ACO Name and Location

Mission Health Partners, Inc.
509 Biltmore Avenue
Asheville, North Carolina 28801

 

ACO Primary Contact

Primary Contact Name

Amanda Gerlach

Primary Contact Phone Number

828-213-5384

Primary Contact Email Address

amanda.gerlach@msj.org

 

Organizational Information

ACO participants:

ACO Participants

ACO Participant in Joint Venture (Enter Y or N)

Steven Cahan

N

Charles J. McGraw MD, LTD

N

Appalachian Foot & Ankle Associates PA

N

Moore Foot & Ankle Specialists, PA

N

Apple Valley Family Medicine PA

N

Chad Smoker MD PC

N

October Road, Inc.

N

Charles J. DePaolo, M.D, P.A.

N

ABC Pediatrics of Asheville PA

N

Asheville Medicine & Pediatrics Ltd

N

Vickery Family Medicine, Pllc

N

Forest Dermatology, PA

N

North Buncombe Family Medicine, P.A.

N

Appalachian Regional Medical Associates, Inc.

N

STMD LLC

N

Wellspring Family Practice, PA

N

Carolina Mountain Gastroenterology Endoscopy Center, LLC

N

Mission Medical Associates Inc.

N

Blue Sky Pediatrics Asheville PA

N

Dry Ridge Family Medicine PLLC

N

Chad Smoker

N

Hazelwood Family Medicine, PLLC

N

UWH of North Carolina, LLP

N

Our Family Doctor, PLLC

N

John Baker

N

Highlands-Cashiers Physician Services Inc

N

Cannon Family Health, PLLC

N

Trillium Family Medicine, PLLC

N

WNC Birth Center

N

Asheville Podiatry Associates PA

N

Park Hill Medicine, PA

N

Appalachian Mountain Community Health Centers

N

Brie Folkner MD PC

N

Asheville Gynecology & Wellness Pllc

N

Allan Nash

N

Highlands-Cashiers Hospital, Inc.

N

Watauga Medical Center, Inc.

N

Charles A. Cannon, Jr., Memorial Hospital, Inc.

N

Mission Hospitals Inc

N

Transylvania Community Hospital, Inc.

N

The McDowell Hospital Inc.

N

Asheville Radiology Associates, PA

N

Carolina Internal Medicine Associates, PA

N

Asheville Pediatric Associates

N

ALLCARE CLINICAL ASSOCIATES PA

N

W.N.C. Ear Nose Throat Head and Neck Surgeons, PA

N

Hendersonville Pediatrics, P.A.

N

Blue Ridge Regional Hospital Inc.

N

Mountain Area Health Education Center, Inc.

N

Clay Comprehensive Health Services, Inc.

N

Bakersville Community Medical Clinic, Incorporated

N

Haywood Pediatric and Adolescent Medicine Group, P.A.

N

Sylva Family Practice, PA

N

Digestive Health Partners Pa

N

The Family Health Centers, PA

N

Mountain Kidney & Hypertension Associates, P.A.

N

Allan Nash

N

Mountain Radiation Oncology, P.A.

N

Carolina Ophthalmology, PA

N

Asheville Plastic Surgery PA

N

Asheville Endocrinology Consultants, PA

N

Pathologists Medical Laboratory, P.A.

N

Asheville Arthritis and Osteoporosis Center, P.A.

N

James J. Caserio, M.D., PA

N

Asheville Internal Medicine, P.A.

N

Mountain Docs Family Medicine P.A

N

Community Family Practice, PA

N

Asheville Children's Medical Center PA

N

Murphy Medical Center, Inc.

N

Western North Carolina Community Health Services, Inc.

N

The Pisgah Institute for Psychotherapy & Education PA

N

Andrews Internal Medicine PA

N

Franklin Family Practice, PA

N

Transylvania Physician Services Inc

N

Asheville Eye Associates PLLC

N

Mountain Area Pediatric Associates, P.A.

N

Carolina Mountain Emergency Medicine PA

N

Community CarePartners, Inc.

N

Steven L Cahan MD PA

N

Henderson County Hospital Corporation

N

Primary Eye Care Associates, OD, PA

N

MOUNTAIN AREA PATHOLOGY PA

N

East Asheville Family Health Care P.A.

N

WNC INTERNAL MEDICINE, PLLC

N

MemoryCare

N

Carolina Hand and Sports Medicine, P.A.

N

Mountain Diabetes And Endocrine Center PLLC

N

Brosnan Eye Associates

N

Angel Medical Center, Inc.

N

Brie Folkner

N

Don Jablonski DO PA

N

Radiation Therapy Associates Of Western North Carolina, Pa

N

Krishna Internal Medicine, P.C.

N

French Broad Pediatric Associates

N

Mission Community Anesthesiology Specialists LLC

N

Halvorson Plastic Surgery, PA

N

Plastic Surgery of Asheville, PA

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

Buys

Elizabeth

Director

Class I

ACO Participant Representative

Mountain Area Health Education Center

Cook

Jason

Director

Class I

ACO Participant Representative

The Family Health Centers PA

Heck

Jeffrey

Director and Vice Chair

Class I

ACO Participant Representative

Mountain Area Health Education Center

Kubitschek

Kenneth

Director

Class I

ACO Participant Representative

Caolina Internal Medicine Associates

Love

Scott

Director

Class I

ACO Participant Representative

ABC Pediatrics of Asheville PA

Moore

Robert

Dir and Chair

Class I

ACO Participant Representative

North Buncombe Family Medicine

Moreadith

Jeffrey

Director

Class I

ACO Participant Representative

Mission Medical Associates

Pagano

Nunzio

Director

Class I

ACO Participant Representative

Asheville Internal Medicine

Russell

Amy

Director

Class I

ACO Participant Representative

Mountain Area Health Education Center

Tomkins

Calvin

Director

Class I

ACO Participant Representative

Asheville Pediatrics Associates

Weizman

Michael

Director

Class I

ACO Participant Representative

Our Family Doctor

Franklin

David

Director

Class II

ACO Participant Representative

Mission Medical Associates

Hathaway

William

Director

Class II

ACO Participant Representative

Mission Hospital

Hoggard Green

Jill

Director

Class II

ACO Participant Representative

Mission Medical Associates

Ball

John

Director

Class II

Medicare Beneficiary Representative

 

Garrett

John

Director

Class II

Community Stakeholder Representative

 

Gerlach

Amanda

Ex Officio

Non Voting Member

Executive Director

 

 

 

Key ACO clinical and administrative leadership:

Amanda Gerlach

ACO Executive

Calvin Tomkins

Asst. Medical Director

Gwen McKinney

Compliance Officer

Calvin Tomkins

Quality Assurance/Improvement Officer

 

Associated committees and committee leadership:

Committee Name

Committee Leader Name and Position

Finance Committee

Dr. Alan Baumgarten

Quality Committee

Dr. Calvin Tomkins

 

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

  • Partnerships or joint venture arrangements between hospitals and ACO professionals
  • Critical Access Hospital (CAH) billing under Method II
  • Federally Qualified Health Center (FQHC)
  • Rural Health Clinic (RHC)

 

Shared Savings and Losses

Amount of Shared Savings/Losses

  • First Agreement Period
    • Performance Year 2016, $5,375,365
    • Performance Year 2015, $0

 

Shared Savings Distribution

  • First Agreement Period
    • Performance Year 2016
      • Proportion invested in infrastructure: 10%
      • Proportion invested in redesigned care processes/resources: 45%
      • Proportion of distribution to ACO participants: 45%
    • 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

 

Quality Performance Results

2016 Quality Performance Results:

ACO#

Measure Name

Rate

ACO Mean

ACO-1

CAHPS: Getting Timely Care, Appointments, and Information

83.57

80.51

ACO-2

CAHPS: How Well Your Providers Communicate

93.54

93.01

ACO-3

CAHPS: Patients’ Rating of Provider

91.80

92.25

ACO-4

CAHPS: Access to Specialists

84.00

83.49

ACO-5

CAHPS: Health Promotion and Education

63.08

60.32

ACO-6

CAHPS: Shared Decision Making

78.99

75.40

ACO-7

CAHPS: Health Status/Functional Status

70.33

72.30

ACO-34

CAHPS: Stewardship of Patient Resources

28.85

26.97

ACO-8

Risk Standardized, All Condition Readmission

13.15

14.70

ACO-35

Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM)

16.20

18.17

ACO-36

All-Cause Unplanned Admissions for Patients with Diabetes

44.08

53.20

ACO-37

All-Cause Unplanned Admissions for Patients with Heart Failure

64.55

75.23

ACO-38

All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions

50.97

59.81

ACO-9

Ambulatory Sensitive Condition Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5)

4.89

9.27

ACO-10

Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8)

12.28

14.53

ACO-11

Percent of PCPs who Successfully Meet Meaningful Use Requirements

98.68

82.72

ACO-39

Documentation of Current Medications in the Medical Record

84.80

87.54

ACO-13

Falls: Screening for Future Fall Risk

69.54

64.04

ACO-14

Preventive Care and Screening: Influenza Immunization

76.39

68.32

ACO-15

Pneumonia Vaccination Status for Older Adults

78.39

69.21

ACO-16

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up

73.60

74.45

ACO-17

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

95.36

90.98

ACO-18

Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan

58.97

53.63

ACO-19

Colorectal Cancer Screening

68.09

61.52

ACO-20

Breast Cancer Screening

72.79

67.61

ACO-21

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

84.73

76.79

ACO-42

Statin therapy for the Prevention and Treatment of Cardiovascular Disease

76.28

77.72

ACO-27

Diabetes Mellitus: Hemoglobin A1c Poor Control

14.38

18.24

ACO-41

Diabetes: Eye Exam

55.18

44.94

ACO-28

Hypertension (HTN): Controlling High Blood Pressure

67.84

70.69

ACO-30

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

89.44

85.05

ACO-31

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

85.34

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%)

73.93

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 “Mission Health Partners, Inc.” to view the quality performance results. This ACO can also be found by using the ACO ID A39107 in the public use files on data.cms.gov.

Payment Rule Waivers

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

Waivers:

To further the purposes of the Medicare Shared Savings Program and the clinical integration efforts of Mission Health Partners, Inc., and its participants, Mission Health Partners, Inc. Board of Directors has approved the following participation waivers and authorizes the provision of the following items/services for all network participants and their employed providers:

  • Clinical Documentation Integrity "CDI" services which will include documentation specificity queries, code reviews, data analysis and education on findings related to documentation requirements and tools to support processes.  These services will ensure that accurate documentation and code capture is at the most appropriate level of specificity to support patient condition identification and the appropriate delivery of quality care. 

  • Mission Health Partners, Inc. (“MHP”) has implemented a Telepsychiatry Program that will provide tablets and software, free of charge, to selected MHP member primary care practices. The Program will allow the selected primary care practices to facilitate telepsychiatry visits in their offices for their patients through telemedicine equipment. Using telemedicine will reduce the need and costs for patients to travel for psychiatric care.  If successful, the piloted program will expand into other practices in the near future.

  • A common electronic platform that will enhance clinical integration required under the MSSP and will promote accountability for quality, cost and overall care of the Medicare population.  An integrated or shared electronic health record system (“EHR”) will facilitate high quality medical care for beneficiaries, increase MHP participant access to beneficiary medical records and clinical information specific to beneficiaries, facilitate the communication and coordination of care across the continuum, reduce the number of disparate patient records, improve quality reporting capabilities, and increase patient engagement.

  • ICD-10 training modules and readiness checklists which will be covered as part of the MHP Participation Fee. The express purpose of this provision is to facilitate an accurate transition to the revised medical classification system and aid in coding improvements to increase quality and decrease cost of care according to the requirements of the Medicare Shared Savings Program.

  • A Quality Incentive Program that is designed to incentivize quality improvement behaviors among network providers, set a culture of communication and collaboration, build infrastructure and establish goodwill by providing financial incentives to providers who meet or exceed pre-established connectivity, reporting and quality metrics.  The Quality Incentive Program will contribute to the promotion of high quality and efficient care to network patients by encouraging providers to adhere to quality metrics and facilitate management and coordination of care.

  • QlikView, a quality improvement tool which offers an online analytics dashboard that gives network providers access to patient-level quality data, will increase the quality of care provided to their patients by targeting patients who need a specific screening.  This tool will also ensure that providers complete reporting on all quality measures for each tier threshold in a timely and efficient manner.  QlikView supports the provision of high quality and efficient care for MHP’s beneficiary population at a lower cost.

To further the purposes of the Medicare Shared Savings Program and the clinical integration efforts of Mission Health Partners, Inc., and its participants, Mission Health Partners, Inc. Board of Directors has approved the following patient incentive waivers and authorizes the provision of the following items/services for all network participants and their employed providers

  • Mission Health Partners, Inc. (“MHP”) is implementing a program designed to assist high-risk patients with transportation to appointments for follow-up care (the “Program”).  The Program will advance MHP’s clinical goals by helping patients adhere to a treatment or drug regime, follow-up care plan, or to facilitate management of a chronic disease.  The Program will improve access to primary care by facilitating transportation which would eliminate the need for more expensive intervention and/or Emergency Room visits.    

 

Additional Information

For additional information or general beneficiary questions, please visit www.medicare.gov/acos.html. You can also call 1-800-MEDICARE (1-800-633-4227 (TTY users should call 1-877-486-2048)) for questions about Accountable Care Organizations.


Hours of Operation

Monday through Friday
8 a.m. - 5 p.m.