Overview
Esse Health ACO is an Accountable Care Organization, or “ACO,” authorized by Medicare to help coordinate the healthcare of Medicare beneficiaries through Medicare’s ACO REACH program. The ACO REACH (Realizing Equity, Access, and Community Health) model is designed to improve the quality of care for people with Medicare through better care coordination and connecting health care providers and beneficiaries, including those beneficiaries who are underserved. Through this program, the healthcare providers, clinical teams, and administrative leadership of Esse Health ACO are working closely together to provide Medicare patients a coordinated healthcare experience that is catered to each patients’ individual needs. We are focused on improving the quality-of-care patients receive while also reducing their costs by providing access to services, resources, and programs that focus on helping patients stay healthy and better manage any chronic health conditions they may have.
Additional benefits may be available to you based on your alignment to a participating provider in our ACO. Benefits may include home health services and direct or accelerated transfer to Skilled Nursing Facilities.
Eligibility Requirements
You may be eligible to participate in the program if you meet the following criteria:
- You are enrolled in both Medicare Parts A and B and have Medicare as your primary health insurance
- You are a resident of the United States and live in one of our qualified service areas
- You are not currently enrolled in a Medicare Advantage plan, Medicare Cost Plan under section 1876, PACE organization or other Medicare health plan besides Original Medicare (Parts A and B).
How to Participate
If you are eligible for the program, there are several ways you can participate:
If you regularly see a doctor who is part of our provider network, you may have been auto-enrolled in the program by Medicare. If you have been auto-enrolled, you will receive a welcome letter in the mail from us.
OR
You also have the option to sign up by choosing a doctor in our network and completing a Voluntary Alignment form. Find out how to complete your Voluntary Alignment form.
If you are eligible for the program, there are several ways you can participate:
If you regularly see a doctor who is part of our provider network, you may have been auto-enrolled in the program by Medicare. If you have been auto-enrolled, you will receive a welcome letter in the mail from us.
You also have the option to sign up by choosing a doctor in our network and completing a Voluntary Alignment form. Find out how to complete your Voluntary Alignment form.
Common Questions
Is this a health plan?
No. This is a special program for people enrolled in Original Medicare (Parts A & B). If you elect to participate in our program, you will continue to receive the same Medicare benefits that you do today.
Can I see any doctor?
Yes. You may still see any doctor who accepts Medicare.
Can I participate if I have a Medicare Supplement policy?
Yes. If you enrolled in Original Medicare and also have a Medicare Supplement policy, you can still participate in the program.
About Us
Esse Health ACO, LLC
Mailing Address
Esse Health ACO
P.O. Box 5098
Troy, MI 48007
Corporate Address
Esse Health ACO
12655 Olive Blvd 4th Floor
St. Louis, MO 63141
Primary Contact
Joseph Satorius
Administrative Officer
jsatorius@essencemp.com
If you are a Medicare patient and have questions regarding our program, call 1-855-947-0090 (TTY: 711).
Clinical & Administrative Leadership
Joseph Satorius – Administrative Officer – LGHC
Rishi Sud, MD – Medical Director – Esse Health
Britton Whitbeck – Compliance Officer – LGHC
Jean-Claude Saghbini – Technology Officer – LGHC
Erin Venable – Finance Officer – LGHC
Governing Body
All voting members
David Hartenbach, MD – Board Chairman and Physician – Esse Health
Robert Curtin, MD – Board Member and Physician – Esse Health
Patrick Nakashima-Moran, MD – Board Member and Physician – Esse Health
Phil Berwick – Beneficiary Representative – Retired
Mike Long – Chief Executive Officer – Lumeris
Chuck Willey, MD – Board Member & Physician – Vicinia Health
Jim Althoff, MD – Board Member & Physician – Vicinia Health
Richard Berliner – Consumer Advocate – Retired
Joint Ventures
American Multispecialty Group, Inc, (d/b/a Esse Health), a medical group consisting of Participating and Preferred Providers, holds an ownership interest in Esse Health ACO.
Public Reporting
-
2023 CMS Total Quality Score
74.12% -
Shared Savings
$26,016,654.61 -
Shared Savings Investments
42% -
Shared Savings Distributions
58% -
Risk-Standardized, All Condition Readmission
15.40 -
All-Cause Unplanned Admissions for Patients with Multiple
Chronic Conditions
36.48 -
Timely Follow-Up After Acute Exacerbations of Chronic
Conditions
74.14 -
CAHPS
0.90
CAHPS Survey Results
-
Getting Timely Appointments, Care, and Information
85.43 -
How Well Providers Communicate
94.58 -
Care Coordination
87.53 -
Shared Decision-Making
64.69 -
Patient Rating of Provider
92.94 -
Courteous and Helpful Office Staff
94.85 -
Health Promotion and Education
61.77 -
Stewardship of Patient Resources
27.02
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Are you a participating provider? View our Overview of Program Compliance
Requirements.