360 HEALTH DCE

Participant Providers

DCE Participant

Type of Provider

Identification of Joint Venture (Y/N)

ABDELSALAM MOGASBE

DC Participant Provider

N

ADOLFO QUIROGA

DC Participant Provider

N

ALYN ANDERSON

DC Participant Provider

N

AMANDA BENNETT

DC Participant Provider

N

AMANDA DAVIS

DC Participant Provider

N

ASHRAF ZADSHIR

DC Participant Provider

N

BRIAN-LINH NGUYEN

DC Participant Provider

N

CHRISTIAN ROMERO

DC Participant Provider

N

CHRISTINE NGUYEN

DC Participant Provider

N

DALIA CORLEONE

DC Participant Provider

N

DANIEL HILTON

DC Participant Provider

N

DAVID NGUYEN

DC Participant Provider

N

DAWN WALKER

DC Participant Provider

N

DUC NGUYEN

DC Participant Provider

N

ELISABETH WANG

DC Participant Provider

N

FRANCES GRILL

DC Participant Provider

N

GABRIEL COLON CABALLERO

DC Participant Provider

N

GREGORIO SOSA

DC Participant Provider

N

GRETA RIOS-STEED

DC Participant Provider

N

HAI NGUYEN

DC Participant Provider

N

JAMES KOHAN

DC Participant Provider

N

JAVIER RIOS

DC Participant Provider

N

JHOANA TOVAR

DC Participant Provider

N

JOANNA FALCON

DC Participant Provider

N

JOHN STRONG

DC Participant Provider

N

JOSEPH NASSIR

DC Participant Provider

N

JOSHUA KOH

DC Participant Provider

N

JUAN VELAZQUEZ

DC Participant Provider

N

JULIE HILTON

DC Participant Provider

N

KENNETH BABBITT

DC Participant Provider

N

LAURA HOLZER

DC Participant Provider

N

MARIA ROBLES

DC Participant Provider

N

MAYRA PADILLA ARECHIGA

DC Participant Provider

N

MAYRA SILHY

DC Participant Provider

N

MICHELINE HELOU

DC Participant Provider

N

NICOLE AUGSBURGER

DC Participant Provider

N

NIGHTINGALE JORDAN

DC Participant Provider

N

NOEL SANTAMARIA

DC Participant Provider

N

RODOLFO ROJAS

DC Participant Provider

N

TAM NGUYEN

DC Participant Provider

N

THANG NGUYEN

DC Participant Provider

N

THUY PHAM

DC Participant Provider

N

TIEN VO

DC Participant Provider

N

WADE HUNSAKER

DC Participant Provider

N

 

Preferred Providers

DCE Participant

Type of Provider

Identification of Joint Venture (Y/N)

24/7 CARE AT HOME- HOME HEALTH

Preferred Provider

N

ANOOP MAHESHWARI

Preferred Provider

N

CHING FONG CHIN

Preferred Provider

N

GALEN HUANG

Preferred Provider

N

GAYTRI MANEK

Preferred Provider

N

KHANH DUONG

Preferred Provider

N

MAXCARE HOSPICE

Preferred Provider

N

PHILIP YANG

Preferred Provider

N

TUAN NGUYEN

Preferred Provider

N

 

Governing Body

Name

Title/Position

Membership Type

Dawn Walker, D.O

Voting Member

DC Participant Provider

Dung Trinh, M.D.

Voting Member

DC Participant Provider

Hanh Le

Medicare Beneficiary / Consumer Advocate

Medicare and Consumer Advocate

Jordan Hall, DNP

Voting Member

DC Executive Officer

Kenny Nguyen, M.D.

Voting Member

DC Participant Provider

Tam Nguyen, D.O.

Voting Member

DC Participant Provider

Thy Manh

Voting Member

DC Participant Provider

Vicky Silva

Voting Member

DC Participant Provider

 

Leadership

Name

Title/Position

Kyle Wailes

Chief Executive Officer

Mark Montoney, M.D.

Chief Medical Officer

Cassie Smith

Chief of Staff

Phil Harrison

Chief Strategy & Analytics officer

Jordan Hall

DCE Executive Office/CMS Liaison

Scott Lenz

EVP, General Counsel

Sean Henson

SVP of Operations

Wes Stolp

Vice President - Network Management

 

FAQs

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.

Q: 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.

 

Performance Review

We will be updated with shared savings, losses and quality as it becomes available in 2022

 

Contact Us

Primary Contact: 

Jordan Hall, DNP: DCE Executive
Jordan.Hall@360.MD 

 

Phone Numbers 

360 Health DCE: (800) 253-9999
CMS: (800) 633-4227

Email

DCE@360.MD