Accountable Care Organization Info

ACO name and location:
Carolinas HealthCare System ACO, LLC
Previous Names: N/A
1000 Blythe Blvd.
Charlotte, NC 28203

ACO primary contact:
Primary Contact Name: Marque Macon, AVP, Network & Business Development
Primary Contact Phone Number: 704-446-3116
Primary Contact Email Address: Marque.Macon@AtriumHealth.org

Organizational Information:

ACO Participants	ACO Participant in Joint Venture (Enter Y or N)
Arboretum Urgent Care Center	N
Aswad Surgical Group, PC	N
Barnett Family Practice	N
Blue Ridge Healthcare Medical Group, Inc.	N
Bradford K Faulkenberry M.D.	N
Cabarrus Gastroenterology Associates Pllc	N
Cabarrus Pathology Associates, P.A.	N
Carmel Family Physicians	N
Carolina Bone & Joint, P.A.	N
Carolinas Ambulatory Surgery, Inc	N
Carolinas Emergency Physicians, P.A.	N
Carolinas Imaging Services, LLC	Y
Carolinas Medical Center	N
Carolinas Medical Center at Home, LLC	N
Carolinas Palliative Care and Hospice Network, Inc.	N
Carolinas Pathology Group, Pa	N
Carolinas Physicians Network Inc.	N
Carolinas Physicians Network Inc. Eastover Obstetrics and Gynecology	N
Carolinas Rehabilitation	N
Carolinas-Anson Healthcare, Inc.	N
Charlotte Eye Ear Nose & Throat Associates, P.A.	N
Charlotte Medical Clinic, Inc.	N
Charlotte Obstetric and Gynecological Associates	N
Charlotte Radiology, P.A.	N
Christopherson Family Medicine, LLC	N
Cleveland Ambulatory Services, LLC	N
Columbus Regional Health Network	N
Cornerstone Ear Nose & Throat, P.A.	N
Cotswold Family Medicine	N
Cox Road Urgent Care	N
Davidson Clinic	N
East Carolina Surgical, P.A.	N
Eastland Urgent Care	N
Eastover University Obstetrics & Gynecology Associates	N
Eastridge Family Medicine	N
ENT Carolina, P.A.	N
Emergency Medicine Physicians of Mecklenburg County, PLLC.	N
Harrisburg Family Physicians	N
Hospice of Cabarrus County, Inc.	N
Huntersville Oaks	N
Lakemont Family Medicine	N
Lincoln Family Practice	N
Mecklenburg Medical Group	N
Medical Associates of Rock Hill	N
Mercy Hospital, Inc.	N
Northcross Family Physicians	N
Northcross Obstetric And Gynecologic Associates	N
Northeast Anesthesia & Pain Specialists, P.A.	N
OrthoCarolina, P.A.	N
Paragon Surgical Specialists, P.A.	N
Piedmont Gynecological and Obstetrical Associates	N
Pulmonary Clinic of The Carolinas, P.C.	N
Randolph Internal Medicine Associates	N
Riverbend Family Physicians	N
Sandra Lee McCormack	N
Sardis Oaks	N
Scotland Regional Health Network	N
Scotland Memorial Hospital Inc.	N
Shiland Family Medicine	N
South Charlotte Primary Care	N
Southeast Radiation Oncology Group, P.A.	N
Steele Creek Urgent Care	N
St. Luke's Physician Network, Inc.	N
St. Luke's Hospital, Inc.	N
Surgical Specialists of Charlotte, P.A.	N
The Charlotte-Mecklenburg Hospital Authority	N
Urology Specialists of The Carolinas	N
West Primary Care, Inc.	N

ACO governing body:

Member
First Name	Last Name	Title/Position	Member’s Voting Power - Expressed as a Percentage or Number	Membership Type	ACO Participant Legal Business Name/DBA, if applicable
Ruth	Krystopolski	Co-Chair	Voting Member (1)	ACO Participant Representative	THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Jennifer	Brady, MD	Co-Chair	Voting Member (1)	ACO Participant Representative	THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Kathleen	Kaney	Member	Voting Member (1)	ACO Participant Representative	CAROLINAS MEDICAL CENTER AT HOME, LLC
Suzanna	Fox, MD	Member	Voting Member (1)	ACO Participant Representative	MERCY HOSPITAL, INC.
Al	Hudson, MD	Member	Voting Member (1)	ACO Participant Representative	CAROLINAS PHYSICIAN NETWORK, INC.
Suzanne	Kausend	Member	Voting Member (1)	ACO Participant Representative	CAROLINAS PHYSICIAN NETWORK, INC.
Britney	Broyhill, DNP, ACNP-BC, NP	Member	Voting Member (1)	ACO Participant Representative	CAROLINAS PHYSICIAN NETWORK, INC.
Adam	Ravin, MD	Member	Voting Member (1)	ACO Participant Representative	THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Gary	Little, MD	Member	Voting Member (1)	ACO Participant Representative	THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Louis	Zbinden, MD	Member	Voting Member (1)	ACO Participant Representative	SURGICAL SPECIALISTS OF CHARLOTTE, P.A.
Robert	Mittl, MD	Member	Voting Member (1)	ACO Participant Representative	CHARLOTTE RADIOLOGY, P.A.
Mark	Aldous, MD	Member	Voting Member (1)	ACO Participant Representative	CABARRUS GASTROENTEROLOGY ASSOCIATES, LLC
Bruce	Cohen, MD	Member	Voting Member (1)	ACO Participant Representative	ORTHOCAROLINA, P.A.
Ellen	Sheppard	Member	Voting Member (1)	Medicare Beneficiary Representative	N/A
Still open		Member	Voting Member (1)	Community Stakeholder

Key ACO clinical and administrative leadership:

Ruth Krystopolski ACO Executive
Brian Kersten, M.D Medical Director
Alicia Bowers Compliance Officer
Valerie Cloud Compliance Officer
Pamela Beckwith Quality Assurance/Improvement Officer

Associated committees and committee leadership:

Committee Name	Committee Leader Name and Position
Network Development Committee	Marque Macon, Chair
Clinical Effectiveness Committee	Zeev Neuwirth, MD, Co-Chair Louis Zbinden, MD, Co-Chair
Finance Committee	Adam Ravin, MD, Co-Chair
Operations Committee	Al Hudson, MD, Chair
Nominating Committee	Jennifer H. Brady, MD, Co-Chair Ruth Krystopolski, Co-Chair

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

ACO professionals in a group practice arrangement
Hospital employing ACO professionals
Network of individual practices of ACO professionals
Partnership or joint venture arrangement between hospitals and ACO professionals

Shared Savings and losses:

Amount of shared savings/losses:
- First Agreement Period
  - Performance Year 2018, $0
Shared savings distribution: First Agreement Period
- Performance Year 2018
  - 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

2018 Quality Performance Results

ACO #	Measure Name	Rate	ACO Mean
ACO-1	CAHPS: Getting Timely Care, Appointments, and Information	85.12	86.14
ACO-2	CAHPS: How Well Your Providers Communicate	93.58	93.93
ACO-3	CAHPS: Patients’ Rating of Provider	92.15	92.45
ACO-4	CAHPS: Access to Specialists	78.02	81.50
ACO-5	CAHPS: Health Promotion and Education	59.45	59.26
ACO-6	CAHPS: Shared Decision Making	62.25	61.94
ACO-7	CAHPS: Health Status/Functional Status	75.82	73.35
ACO-34	CAHPS: Stewardship of Patient Resources	28.43	26.26
ACO-8	Risk Standardized, All Condition Readmission	14.48	14.98
ACO-35	Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM)	18.01	18.59
ACO-36	All-Cause Unplanned Admissions for Patients with Diabetes	39.58	37.01
ACO-37	All-Cause Unplanned Admissions for Patients with Heart Failure	79.86	76.75
ACO-38	All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions	63.04	59.00
ACO-43	Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91)	2.39	1.98
ACO-11	Use of Certified EHR Technology	99.94	98.20
ACO-12	Medication Reconciliation Post-Discharge	97.83	85.91
ACO-13	Falls: Screening for Future Fall Risk	85.89	79.73
ACO-44	Use of Imaging Studies for Low Back Pain	62.88	64.36
ACO-14	Preventive Care and Screening: Influenza Immunization	71.49	72.71
ACO-15	Pneumonia Vaccination Status for Older Adults	79.44	75.97
ACO-16	Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up	84.58	76.83
ACO-17	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	43.48	72.81
ACO-18	Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan	65.73	66.74
ACO-19	Colorectal Cancer Screening	72.58	68.27
ACO-20	Breast Cancer Screening	77.42	71.96
ACO-42	Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	80.44	81.47
ACO-27	Diabetes Mellitus: Hemoglobin A1c Poor Control	9.27	15.51
ACO-41	Diabetes: Eye Exam	54.03	52.42
ACO-28	Hypertension (HTN): Controlling High Blood Pressure	71.37	73.10
ACO-30	Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet	95.16	88.92

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

For 2018 Quality Performance Results, please visit https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/2018-Shared-Savings-Program-SSP-Accountable-Care-O/v47u-yq84/data

Note: In the Quality Performance Results file(s) above, search for “Carolinas HealthCare System ACO, LLC” to view the quality performance results. This ACO can also be found by using the ACO ID A3675 in the public use files on data.cms.gov.

Payment rule waivers

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

Accountable Care Organization (ACO) & Medicare Shared Savings Program Frequently Asked Questions

What is an Accountable Care Organization (ACO)?

An accountable care organization (ACO) is a group of doctors and other healthcare providers who agree to work together with Medicare to improve quality, cost, and coordination of care you receive in the healthcare setting.

An ACO does not change your Medicare benefits.
An ACO is not a Health Maintenance Organization (HMO), managed care, or an insurance plan. An ACO can’t tell you which healthcare providers to see or hospital to visit, and can’t limit your Medicare benefits.
You still have the right to choose any hospital or doctor that accepts Medicare, at any time, even if that hospital or doctor isn’t a part of an ACO. Your doctor or healthcare provider may make recommendations, but it is always your choice on what doctors or hospitals you use.

How do I know if my doctor participates in an ACO?

Doctors and healthcare providers that participate in an ACO must display a poster that notifies you of your doctor’s participation in an ACO.

For general information about ACOs, call 1-800-MEDICARE.

How will an ACO help my doctor coordinate my care?

Your doctors will have a more complete picture of your health through talking with your other healthcare providers.
Medicare will share certain health information with us about the care you receive from your doctors and other healthcare providers unless you ask Medicare not to share it. Medicare may also share your health information with other ACOs in which your doctors or healthcare providers participate.

What can you expect if your doctor is in an ACO?

With an ACO you are the center of care, and your satisfaction is one of the goals. Over time, you may notice that:

You don’t have to fill out as many medical forms with the same information
The doctors and healthcare providers that you see all know what’s going on with your health because they communicate with each other
You don’t need to repeat medical tests because your results are shared among your doctors and healthcare providers

What do you need to do?

If you want Medicare to share information about the healthcare you received with Atrium Health ACO, LLC or with other ACOs in which your doctors or healthcare providers participate, there's nothing more you need to do.
If you do not want Medicare to share your health care information, you need to call 1-800 MEDICARE (1-800-633-4227) and tell the representative that your doctor is part of an ACO and you don't want Medicare to share your health information. TTY user should call 1-877-486-2048.
If you change your mind in the future, you can call 1-800-MEDICARE and tell the representative what you have decided. We can't communicate with Medicare on your behalf.
Even if you decline to share your healthcare information, Medicare will still use your information for some purposes, like assessing the financial and quality of care performance of the providers participating in ACOs. Also, Medicare may share some of your healthcare information with ACOs when measuring the quality of care given by healthcare providers participating in those ACOs.

Public Website Disclaimer Statement

The Centers for Medicare and Medicaid Services and the U.S. Department of Health and Human Services’ Office of Inspector General have made available waivers of certain federal fraud and abuse laws in connection with the operation of accountable care organizations (“ACOs”) that have entered into a participation agreement under the Medicare Shared Savings Program (“MSSP”).

Carolinas HealthCare System ACO, LLC (the “Company”) is an ACO participating in MSSP. The Company has entered into an agreement with CVS Pharmacy, Inc. (“CVS”) under which CVS will provide education, outreach and medication adherence support services for certain Medicare beneficiaries attributed to the Company.

The Company’s Board authorized the application of the Participation Waiver to the CVS Agreement on April 3, 2019. The Company’s Board, as the governing body of the Company, has made a bona fide determination that the CVS Agreement supports the goals of the Company and is reasonably related to the purposes of the MSSP as the services rendered by CVS are designed to help improve patient experience of care, improve population health by providing education and medication adherence support services, and reduce the costs of healthcare.

NC ACO Public Reporting – MSSP

Accountable Care Organization (ACO) & Medicare Shared Savings Program Frequently Asked Questions

What is an Accountable Care Organization (ACO)?

How do I know if my doctor participates in an ACO?

How will an ACO help my doctor coordinate my care?

What can you expect if your doctor is in an ACO?

What do you need to do?

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