COMPANY WILL MANAGE CARE AND PAY CLAIMS FOR 32,000 MEDICARE PATIENTS
MONTHLY PAYMENTS TO BEGIN IN APRIL 2017
GLENDALE, Calif., April 11, 2017 /PRNewswire/ -- Apollo Medical Holdings, Inc. ("ApolloMed" or "the Company") (OTC: AMEH), an integrated population health management company delivering value-based care, today announced that its subsidiary, APA ACO, Inc., has, effective April 1, 2017, commenced All-Inclusive Population-Based Payment operations as a participant in the Centers for Medicare and Medicaid Services ("CMS") Next Generation ACO Model ("NGACO Model").
As previously announced, APA ACO is one of 44 ACOs in the country selected by CMS to participate in the Next Generation ACO Model. APA ACO was approved to participate in the All-Inclusive Population-Based Payment ("AIPBP") track, which is the most advanced risk-taking payment model, and is the only ACO in the country out of 44 which is participating in the AIPBP model. Under the AIPBP track, CMS will estimate the total annual expenditures for the Next Gen ACO's patients and then pay that projected amount to the ACO in a per-beneficiary, per-month ("PBPM") payment. The Next Gen ACO would then be responsible for paying all Part A and Part B costs for in-network participating providers and preferred providers with whom it has contracted.
ApolloMed believes that APA ACO's participation in the NGACO Model may generate an average of between $9 million to $10 million per month in revenue, beginning in April 2017. For the trailing twelve months ended on December 31, 2016, ApolloMed reported revenues of $55 million.
Under the NGACO Model, APA ACO will be responsible for the medical management and care coordination of over 32,000 Medicare beneficiaries in California. This number may decrease due to beneficiaries who join a managed care (HMO) plan, pass away or move out of the ACO's service area. In 2016, in advance of commencing its participation in the program, APA ACO signed agreements with over 700 providers, including over 590 physicians, 18 hospitals, over 15 skilled nursing facilities and multiple labs, radiology centers, outpatient surgery centers, dialysis clinics and other service providers. Under the terms of these agreements, the Next Gen ACO providers, including hospitals, agreed to get 100% of their claims for ACO beneficiaries reimbursed by APA ACO. APA ACO successfully negotiated discounted Medicare rates with multiple physicians and other service providers, discounted DRG (diagnosis-related group) rates with multiple hospitals and discounted RUG (resource utilization group) rates with multiple skilled nursing facilities.
APA ACO is jointly owned by ApolloMed and Network Medical Management, Inc. ("NMM"). As announced on December 22, 2016, ApolloMed and NMM have signed a definitive merger agreement pursuant to which the companies will combine in a stock-for-stock transaction. On a proforma basis, and excluding the impact of APA ACO's participation in the NGACO Model, the combined organization would have had more than $330 million in revenues for the twelve months ended on December 31, 2015 and would provide medical management and care coordination for over 700,000 patients through a network of over 3000 healthcare professionals and over 400 employees.
"We believe that our selection to participate in the NGACO Model and especially the AIPBP track reflects our success in providing high-quality, cost-efficient, coordinated care," stated Warren Hosseinion, M.D., Chief Executive Officer of Apollo Medical Holdings. "It also validates our ongoing, multi-year investments in creating an advanced technology and care platform that promotes value-based care over volume-driven care."
"The investments we have made in ApolloMed's clinical knowledge base and risk management infrastructure have positioned the Company to participate in this important healthcare program," stated Gary Augusta, Executive Chairman of Apollo Medical Holdings. "Our integrated model spans the entire inpatient and outpatient care continuum, and includes Apollo Care Connect, a robust, cost-effective population health platform that combines technology, data and connectivity into clinical and risk-management processes that are essential for the delivery of value-based care."
About Apollo Medical Holdings, Inc.
Founded in 2001 and headquartered in Glendale, California, ApolloMed is an integrated population health management company committed to providing exceptional multi-disciplinary care in the communities it serves. ApolloMed is addressing the healthcare needs of its patients by leveraging its integrated healthcare delivery platform comprised of: ApolloMed Hospitalists, ApolloMed ACO (Accountable Care Organization), APA ACO (Next Generation ACO), Maverick Medical Group (Independent Physician Association), Apollo Care Connect and Apollo Palliative Services (Hospice/Palliative Care and Home Health Services). ApolloMed strives to improve medical outcomes with high-quality, cost-efficient care. For more information, please visit www.apollomed.net
Forward Looking Statements
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SOURCE Apollo Medical Holdings, Inc.