Formation and Development of ACO



ACO Formation and Development

Responding to national concerns about quality and costs of healthcare, providers are forming Accountable Care Organizations (ACO). In less than one year since the announcement of Final Rule, 221 new ACOs were formed in the United States making it one of the most rapidly growing forms of organized health care. Following two case studies illustrate our work in formation of ACOs in California and Texas.



Case Study #1:
Case Study #2:

Golden Life ACO, Sacramento, California


In Sacramento and surrounding rural counties in California, a group of physicians and other healthcare providers had investigated the option of creating an Accountable Care Organization and sought legal advice. However, they had found legal issues daunting and benefits unclear. Therefore, they had decided to forgo the ACO project until more convincing information about the benefits was available. In February 2012, Dr. Vipul Mankad met with five leaders/providers and reviewed the concepts of Accountable Care Organization and benefits and risks of Track I, Advance Payment Model ACO. Based on Dr. Mankad’s presentation, the leadership group decided to pursue the formation of the ACO.


Since the deadline for submission of Notification of Intent was only days away with final submission of the CMS application within a month, Dr. Mankad’s team began working immediately with the physician leadership as well as a low volume rural hospital. Physician leadership in Sacramento was successful in recruiting sufficient number of physician participants. Dr. Mankad skillfully developed a CMS application and helped in developing consensus around all requirements and processes.


With successful application, the Golden Life ACO became the first ACO in Central California Valley and the only Advance Payment Model ACO in the State of California as of July 2012. In partnership with a team from SysInformation LLC, Dr. Mankad is helping in setting up IT Infrastructure, analyzable Database from disparate data sources and Predictive Modeling to identify quality improvement and cost reduction opportunities, described in greater detail in a separate case study.


“Dr. Mankad’s presentation on the concepts and benefits of ACO was so clear and pursuasive, that our leadership group was convinced about the project within an hour. Then, like a Manhattan Project, he worked with us to create a successful application for a Medicare Shared Savings Program. Now, we are working with his team to implement an innovative IT infrastrucuture. We believe his work with us will make a positive impact on lives of citizens in Sacramento valley. It already has”.

Venu Kondle, M.D.
President and CEO,
Golden Life ACO
Tel: (530) 713 9829
Cell: (530) 300 3074

“In March of 2012, I had the pleasure of working with Vipul Mankad, MD from Qualitas Healthcare Solutions Inc. to submit our Advanced Payment ACO application.  I found Dr. Mankad to be a modest yet highly knowledgeable, big picture, creative and innovative expert to compile the entire application with long hours during this tight window of opportunity to complete the application expeditiously; he was always available to me to consult and advice.  Despite the pressure of time constraint, he is a gentle and temperate partner to assist our successful application submission.  In dealing with a complex board, he is a statesman”.

Silas Ting, MBA, MPH
Executive Vice President/COO
Golden Life Healthcare,LLC
Tel:  916.640.1800
Cell: 916.248.0011

paste14Case Study #2:
Case Study #1:

Integrated ACO, Midland, Texas


Dr. Nick Shroff, a Urologist practicing in Midland for 30+ years had considered forming an ACO in the Permian Basin region of Texas. He had educated himself through AMA position papers on ACO. However, primary care physicians in that region were either not familiar with this rapidly growing form of organization or in some cases, apprehensive about risks or skeptical about benefits of ACO. Although healthcare market place in other parts of the country was moving forward to adopt this form of organization, providers in the Permian Basin area were expecting overturn of Affordable Care Act by the Supreme Court.


Dr. Mankad and Dr. Shroff met with more than 50 primary care providers in Midland, Odessa, Andrews, Big Springs and Alpine, Texas. Dr. Mankad presented the macroeconomic trends in healthcare market place and explained that regardless of the outcome of the Supreme Court review of the Affordable Care Act, national concerns about quality and costs were leading the country to the ACO model. Drs. Shroff and Mankad were able to develop a consensus among 22+ practices in the region who joined the ACO application as participants. Dr. Mankad’s developed an outstanding application, which received no adverse comments from CMS.


Integrated ACO was approved as the only Advance Payment Model ACO in the State of Texas in January 2013. In collaboration with SysInformation LLC, Dr. Mankad and his colleagues are implementing an IT Infrastructure, Analyzable Database and Predictive Modeling Analysis to identify quality improvement and cost reduction opportunities in the population served by Integrated ACO.


“I have known Dr. Vipul Mankad for many years for his work in academic medicine and health policy, for which he is nationally known. Recently, I came to know about his knowledge of health law and regulations. He is the national expert on formation and development of Accountable Care Organizations. Having already developed a successful Advance Payment Model ACO in California, he teamed up with us to develop one in the Permian Basin region of Texas, now with services in other regions of Texas. His work will make a positive impact on lives of people in Texas and the United States.”

Nick Shroff, M.D.
Chairman, Governing Board
(432) 352 0219