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Accountable Care Organization

ACO Name and Location

ProHealth Physicians ACO, LLC
Three Farm Glen
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 14% ACO Participant Representative ProHealth Physicians, PC
Buckley Timothy ACO Provider 14% ACO Participant Representative ProHealth Physicians, PC
Catsam Arthur ACO Provider 14% ACO Participant Representative ProHealth Physicians, PC
Donahue Jennifer ACO Provider 14% ACO Participant Representative ProHealth Physicians, PC
Herlands Stuart ACO Provider 14% ACO Participant Representative ProHealth Physicians, PC
Pazer David ACO Provider 14% ACO Participant Representative ProHealth Physicians, PC
Rosen Jonathan ACO Provider 14% ACO Participant Representative ProHealth Physicians, PC
Rosenberg Eric ACO Provider Ex-Officio (non-voting member) ACO Participant Representative ProHealth Physicians, PC
Cox-Chapman James ACO Medicare Beneficiary 2% Medicare Beneficiary Representative NA

 

Key ACO clinical and administrative leadership:

Jack Reed ACO Executive
Richard Guerriere Medical Director
Maura Geirin Compliance Officer
Robert Wenick 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 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 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

2016 Quality Performance Results:

ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 86.99 80.51
ACO-2 CAHPS: How Well Your Providers Communicate 94.21 93.01
ACO-3 CAHPS: Patients’ Rating of Provider 94.43 92.25
ACO-4 CAHPS: Access to Specialists 82.99 83.49
ACO-5 CAHPS: Health Promotion and Education 62.62 60.32
ACO-6 CAHPS: Shared Decision Making 75.35 75.40
ACO-7 CAHPS: Health Status/Functional Status 74.85 72.30
ACO-34 CAHPS: Stewardship of Patient Resources 23.74 26.97
ACO-8 Risk-Standardized, All Condition Readmission 14.42 14.7
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) 16.88 18.17
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes 44.19 53.2
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 65.88 75.23
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 51.97 59.81
ACO-9 Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5) 6.77 9.27
ACO-10 Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8 ) 15.76 14.53
ACO-11 Percent of PCPs who Successfully Meet Meaningful Use Requirements 89.93 82.72
ACO-39 Documentation of Current Medications in the Medical Record 94.14 87.54
ACO-13 Falls: Screening for Future Fall Risk 89.97 64.04
ACO-14 Preventive Care and Screening: Influenza Immunization 78.85 68.32
ACO-15 Pneumonia Vaccination Status for Older Adults 87.56 69.21
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up 79.77 74.45
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 98.03 90.98
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 87.5 53.63
ACO-19 Colorectal Cancer Screening 80.23 61.52
ACO-20 Breast Cancer Screening 81.18 67.61
ACO-21 Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented 51.35 76.79
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 70.74 77.72
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 11.17 18.24
ACO-41 Diabetes: Eye Exam 70.33 44.94
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 76.18 70.69
ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 90.17 85.05
ACO-31 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 86.67 88.67
ACO-33 Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy – for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%) 82.98 79.67

 

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low samples.

 

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.