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Accountable Care Organization

ACO Name and Location

ProHealth Physicians ACO, LLC
3 Farm Glen Blvd
Farmington, Connecticut 06032-1981

ACO Primary Contact

Primary Contact Name Ms. Cheryl Lescarbeau
Primary Contact Phone Number (860) 284-5204
Primary Contact Email Address clescarbeau@prohealthmd.com

Organizational Information

ACO participants:

ACO Participants ACO Participant in Joint Venture (Enter Y or N)
ProHealth Physicians, PC N

 

ACO governing body:

Member Member’s Voting Power Membership Type ACO Participant TIN Legal Business Name/DBA, if Applicable
Last Name First Name Title/Position
Brown Seth ACO Provider 19.6% ACO Participant Representative ProHealth Physicians, PC
Buckley Timothy ACO Provider 19.6% ACO Participant Representative ProHealth Physicians, PC
Donahue Jennifer ACO Provider 19.6% ACO Participant Representative ProHealth Physicians, PC
Herlands Stuart ACO Provider 19.6% ACO Participant Representative ProHealth Physicians, PC
Pazer David ACO Provider 19.6% ACO Participant Representative ProHealth Physicians, PC
Cox-Chapman James ACO Medicare Beneficiary 2% Medicare Beneficiary Representative NA

 

Key ACO clinical and administrative leadership:

Cheryl Lescarbeau ACO Executive
Richard Guerriere Medical Director
Maura Geirin Compliance Officer
Richard Guerriere Quality Assurance/Improvement Officer

 

Associated committees and committee leadership:

Committee Name Committee Leader Name and Position
Clinical Council Dr. Richard Guerriere, SVP, Chief Medical Officer and Medical Director (Chair)
Privacy and Security Committee Richard Lugli, SVP, General Counsel and Privacy Officer (Co-chair)Elizabeth Thornquist, VP Information Services and Security Officer (Co-chair)Maura Geirin, Compliance Officer (Co-chair)
Richard Guerriere, SVP, Chief Medical Officer and Medical Director (Co-chair, Clinical Lead)
Patient Advisory Council Tracy Weber Tierney, Director of Patient Experience (Chair)

 

Types of ACO participants, or combinations of participants, that formed the ACO:

  • ACO professionals in a group practice arrangement

Shared Savings and Losses

Amount of Shared Savings/Losses

  • Second Agreement Period
    • Performance Year 2017, $8,618,964
    • Performance Year 2016, $5,996,474
  • First Agreement Period
    • Performance Year 2015, $0
    • Performance Year 2014, $0
    • Performance Year 2013, $0

Shared Savings Distribution

  • Second Agreement Period
    • Performance Year  2017
      • Proportion invested in infrastructure: 30%
      • Proportion invested in redesigned care processes/resources: 40%
      • Proportion of distribution to ACO participants: 30%
    • Performance Year 2016
      • Proportion invested in infrastructure: 25%
      • Proportion invested in redesigned care processes/resources: 25%
      • Proportion of distribution to ACO participants: 50%
  • First Agreement Period
    • Performance Year 2015
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A
    • Performance Year 2014
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A
    • Performance Year 2013
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A

Quality Performance Results

2017 Quality Performance Results:

ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 79.51 80.60
ACO-2 CAHPS: How Well Your Providers Communicate 93.15 93.13
ACO-3 CAHPS: Patients’ Rating of Provider 92.96 92.31
ACO-4 CAHPS: Access to Specialists 83.24 83.32
ACO-5 CAHPS: Health Promotion and Education 66.18 62.30
ACO-6 CAHPS: Shared Decision Making 75.03 75.85
ACO-7 CAHPS: Health Status/Functional Status 77.18 73.05
ACO-34 CAHPS: Stewardship of Patient Resources 18.65 25.68
ACO-8 Risk-Standardized, All Condition Readmission 14.90 15.01
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) 16.46 18.46
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 74.01 79.16
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 55.46 61.74
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 1.70 1.93
ACO-11 Use of Certified EHR Technology 100 98.48
ACO-12 Medication Reconciliation 99 75.32
ACO-13 Falls: Screening for Future Fall Risk 90 74.38
ACO-44 Imaging Studies for Low Back Pain 72.41 67.32
ACO-14 Preventive Care and Screening: Influenza Immunization 86.61 72.52
ACO-15 Pneumonia Vaccination Status for Older Adults 90.21 72.92
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up 75.86 70.69
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 99.67 90.48
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 95.12 61.98
ACO-19 Colorectal Cancer Screening 81.82 64.58
ACO-20 Breast Cancer Screening 82.30 70.05
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 79.30 79.89
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 8.95 16.74
ACO-41 Diabetes: Eye Exam 72.29 50.37
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 79.22 71.47
ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 94.29 86.86

 

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low samples, and the ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes quality measure is not included in public reporting due to a non-material technical error.

 

Note: In the Quality Performance Results file(s) above, search for “ProHealth Physicians ACO, LLC” to view the quality performance results. This ACO can also be found by using the ACO ID A65320 in the public use files on data.cms.gov.

Payment Rule Waivers

  • No, our ACO does not use the SNF 3-Day Rule Waiver.