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Accountable Care Organization

ACO Name and Location:ProHealthLOGO_2014-ACO_100dpi

ProHealth Physicians ACO, LLC
Three Farm Glen Boulevard
Farmington, CT 06032

ACO Primary Contact:

Ms. Cheryl Lescarbeau
clescarbeau@prohealthmd.com 860-284-5204

Organizational Information:

  • ACO Participants:
    • ProHealth Physicians, PC
  • ACO Participants in Joint Ventures between ACO Professionals and Hospitals:
    • No participants are involved in a joint venture between ACO Professionals and Hospitals.
  • ACO Governing Body:
    • ACO Board of Managers
      • Dr. James W. Cox-Chapman, Class 1 Voting Member and Chairman of ProHealth Advisory Board, representing ACO Participant, ProHealth Physicians, PC
      • Dr. Seth Brown, Class 1 Voting Member and ACO Provider, representing ACO Participant, ProHealth Physicians, PC
      • Dr. Timothy Buckley, Class 1 Voting Member and ACO Provider, representing ACO Participant, ProHealth Physicians, PC
      • Dr. Arthur Catsam, Class 1 Voting Member and ACO Provider, representing ACO Participant, ProHealth Physicians, PC
      • Dr. Jennifer Donahue, Class 1 Voting Member and ACO Provider, representing ACO Participant, ProHealth Physicians, PC
      • Dr. Stuart Herlands, Class 1 Voting Member and ACO Provider, representing ACO Participant, ProHealth Physicians, PC
      • Dr. David Pazer, Class 1 Voting Member and ACO Provider, representing ACO Participant, ProHealth Physicians, PC
      • Dr. Jonathan Rosen, Class 1 Voting Member and ACO Provider, representing ACO Participant, ProHealth Physicians, PC
      • Dr. Eric Rosenberg, Ex-Officio (non-voting member) and ACO Provider, representing ACO Participant, ProHealth Physicians, PC
      • Dr. David Ross-Russell, Class 1 Voting Member and ACO Provider, representing ACO Participant, ProHealth Physicians, PC
      • Ms. Brenda Kelley, Class 3 Voting Member ACO Medicare Beneficiary
  • Key ACO Clinical and Administrative Leadership:
    • ACO Executive: Mr. Jack Reed, President and Chief Executive Officer
    • Medical Director: Dr. Richard Guerriere, Chief Medical Officer
    • Compliance Official: Ms. Maura Geirin
    • Quality Assurance/Improvement Officer: Dr. Robert Wenick, ACO Provider, representing ACO Participant, ProHealth Physicians, PC
  • Associated Committees and Committee Leadership:
    • Clinical Council—Dr. Richard Guerriere, SVP, CMO 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
      • Dr. Richard Guerriere, SVP, CMO and Medical Director, Clinical Lead
    • Patient Advisory Committee—Tracy Weber-Tierney, 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:
    • Agreement period beginning 2013, Performance Year 1: $0
    • Agreement period beginning 2013, Performance Year 2014: $0
    • Agreement period beginning 2013, Performance Year 2015: $0

• Shared Savings Distribution:

  • Agreement period beginning 2013, Performance Year 1 Proposed Distribution:
    • Proportion proposed for investment in infrastructure: 50%
    • Proportion proposed for investment in redesigned care processes/resources: 25%
    • Proportion proposed for distribution to ACO participants: 25%
  • Agreement period beginning 2013, Performance Year 2014, 2015 Proposed Distribution:
    • Proportion proposed for investment in infrastructure: 50%
    • Proportion proposed for investment in redesigned care processes/resources: 25%
    • Proportion proposed for distribution to ACO participants: 25%

• Payment Rule Waiver:

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

Quality Performance Results—2015:

2015 Reporting Period
Measure Number Measure Name ACO Performance Rate Mean Performance Rate (SSP ACOs)
ACO-1 CAHPS:  Getting Timely Care, Appointments and Information 84.21 80.61
ACO-2 CAHPS:  How Well Your Providers Communicate 92.74 92.65
ACO-3 CAHPS:  Patients’ Rating of Provider 91.67 91.94
ACO-4 CAHPS:  Access to Specialists 83.30 83.61
ACO-5 CAHPS:  Health Promotion and Education 62.25 59.06
ACO-6 CAHPS:  Shared Decision Making 74.03 75.17
ACO-7 CAHPS:  Health Status/Functional Status 75.64 72.30
ACO-34 CAHPS:  Stewardship of Patient Resources* 27.05 26.87
ACO-8 Risk Standardized, All Condition Readmissin 15.19 14.86
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM)* Readmission 17.81 18.07
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes* 57.01 54.60
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure* 81.18 76.96
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 65.56 62.92
ACO-9 Ambulatory Sensitive Conditions:  Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality  Indicator (PQI) #5) .90 1.11
ACO-10 Ambulatory Sensitive Conditions:  Heart Failure (AHRQ Prevention Quality  Indicator (PQI) #8) 1.12 1.04
ACO-11 Percent of Primary Care Physicians who Successfully Meet Meaningful Use Requirements 100% 76.22%
ACO-39 Documentation of Current Medications in the Medical Record* 91.27% 84.07%
56.46ACO-13 Falls:  Screening for Future Fall Risk 87.77% 56.46%
ACO-14 Preventive Care and Screening:  Influenza Immunization 68.31% 62.03%
ACO-15 Pneumonia Vaccination Status for Older Adults 87.80% 63.73%
ACO-16 Preventive Care and Screening:  Body Mass Index (BMI) Screening and Follow-Up 72.68% 71.15%
ACO-17 Preventive Care and Screening: Tobacco Use:  Screening and Cessation Intervention 93.17% 90.16%
ACO-18 Preventive Care and Screening:  Screening for Clinical Depression and Follow-Up Plan 81.13% 45.25%
ACO-19 Colorectal Cancer Screening 73.89% 60.06%
ACO-20 Breast Cancer Screening 75.20% 65.67%
ACO-21 Preventive Care and Screening:  Screening for High Blood Pressure and Follow-Up Documented 55.75% 70.04%
ACO-40 Depression Remission at Twelve Months* N/A N/A
ACO-27 Diabetes Mellitus:  Hemoglobin A1c Poor Control 10.16% 20.38%
ACO-41 Diabetes:  Eye Exam* 70.41% 41.05%
ACO-28 Hypertension:  Controlling High Blood Pressure 80.70% 69.62%
ACO-30 Ischemic Vascular Disease:  Use of Aspirin or Another Antithrombotic 90.20% 83.82%
ACO-31 Heart Failure:  Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 94.74% 87.22%
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%) 76.16% 77.73%

CAHPS = Consumer Assessment of Healthcare Providers and Systems, PQI = Prevention Quality Indicator, LVSD = left ventricular systolic dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery disease.

*Measure required beginning Reporting Year 2015

N/A = Reporting on the depression remission measure is not required for 2015, as indicated by N/A

 

Quality Performance Results—2012–2014:

2012 Reporting Period 2013 Reporting Period 2014 Reporting Period
Measure Number Performance measure ACO performance rate Mean performance for all ACOs ACO performance rate Mean performance for all ACOs ACO performance rate Mean performance for all ACOs
ACO#1 Getting timely care, appointments and information Not in operations Not in operations 85.28 81.48 86.25 80.13
ACO #2 How well your doctors communicate Not in operations Not in operations 94.09 92.96 92.86 92.39
ACO #3 Patient’s rating of doctor Not in operations Not in operations 92.80 92.06 92.68 91.58
ACO #4 Access to specialists Not in operations Not in operations 81.92 85.12 83.63 83.97
ACO #5 Health promotion and education Not in operations Not in operations 61.72 58.38 66.36 58.29
ACO #6 Shared decision making Not in operations Not in operations 77.01 74.53 76.76 74.60
ACO #7 Health status/functional status Not in operations Not in operations 73.27 71.12 72.23 71.10
ACO #8 Risk standardized, all condition readmissions Not in operations Not in operations 14.92 14.90 14.75 15.15
ACO #9 ASC admissions: COPD or asthma in older adults Not in operations Not in operations 0.99 1.17 .96 1.08
ACO #10 ASC admission: Heart failure Not in operations Not in operations 1.22 1.20 1.21 1.19
ACO #11 Percent of PCPs who qualified for EHR incentive payment Not in operations Not in operations 82.07 66.21 88.28 76.71
ACO #12 Medication reconciliation Not in operations Not in operations 0.00 73.56 55.03 82.61
ACO #13 Falls: screening for fall risk Not in operations Not in operations 4.26 39.57 70.68 45.60
ACO #14 Influenza immunization Not in operations Not in operations 36.72 56.93 66.72 57.51
ACO #15 Pneumococcal vaccination Not in operations Not in operations 65.20 54.76 82.87 55.03
ACO #16 Adult weight screening and follow-up Not in operations Not in operations 44.68 61.61 58.12 66.75
ACO #17 Tobacco use assessment and cessation intervention Not in operations Not in operations 27.57 84.01 80.75 86.79
ACO #18 Depression screening Not in operations Not in operations 35.49 31.19 59.26 39.27
ACO #19 Colorectal cancer screening Not in operations Not in operations 59.31 59.30 72.74 56.14
ACO #20 Mammography screening Not in operations Not in operations 53.98 62.05 64.66 61.41
ACO #21 Proportion of adults who had blood pressure screened in past 2 years Not in operations Not in operations 53.83 74.25 42.08 60.24
ACO #22 Hemoglobin A1c control (HbA1c < 8 percent) Not in operations Not in operations 77.33 68.58 80.30 69.30
ACO #23 Low density lipoprotein (LDL) < 100mg/dL Not in operations Not in operations 71.20 54.78 76.03 56.53
ACO #24 Blood pressure (BP) <140/90 Not in operations Not in operations 79.20 69.53 82.76 69.57
ACO #25 Tobacco non use Not in operations Not in operations 80.00 63.33 89.66 75.33
ACO #26 Aspirin Use Not in operations Not in operations 66.67 74.82 75.86 80.15
ACO #27 Percent of beneficiaries with diabetes whose HbA1c in poor control (HbA1c<9 percent) Not in operations Not in operations 14.40 22.11 9.69 20.35
ACO #28 Percent of beneficiaries with hypertension whose BP<140/90 Not in operations Not in operations 73.28 67.79 80.53 68.02
ACO #29 Percent of beneficiaries with IVD with complete lipid profile and LDL control <100mg/dL Not in operations Not in operations 68.25 55.44 64.73 57.29
ACO #30 Percent of beneficiaries with IVD who use Aspirin or other antithrombotic Not in operations Not in operations 44.05 76.35 69.71 80.79
ACO #31 Beta blocker therapy for LVSD Not in operations Not in operations 0.00 79.82 72.22 82.71
ACO #32 Drug therapy for lowering LDL cholesterol Not in operations Not in operations 74.26 71.60 79.09 74.22
ACO #33 ACE inhibitor or ARB therapy for patients with CAD and Diabetes and/or LVSD Not in operations Not in operations 63.41 69.13 71.65 74.99

Note: ASC = ambulatory sensitive conditions, COPD = chronic obstructive pulmonary disease, PCP = primary care physician, EHR = electronic health record, IVD = ischemic vascular disease, LVSD = left ventricular systolic dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery disease. For more information on how to interpret scores on the above quality performance measures, visit this site. Please visit http://www.medicare.gov/acos.html or call 1-800-MEDICARE (1-800-633-4227—TTY users should call 1-877-486-2048) for general questions or additional information about Accountable Care Organizations.