Direct Contracting

Auxilium Health Network DCE

Participant

DCE Participant Type of Provider
ADIOFEL MARK MENDOZA DC Participant Provider
Afshar Neda DC Participant Provider
ALFRED CISNEROS DC Participant Provider
AMH Comprehensive Medical Centers DC Participant Provider
ANDREW MUI DC Participant Provider
Baldwin Park Medical Group Inc. DC Participant Provider
BENJAMIN BEHROOZAN DC Participant Provider
BEVERLY CHIONG DC Participant Provider
BRIAN YANG DC Participant Provider
CARE PLUS MEDICAL GROUP INC DC Participant Provider
CHRISTINA LEE DC Participant Provider
CHRISTOPHER LINEBACK DC Participant Provider
CHRISTOPHER TOUPIN DC Participant Provider
COURTNEY COOPER DC Participant Provider
DEBRALYNNE ZICKAFOOSE DC Participant Provider
DENNIS KIM DC Participant Provider
DEWEY PILLAI DC Participant Provider
EDGARDO FALCON DC Participant Provider
EDWIN MANGUNE DC Participant Provider
GENARO MARTINEZ DC Participant Provider
George Adepeju DC Participant Provider
GEORGE JAYATILAKA DC Participant Provider
GERARDO CANCHOLA DC Participant Provider
GREGORY SMITH DC Participant Provider
HEATHER PLESKOW-WEISMAN DC Participant Provider
HELEN TRAN DC Participant Provider
JACOB FLORES DC Participant Provider
JASON GROOMER DC Participant Provider
JEFF HUANG DC Participant Provider
JEFFREY EDMUNDS DC Participant Provider
JM GEISS DO APC DC Participant Provider
JONATHAN DINH DC Participant Provider
JOSE DE LA LLANA DC Participant Provider
JOSEPH DEMATTIA DC Participant Provider
JUAN SAM DC Participant Provider
KALIASH DHAMIJA DC Participant Provider
KAREN KIM DC Participant Provider
KAVEN HOSSEINZADEH DC Participant Provider
KENNETH KIM DC Participant Provider
KWAN TAN DC Participant Provider
LEEANN GREEN DC Participant Provider
MALVIN YAN DC Participant Provider
MARJAN SABA DC Participant Provider
MERCEDES DE LAS ALAS DC Participant Provider
MICHAEL CHARVIS DC Participant Provider
MOHAMMAD SADRI DC Participant Provider
NIKITA SMITH DC Participant Provider
NOBLEQUEST HEALTH FOUNDATION INC DC Participant Provider
PAUL SUCGANG DC Participant Provider
PREVENTIVE CARE NETWORK MEDICAL SERVICES, INC. DC Participant Provider
PROMPT HEALTHCARE INC A MEDICAL CORPORATION DC Participant Provider
RAKESH SHISHODIA DC Participant Provider
RAVINDRA GAUTAM DC Participant Provider
RAVINDRA GAUTAM, M.D., INC. DC Participant Provider
REUVEN SISON DC Participant Provider
RUBEN RUIZ DC Participant Provider
SAMARITANA MEDICAL CLINIC,INC. DC Participant Provider
SOFIA GONZALEZ-POST DC Participant Provider
STEVEN ROSENBLATT DC Participant Provider
SUHAIL JAFREY DC Participant Provider
SUSAN SHARP DC Participant Provider
SUZANNE CHANG DC Participant Provider
TRINH KOSOBUCKI DC Participant Provider
VICTOR NGUYEN DC Participant Provider
VINH VU DC Participant Provider
WILLIAM CHU DC Participant Provider
WINSTON WONG DC Participant Provider
YU-NAN HSU DC Participant Provider
ADEL ZAKI Preferred Participant
ARMIN VISHTEH Preferred Participant
ARTIN GEVORGIAN Preferred Participant
HSIU HSIEN LING Preferred Participant
KOUROSH HAROUNIAN Preferred Participant
LUNG CHANG Preferred Participant
MOHAMED KATTIH Preferred Participant
RAYMOND TATEVOSSIAN Preferred Participant
RAYMUNDO BAUTISTA Preferred Participant
REGINALD AJAKWE Preferred Participant
ROSTAM KHOSHSAR Preferred Participant
STANLEY SCHINKE Preferred Participant
TRANG DUONG Preferred Participant

Leadership

Name Title/Position
Chris Tsang CEO
Karen Kim, M.D. Medical Director
Michael Cambron, PhD EVP

Governing Body

Name Title/Position Membership Type
Karen Kim, M.D. Voting Member Participant Provider
William Chu Voting Member Participant Provider
Lee Suyanaga Medicare Beneficiary/ Consumer Advocate Medicare and Consumer Manager
Makabis Yousefpour, DPM Voting Member DCE Preferred Provider
Chris Tsang Voting Member N/A
Michael Cambron, PhD Voting Member N/A
Performance Review We will be updated with shared savings, losses and quality as it becomes available in 2022 Contact Us Primary Contact:  Karen Kim MD Medical Director Phone Numbers  323 694 6732 Email info@auxiliumhealth.us

Frequently Asked Questions (FAQ)s

Q: What is a DCE? DCE is a legal entity which participates in Direct Contracting pursuant to a Participation Agreement with CMS. Various types of organizations may apply to become a DCE including Accountable Care Organizations (ACOs). Under Direct Contracting, there will be three types of DCEs with different characteristics and operational parameters. Q: What is the Direct Contracting Model? The Direct Contracting Model creates a new opportunity for the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) to test an array of financial risk-sharing arrangements expected to reduce Medicare expenditures while preserving or enhancing the quality of care furnished to beneficiaries. The Direct Contracting Model leverages lessons learned from other Medicare Accountable Care Organization (ACO) initiatives, such as the Medicare Shared Savings Program and the Next Generation ACO (NGACO) Model, as well as innovative approaches from Medicare Advantage (MA) and private sector risk-sharing arrangements. This model is part of a strategy by the CMS Innovation Center to use the redesign of primary care as a platform to drive broader health care delivery system reform. The model creates a variety of pathways for participants to take on financial risk supported by enhanced flexibilities. Because the model reduces burden, supports a focus on complex, chronically and seriously ill patients, and aims to encourage organizations to participate that have not typically participated in Medicare fee-for-service (FFS) Innovation Center models, we anticipate that this model will appeal to a broad range of physician organizations and other types of health organizations. What are the model options under Direct Contracting? The CMS Innovation Center will test up to three voluntary risk-sharing options: 1) Professional, a lower-risk option (50 percent Shared Savings/Shared Losses) and Primary Care Capitation (PCC) equal to seven percent of the total cost of care benchmark for enhanced primary care services; and 2) Global, a full risk option (100 percent Shared Savings/Shared Losses) and either PCC or Total Care Capitation (TCC). CMS has also sought comment on a potential third option, the Geographic Option, which is another full risk option (100 percent Shared Savings/Shared Losses) that will offer an opportunity for participants to assume total cost of care risk for Medicare Parts A and B services for Medicare FFS beneficiaries in a defined target region. Q: What are the benefits of participating in Direct Contracting? Direct Contracting is intended to test whether the risk-based payment strategies available under the model align financial incentives and offer model participants (Direct Contracting Entities or DCEs) flexibility in engaging health care providers and patients in care delivery that results in preserving or enhancing quality of care while at the same time reducing the total cost of care. Specifically, Direct Contracting offers:
  • Multiple risk-sharing arrangements
  • Flexible beneficiary alignment options, including enhancements to voluntary alignment relative  to existing Medicare initiatives
  • Capitation payment options that vary by risk-sharing arrangement
  • Benefit enhancements and payment rule waivers to improve care coordination and service delivery
  • A focus on complex chronic and seriously ill beneficiaries, and
  • Options for organizations that have not participated in Medicare FFS previously
Q: How many years is Direct Contracting? The model will be implemented over six performance years (PY1-6), with an optional initial Implementation Period (IP). The IP will occur from October 2020 through March 2021, PY1 will occur from April 2021 through December 2021, and PY2, PY3, PY4, PY5 and PY6 will occur in calendar years 2022, 2023, 2024, 2025, and 2026 respectively. Q: What is the difference between DC Participant Providers and Preferred Providers? DC Participant Providers are the core providers and suppliers in the Professional and Global Options. Beneficiaries are aligned to the DCE through the DC Participant Providers and these providers and suppliers are responsible for, among other things, reporting quality through the DCE and committing to beneficiary care improvement. DC Participant Providers, unlike Preferred Providers, are subject to the Capitation Payment Mechanism selected by the DCE, which involves Medicare Fee-For-Service claims reductions and the requirement that the DCE and the DC Participant Provider enter into a negotiated payment arrangement. Preferred Providers contribute to DCE goals by extending and facilitating valuable care relationships beyond the DCE. For example, Preferred Providers may participate in benefit enhancements approved and available in PY1 and alternative payment arrangements with the DCE. Services furnished by Preferred Providers will not be considered in beneficiary alignment and Preferred Providers are not responsible for reporting quality through the DCE. In addition to DC Participant Providers and Preferred Providers, beneficiaries aligned to a DCE may also choose to receive services from Medicare FFS providers and suppliers that are not associated with the DCE. Q: How does CMS align beneficiaries to DCEs? For the purpose of assigning accountability for risk sharing and the total cost of care, beneficiaries may be aligned to a DCE in two ways; however, the beneficiary alignment options available to a DCE will depend upon the DCE type. The two beneficiary alignment options are as follows:
  • Claims-based alignment where beneficiaries are aligned based on the plurality of primary care services furnished by DC Participant Providers, as evidenced in claims utilization data.
  •  Voluntary alignment where beneficiaries communicate their desire to be aligned with a DC Participant Provider.