Community Advisory Committee:Ramon Anibal Ramos, Chair

Types of ACO participants that formed the ACO:
  • 1.Individual practices of ACO professionals

  • 2.ACO professionals in group practice arrangements

SHARED SAVINGS & LOSSES:
Amount of Shared Savings/Losses
  • Agreement period beginning 2013, Performance Year 1: $0

  • Agreement period beginning 2013, Performance Year 2014: $0

  • Agreement period beginning 2013, Performance Year 2015: : $0

How are Shared Savings Distributed - Performance Years: 2013, 2014, 2015, 2016

Balance ACO plans on using any shared savings to reinvest in the necessary infrastructure to further our mission of improving clinical quality, improving the patient experience, and reducing the cost of care. We also plan to use some of this money to incentivize our ACO participants to continue to improve upon the ACO’s mission.

  • Reinvest in infrastructure: TBD% (Not yet determined)

  • Reinvest in redesign care process/resources: TBD% (Not yet determined)

  • Distribution to ACO Participants: TBD% (Not yet determined)

    • Primary Care Professionals: TBD% (Not yet determined)

    • Specialists: TBD% (Not yet determined

Payment Rule Waivers
  • No, our ACO does not use the SNF 3-Day Rule Waiver.

Quality Performance Results
  • See 2015 Quality Performance Results Table A (below)

  • See 2012 -2014 Quality Performance Results Table B (below)

QUALITY PERFORMANCE RESULTS
TABLE A: Performance Years 2015
2015 Reporting Period
Measure Number Measure Name ACO Performance Rate Mean Performance Rate (SSP ACOs)
ACO-1 CAHPS: GettingTimelyCare, Appointments, andInformation 80.45 80.61
ACO-2 CAHPS: HowWellYour Doctors Communicate 93.70 92.65
ACO-3 CAHPS: Patients’Rating of Doctor 91.85 91.94
ACO-4 CAHPS: AccesstoSpecialists 83.64 83.61
ACO-5 CAHPS: Health Promotion and Education 63.73 59.06
ACO-6 CAHPS:  Shared Decision Making 73.73 75.17
ACO-7 CAHPS:  Health Status/Functional Status 64.76 72.30
ACO-34 CAHPS:  Stewardship of Patient Resources* 23.90 26.87
ACO-8 Risk Standardized, All Condition Readmissin 17.49 14.86
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM)* Readmission 17.59 18.07
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes* 81.66 54.60
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure* 110.57 76.96
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 88.38 62.92
ACO-9 Ambulatory Sensitive Conditions:  Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality  Indicator (PQI) #5) 2.03 1.11
ACO-10 Ambulatory Sensitive Conditions:  Heart Failure (AHRQ Prevention Quality  Indicator (PQI) #8) 1.37 1.04
ACO-11 Percent of PCPs who Successfully Meet Meaningful Use Requirements 66.01% 76.22%
ACO-39 Documentation of Current Medications in the Medical Record* 93.28% 84.07%
56.46ACO-13 Falls:  Screening for Future Fall Risk 71.08% 56.46%
ACO-14 Preventive Care and Screening:  Influenza Immunization 45.47% 62.03%
ACO-15 Preventative Care and Screening: Pneumococcal Vaccination Status for Older Adults 27.92% 63.73%
ACO-16 Preventive Care and Screening:  Body Mass Index (BMI) Screening and Follow-Up 83.11% 71.15%
ACO-17 Preventative Care and Screening: Tobacco Use Assessment and Cessation Intervention 77.90% 90.16%
ACO-18 Preventive Care and Screening:  Screening for Clinical Depression and Follow-Up Plan 42.45% 45.25%
ACO-19 Colorectal Cancer Screening 35.84% 60.06%
ACO-20 Breast Cancer Screening 46.44% 65.67%
ACO-21 Preventive Care and Screening:  Screening for High Blood Pressure and Follow-Up Documented 82.39% 70.04%
ACO-40 Depression Remission at Twelve Months* N/A N/A
ACO-27 Diabetes Mellitus:  HbA1c Poor Control 29.04% 20.38%
ACO-41 Diabetes:  Eye Exam* 36.81% 41.05%
ACO-28 Hypertension:  Controlling High Blood Pressure 61.28% 69.62%
ACO-30 Ischemic Vascular Disease:  Use of Aspirin or Another Antithrombotic 84.19% 83.82%
ACO-31 Heart Failure:  Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 83.33% 87.22%
ACO-33 Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%) 73.86% 77.73%

Note:CAHPS = Consumer Assessment of Healthcare Providers and Systems, PQI = Prevention Quality Indicator, LVSD dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery *= Measure required beginning Reporting Year 2015. N/A= Reporting on the depression remission measure is not required for 2015, as indicated by N/A

 

TABLE B: Performance Years 2012, 2013, 2014

 

 

Measure number

 

 

Performance measure

2012 reporting period

2013 reporting period

2014 reportingperiod

ACO
performance rate

Mean performance rate for all ACOs

ACO
performance rate

Mean performance rate for all ACOs

ACO
performance rate

Mean performance rate for all ACOs

ACO #1

GettingTimely Care, Appointments, andInformation

N/A

N/A

N/A

N/A

78.24

80.13

ACO #2

How Well Your Doctors
Communicate

N/A

N/A

N/A

N/A

91.41

92.39

ACO #3

Patients’Rating of Doctor

N/A

N/A

N/A

N/A

89.93

91.58

ACO #4

Accessto Specialists

N/A

N/A

N/A

N/A

80.38

83.97

ACO #5

Health Promotionand Education

N/A

N/A

N/A

N/A

61.35

58.29

ACO #6

Shared Decision Making

N/A

N/A

N/A

N/A

73.74

74.60

ACO #7

Health Status/Functional Status

N/A

N/A

N/A

N/A

66.83

71.10

ACO #8

Risk Standardized,All Condition
Readmissions

18.08

15.42

17.96

14.90

17.35

15.15

ACO #9

ASC Admissions:COPD or
Asthmain Older Adults

1.63

1.13

1.96

1.17

1.64

1.08

ACO #10

ASC Admission:Heart Failure

.91

1.09

1.32

1.20

1.36

1.19

ACO #11

Percent of PCPs who Qualifiedfor
EHR IncentivePayment

44.72%

63.37%

25.48%

66.21%

35.76%

76.71

ACO #12

Medication Reconciliation

N/A

N/A

N/A

N/A

100.00%

82.61

ACO #13

Falls: Screeningfor FallRisk

N/A

N/A

N/A

N/A

79.54%

45.60

ACO #14

Influenza Immunization

N/A

N/A

N/A

N/A

41.91%

57.51

ACO #15

Pneumococcal Vaccination

N/A

N/A

N/A

N/A

35.80%

55.03

ACO #16

Adult Weight Screeningand
Follow-up

N/A

N/A

N/A

N/A

69.66%

66.75

ACO #17

Tobacco Use Assessment and
Cessation Intervention

N/A

N/A

N/A

N/A

81.13%

86.79

ACO #18

Depression Screening

N/A

N/A

N/A

N/A

56.22%

39.27

ACO #19

Colorectal Cancer Screening

N/A

N/A

N/A

N/A

40.34%

56.14

ACO #20

Mammography Screening

N/A

N/A

N/A

N/A

46.88%

61.41

 

 

Measure number

 

 

Performance measure

2012reportingperiod

2013reportingperiod

2014reportingperiod

ACO
performance rate

Mean performance rate for all ACOs

ACO
performance rate

Mean performance rate for all ACOs

ACO
performance rate

Mean performance rate for all ACOs

ACO #21

Proportion of Adults who had blood pressure screened in past2 years

N/A

N/A

N/A

N/A

81.85%

60.24

ACO #22

Hemoglobin A1c Control (HbA1c) (<8 percent)

N/A

N/A

N/A

N/A

59.07%

N/A

ACO #23

Low Density Lipo protein(LDL) (<100mg/dL)

N/A

N/A

N/A

N/A

N/A

N/A

ACO #24

Blood Pressure(BP)<140/90

N/A

N/A

N/A

N/A

68.68%

N/A

ACO #25

Tobacco NonUse

N/A

N/A

N/A

N/A

60.85%

N/A

ACO #26

Aspirin Use

N/A

N/A

N/A

N/A

85.58%

N/A

ACO #27

Percent of beneficiaries with diabetes whose HbA1cin poor control(>9 percent)

N/A

N/A

N/A

N/A

29.56%

20.35

ACO #28

Percent of beneficiaries with hypertension whose BP <140/90

N/A

N/A

N/A

N/A

66.84%

68.02

ACO #29

Percent of beneficiaries with IVD with complete lipid profile and LDL control<100mg/dl

N/A

N/A

N/A

N/A

N/A

N/A

ACO #30

Percent of beneficiaries with IVD who use Aspirin or other ant ithrombotic

N/A

N/A

N/A

N/A

82.60%

80.79

ACO #31

Beta-Blocker Therapy for LVSD

N/A

N/A

N/A

N/A

83.70%

82.71

ACO #32

Drug Therapy for Lowering LDL Cholesterol

N/A

N/A

N/A

N/A

85.05%

N/A

ACO #33

ACE Inhibitoror ARB Therapy for Patientswith CAD and Diabetes and /or LVSD

N/A

N/A

N/A

N/A

80.89%

N/A

Note:ASC =ambulatorysensitive conditions,COPD =chronicobstructivepulmonarydisease,PCP =primarycare physician,EHR =electronichealthrecord, IVD = ischemicvascular disease, LVSD= leftventricular systolicdysfunction,ACE = angiotensin-converting enzyme,ARB = angiotensinreceptor blocker,CAD = coronaryarterydisease