100 accountable care organizations to know 2014

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1 100 accountable care organizations to know 2014 Written by Molly Gamble, Heather Punke, Ayla Ellison, Akanksha Jayanthi and Dani Gordon August 13, 2014 Becker's Hospital Review is pleased to highlight a variety of Medicare and commercial ACOs, the majority of which are led by hospitals or health systems. The success of accountable care organizations is not yet completely proven, but the value-based care delivery model has nonetheless gained traction after experiencing a slow start. There are now more than 625 ACOs in the United States, according to a May analysis from Salt Lake City-based Leavitt Partners. More than half of those have government contracts, while 210 have commercial contracts and 74 have both. The total number of ACO-covered lives sits somewhere around 20.5 million. This is the third year Becker's Hospital Review has published its list of ACOs to know, and each year, the pool of ACOs from which we select for inclusion grows. For our 2014 list, Becker's Hospital Review is pleased to highlight a variety of Medicare and commercial ACOs, the majority of which are led by hospitals or health systems. ACOs were selected for inclusion based on the number of physicians involved and lives covered, the lifespan of the ACO, whether it has multi -payer arrangements, and whether it recently struck new agreements with payers. ACOs are presented in alphabetical order and are listed by the formal name of the ACO or, if the ACO has several contracts, it may be listed by the name of its affiliated health system or provider group. Abington (Pa.) Health. Abington Health, a two-hospital system, signed an ACO contract with Independence Blue Cross in That contract was expanded in 2013 to include Lumeris, a population health management company. The ACO collaboration between a health insurer, health system and healthcare technology firm is the first of its kind in the Philadelphia area. Abington Health employs some of the largest primary care physician practices in the region more than 80 percent of which are recognized by the National Committee for Quality Assurance as Level 3 patient-centered medical homes. Accountable Care Alliance of Ventura (Calif.). In January 2014, the Accountable Care Alliance of Ventura, sponsored by Ventura-based Community Memorial Health System, was selected as one of 123 new Medicare ACOs. The Accountable Care Alliance covers approximately 1.5 million Medicare beneficiaries. Adventist Midwest Health (Hinsdale, Ill.). Adventist Health Network, the clinically integrated network of community physicians who collaborate with four-hospital Adventist Midwest Health, signed a collaborative accountable care contract with Cigna in January The ACO covers more than 5,000 Cigna enrollees who receive care from Adventist's 245 primary care physicians and 520 specialists. Advocate Health Care (Downers Grove, Ill.). Advocate Health Care is an ACO pioneer. It launched its commercial ACO, AdvocateCare, with Blue Cross and Blue Shield of Illinois in October As of January 2014, AdvocateCare's costs were trending 2.5 percent below the other hospitals in the Blue Cross PPO network, according to results from BCBS of Illinois. Advocate was also accepted into the Medicare Shared Savings Program in The MSSP ACO covers more than 100,000 Medicare beneficiaries. Alexian Brothers ACO (Arlington Heights, Ill.). The ACO anchored by five-hospital Alexian Brothers Health System joined the Medicare Shared Savings Program in January Alexian Brothers ACO covers roughly 16,000 Medicare beneficiaries and is led by Don Franke, who serves as CEO. Allina Hospitals and Clinics (Minneapolis). The ACO affiliated with twelve-hospital Allina Hospitals and Clinics was one of 32 ACOs selected to participate in CMS' Pioneer ACO program in December In addition to the Pioneer ACO, Allina Health is part of the Northwest Metro Alliance, a collaboration between Allina and HealthPartners in Bloomington, Minn. The NMA is an ACO learning lab and covers more than 300,000 people. Atlantic ACO (Morristown, N.J.). Atlantic ACO is a joint venture between Atlantic Health System and Valley Health System in Ridgewood, N.J. It was one of the first 27 ACOs to become a participant in the Medicare Shared Savings Program. Atlantic ACO is made up of more than 1,200 physician participants and four hospitals, and it covers more than 55,000 beneficiaries. This May, the ACO also struck a contract with UnitedHealthcare, making it the insurer's first ACO in New Jersey. Atrius Health (Newton, Mass.). The ACO of Atrius Health, a nonprofit physician alliance with more than 1,000 physicians, became one of CMS' 32 Pioneer ACOs in In 2013, Atrius Health's ACO did not have either shared savings or shared loss in the first performance year of the Pioneer program. Aurora Health Care (Milwaukee). Aurora Health Care's Lakeshore Medical Clinic was selected as a Medicare Shared Savings Program ACO in July Additionally, Aurora launched its ACO with Aetna the Aurora Accountable Care Network in The ACO offers plans to small- to mid-sized employers and includes more than 1,500 providers, 15 hospitals and 160 clinics. Banner Health Network (Phoenix). Banner Health Network's ACO is comprised of 2,600 affiliated physicians, 13 hospitals in the Phoenix area and a variety of other clinical services and facilities. The ACO was named to CMS' Pioneer ACO program in In the first year of the

2 program, the Pioneer ACO delivered more than $13 million in shared savings. Banner Health also has an ACO with Cigna, which was announced in 2012 and covers more than 20,000 Cigna beneficiaries. Beacon Health (Brewer, Maine). Beacon Health is the ACO affiliated with Eastern Maine Healthcare System. The ACO was selected as one of the first 32 Medicare Pioneer ACOs in late Beacon Health includes three EMHS hospitals. Since its formation, the ACO has expanded coverage from an initial 8,000 Medicare beneficiaries to approximately 24,000. Bellin-ThedaCare Healthcare Partners (Green Bay, Wis.). Bellin-ThedaCare Healthcare Partners is the ACO between Green Bay-based Bellin Health, Neenah, Wis.-based ThedaCare and a network of nearly 700 physicians. It was named one of CMS' first 32 Pioneer ACOs in 2011 and achieved a 4.6 percent reduction in the total cost of care for 20,000 Medicare beneficiaries from Beth Israel Deaconess Care Organization (Westwood, Mass.). BIDCO has a tertiary affiliation with Boston-based Beth Israel Deaconess Medical Center. The ACO includes more than 2,100 primary care physicians and specialists along with numerous community hospitals, including Beth Israel Deaconess Hospital-Milton, Beth Israel Deaconess Hospital-Needham, Beth Israel Deaconess Hospital-Plymouth and the Cambridge Health Alliance. BIDCO was named one of CMS' first 32 Pioneer ACOs in late Billings (Mont.) Clinic. Billings Clinic was selected as a Medicare Shared Savings Program ACO in January That same month, Billings Clinic was one of the first four organizations in the country to receive ACO accreditation from the National Committee for Quality Assurance. BJC HealthCare ACO (St. Louis). The first ACO in the St. Louis area, BJC HealthCare ACO was selected by CMS for participation in the Medicare Shared Savings Program in July The ACO is affiliated with 12-hospital BJC HealthCare and includes more than 100 healthcare delivery settings and delivers care through an integrated network of providers. Sandra Van Trease serves as president of the ACO. Brown & Toland Medical Group (San Francisco). Brown & Toland Physicians, an independent physician organization, was selected by CMS as a Pioneer ACO in late The ACO includes approximately 190 physicians in San Francisco and the East Bay who care for more than 18,000 Medicare beneficiaries. Brown & Toland Physicians helped generate savings for Medicare in its first performance year as a Pioneer. Bon Secours Health System (Marriottsville, Md.). Bon Secours Health System's Good Help ACO was approved by CMS in December 2012 to participate in the Medicare Shared Savings Program. The ACO covers approximately 57,000 Medicare lives across five states. In June 2013, Good Help ACO announced a collaboration with Aetna subsidiary Healthagen to coordinate healthcare for Medicare beneficiaries whose primary physician participates in the Good Help ACO. Cape Cod Health Network ACO (Hyannis, Mass.). Cape Cod Healthcare and Cape Cod Preferred Physicians, a group of approximately 270 physicians, collaborate for their ACO, called Cape Cod Health Network. CMS selected the ACO as a participant in the Medicare Shared Savings Program in January Carilion Clinic (Roanoke, Va.). Carilion Clinic formed its ACO through a partnership with Aetna in The goal of the ACO is to personalize the care needs of patients, including Virginia's Medicaid beneficiaries, and to cut healthcare costs. Carilion Clinic also has an ACO that participates in the Medicare Shared Savings Program, called Doctors Connected. Carolinas HealthCare System (Charlotte, N.C.). Carolinas HealthCare System has more than 791 care locations throughout the Carolinas. The system participated in the Partnership for Care Transformation Readiness Collaborative with Premier, which was launched in 2013 to help organizations decide if they should pursue an ACO model. In 2014, the system announced a collaboration with Aetna to support patientcentered medical homes and other accountable care initiatives. CaroMont Health (Gastonia, N.C.). CaroMont's ACO began participating in CMS' Medicare Shared Savings Program in January The ACO is made up of CaroMont's acute-care hospitals, medical group, hospice, surgical center and women's center. CaroMont also entered a collaborative accountable care agreement with Cigna in July 2013, which covers more than 3,000 people. Cedars-Sinai Accountable Care (Beverly Hills, Calif.). Cedars-Sinai Accountable Care, anchored by 958-bed Cedars-Sinai Medical Center, was selected to participate in the Medicare Shared Savings Program in January Cedars-Sinai Medical Care Foundation providers also participate in the ACO. Children's Hospital of Philadelphia. The Children's Hospital of Philadelphia was the first children's hospital to earn National Committee for Quality Assurance accreditation as an ACO. The ACO accreditation is based on infrastructure that supports quality improvement, patientcentered care and care coordination. Cleveland Clinic Florida (Weston). Cleveland Clinic Florida is a nonprofit academic medical center and extension of Cleveland Clinic in Ohio, with more than 215 physicians. In February 2013, the hospital and Florida Blue signed a letter of intent to form an ACO. The ACO has a value-based compensation structure, rewarding physicians for transparency, care coordination and lack of redundancies.

3 Dartmouth-Hitchcock (Lebanon, N.H.). Dartmouth-Hitchcock's ACO is one of Medicare's original 32 Pioneers and covers more than 17,000 patients. In its first performance year in 2012, the health system-anchored ACO saved enough money to receive about $1 million in shared savings from Medicare. Dartmouth-Hitchcock also participated in the Medicare Physician Group Practice Demonstration, which preceded the Pioneer model, and has similar value-based arrangements with private payers. Additionally, Dartmouth-Hitchcock co-created Medicare ACO OneCare Vermont with Burlington, Vt.-based Fletcher Allen. Dean Clinic and St. Mary's Hospital ACO (Madison, Wis.). St. Mary's Hospital in Madison and its affiliated physician group formed a joint venture to launch an ACO, which was selected to participate in the Medicare Shared Savings Program in July The ACO serves patients in south central Wisconsin. Dignity Health (San Francisco). Along with San Ramon, Calif.-based Hill Physicians and Blue Shield of California, Dignity Health, then doing business as Catholic Healthcare West, launched a pilot program in 2010 to manage the care of more than 40,000 members of the California Public Employees' Retirement System. Based on the pilot's success, the system finalized an accountable care agreement with the City and County of San Francisco and Blue Shield of California, in In 2014, Blue Shield, Hill Physicians Medical Group and Dignity Health announced a three-year accountable care initiative covering approximately 14,600 Blue Shield HMO members in San Joaquin County. Duke Connected Care (Durham, N.C.). Duke Connected Care, the ACO affiliated with Durham, N.C.-based Duke University Health System, is a physician-led group that was selected to participate in the Medicare Shared Savings Program in Emory Healthcare (Atlanta). Emory Healthcare, the largest health system in Georgia, signed an ACO agreement with Blue Cross and Blue Shield of Georgia in January Emory's Healthcare Network includes six hospitals. The partnership between the organizations is designed to improve quality of care and reduce medical costs by increasing collaboration and efficiency. Essentia Health (Duluth, Minn.). Essentia Health was chosen in July 2012 to participate in the Medicare Shared Savings Program as an ACO with more than 33,000 covered lives. In fall 2013, Essentia Heal was one of two organizations in the country to receive level 3 ACO designation from the National Committee for Quality Assurance. Fairview Health Services (Minneapolis). Fairview Health Services was one of the 32 Medicare Pioneer ACOs, named in In 2013, Fairview Health Services and North Memorial Health Care in Robbinsdale, Minn., partnered with health insurer Medica to create Fairview and North Memorial Vantage with Medica, Minnesota's largest ACO. Franciscan Alliance (Mishawaka, Ind.). Franciscan Alliance, a 13-hospital system, has four Medicare ACOs: one in the Pioneer program and three in the Medicare Shared Savings Program. Each is comprised of various Franciscan Alliance hospitals, affiliated physician groups and surgery centers. The Pioneer ACO covers more than 20,000 lives. The MSSP ACOs are the Franciscan AHN ACO, Franciscan Select Health Network ACO and Franciscan Union ACO. The system also has commercial ACOs with Cigna and Aetna. Genesys Physician Hospital Organization (Flint, Mich.). The Genesys Physician Hospital Organization, a collaboration between Genesys Health System and Genesys Physicians Group Practice, was created in It includes about 160 primary care physicians and 400 specialists. CMS selected Genesys Physician Hospital Organizations as one of the original 32 Pioneer ACOs in late Hackensack (N.J.) Alliance ACO. Hackensack University Medical Center, a nonprofit teaching hospital, anchors the Hackensack Alliance ACO. Hackensack Alliance was established to participate in the Medicare Shared Savings Program and was named one of the original participants in the program in April HealthCare Partners California ACO (Torrance, Calif.). Healthcare Partners California ACO is affiliated with HealthCare Partners Medical Group. The ACO includes more than 1,200 employed and affiliated primary care physicians and more than 30,000 employed and contracted specialists. The ACO was one of the original 32 Medicare Pioneer ACOs, but was one of nine to announce its departure from the Pioneer program in July The group also has commercial ACO agreements with Monarch Healthcare and Anthem Blue Cross. HealthCare Partners of Nevada (Las Vegas). HealthCare Partners of Nevada is a multispecialty independent physician organization with more than 200 primary care physicians and roughly 1,700 specialists. The group was named to the Medicare Pioneer program in late 2011, but was one of nine to announce its exit from the program in July Healthier You Alliance in Accountable Care (Wichita, Kan.). Healthier You Alliance is a partnership agreement between Wichita-based Via Christi Health, its hospitals, specialists, clinics and a federally qualified health center. The ACO joined the Medicare Shared Savings Program in HealthPartners (Bloomington, Minn.). HealthPartners is part of the Northwest Metro Alliance, an ACO learning lab that is a collaboration between HealthPartners and Minneapolis-based Allina Health and covers more than 300,00 people. HealthPartners is comprised of a multispecialty group practice with more than 1,700 physicians and five hospitals. Additionally, HealthPartners is one of the first six organizations to receive ACO accreditation from the National Committee for Quality Assurance.

4 Health Management Associates (Naples, Fla.). HMA has 71 hospital locations in 15 states. In 2013, the company announced an accountable care delivery model with Florida Blue for patients specifically in Brevard County, Fla. The agreement includes Wuesthoff Medical Center-Melbourne (Fla.) and Wuesthoff Medical Center-Rockledge (Fla.), along with HMA's physicians. Heritage California ACO (Northridge, Calif.). Heritage California ACO is an affiliate of the Heritage Provider Network, a collaboration of 10 affiliated medical groups and independent practice associations. HPN has contracts with approximately 2,300 primary care physicians, 30,000 specialists and more than 100 hospitals. Heritage California ACO is one of the 32 original and 23 remaining Pioneer ACO program participants. Indiana University Health (Indianapolis). This academic health system is partnered with Indiana University School of Medicine. In July 2012, CMS chose Indiana University Health to participate in the Medicare Shared Savings Program as an ACO, which includes more than 1,800 physicians. Integrated Health Network of Wisconsin (Brookfield). Integrated Health Network of Wisconsin, formerly Quality Health Solutions, is a network with more than 4,500 physicians, 450 clinics and 34 hospitals in 34 Wisconsin counties. Fond du Lac-based Agnesian Healthcare, Milwaukee-based Froedtert & the Medical College of Wisconsin and Milwaukee-based Columbia St. Mary's are among the network's members. In 2014, the network launched an accountable care initiative with UnitedHealthcare covering more than 100,000 UnitedHealthcare employer-sponsored plan participants. John Muir Health (Walnut Creek, Calif.). John Muir Health was formed in 1997 following the merger of two hospitals. In July 2012, John Muir joined the Medicare Shared Savings Program and also signed an ACO contract with Blue Shield of California to last at least three years. The latter ACO covers nearly 16,000 patients. Johns Hopkins Medicine Alliance for Patients (Washington D.C.). The Johns Hopkins Medicine Alliance for Patients, the ACO affiliated with Baltimore-based Johns Hopkins Medicine, joined the Medicare Shared Savings Program in January Patricia M.C. Brown and William Baumgartner, MD, serve as co-chairs of the ACO. Kaleida Health (Buffalo, N.Y.). Kaleida Health formed a commercial ACO with BlueCross BlueShield of Western New York in May Approximately 500 physicians participate in the model. KentuckyOne Health Partners (Louisville, Ky.). Accepted into the Medicare Shared Services Program in January 2013, KentuckyOne Health Partners is a physician-led integrated network affiliated with KentuckyOne Health. KYOne HP's market area extends throughout Kentucky and regional areas in Indiana and Ohio, encompassing nearly 3,000 physicians. Lahey Clinical Performance ACO (Beverly, Mass.). Under parent company Lahey Health, Lahey Clinical Performance ACO joined the Medicare Shared Savings Program in January Gregory Bazylewicz, MD, serves as president of the ACO. LHS Health Network (Camden, N.J.). LHS Health Network, a network of physician practices, hospitals and other healthcare providers affiliated with Lourdes Health System, formed an ACO with Horizon Blue Cross Blue Shield of New Jersey, effective January Approximately 90 physicians participate in the ACO, which serves more than 17,000 patients. The ACO was also named a participant in the Medicare Shared Savings Program in January MaineHealth ACO (Portland). MaineHealth formed its ACO in 2011 and was accepted into the Medicare Shared Savings Program in July In 2013, the system formed the state's first commercial ACO with Anthem Blue Cross and Blue Shield. MaineHealth ACO consists of seven member hospitals and more than 1,000 physicians. Memorial Hermann Health System (Houston). In addition to joining the Medicare Shared Savings Program in July 2012, Memorial Hermann ACO and MHMD, the system's physician network, launched partnerships with Aetna in April 2013 and Blue Cross Blue Shield of Texas in September MHMD's 3,500 physicians and MHACO's 1,900 physicians serve greater Houston and its surrounding areas. Mercy (Chesterfield, Mo.). Mercy joined forces with Humana to develop an ACO serving southwest Missouri. Members of Humana Medicare Advantage can benefit from the new network in Missouri, Arkansas, Kansas and Oklahoma, where more than 2,100 physicians, 700 outpatient facilities and 33 hospitals affiliated with Mercy have access to patients' medical records. Mercy Health Select (Cincinnati). Jeff Copeland and Brent Asplin, MD, serve as co-presidents of Mercy Health Select, which started as the only ACO in Cincinnati. Mercy Health Select, affiliated with Mercy Health, joined the Medicare Shared Savings Program in July 2012 and serves more than 25,000 patients. Methodist Le Bonheur Healthcare (Memphis, Tenn.). In January 2013, BlueCross BlueShield of Tennessee launched a five-year ACO with Methodist Le Bonheur Healthcare. Additionally, Health Choice, a Methodist-affiliated physician hospital organization, entered an ACO agreement with Cigna in September 2011.

5 Methodist Patient-Centered ACO (Dallas). More than 200 physicians are partnered with the Methodist Patient-Centered ACO, which is affiliated with Methodist Health System and was selected to participate in the Medicare Shared Savings Program in July The ACO serves approximately 13,000 patients. MetroHealth Care Partners ACO (Cleveland). MetroHealth Care Partners ACO joined the Medicare Shared Savings Program in January Approximately 500 primary care physicians and specialists are involved in the ACO, which covers about 1.5 million Medicare beneficiaries. Michigan Pioneer ACO (Detroit). Michigan Pioneer ACO, affiliated with Detroit Medical Center, is one of 23 remaining networks participating in CMS' ACO Pioneer Model, coordinating care for approximately 13,000 patients. The ACO reported shared savings of more than $4 million in its first performance year in MissionPoint Health Partners (Nashville, Tenn.). Saint Thomas Health developed MissionPoint Health Partners, which was chosen to participate as an ACO in the Medicare Shared Savings Program in January The ACO has 1,450 participating physicians. MissionPoint also established a telemedicine program, which is within the scope of the MSSP participation waiver. Moffitt Cancer Center (Tampa, Fla.). In 2013, Moffitt Cancer Center partnered with Florida Blue for a cancer-specific ACO. Disease-specific ACOs focus on the same outcomes as primary care ACOs, improving patient outcomes while lowering costs. More than 330 oncologists participate in the ACO. Monarch HealthCare ACO (Irvine, Calif.). Monarch HealthCare ACO was one of the 32 original Pioneer Model ACOs selected by CMS. The ACO's 300 primary care physicians and 500 specialists serve more than 21,000 Medicare beneficiaries. In 2012, Monarch HealthCare ACO cut medical costs by 5.4 percent from its baseline. Montefiore ACO (New York City). Affiliated with Montefiore Medical Center, the Montefiore ACO was designated as a Pioneer Model ACO the only one in New York state covering 23,000 beneficiaries. For its first performance year, data showed monthly Medicare spending per beneficiary among Montefiore ACO participants represented a savings of $104 compared to monthly spending per beneficiary among a local market comparison group. In 2012, Montefiore Medical Center also signed an ACO agreement with Empire BlueCross BlueShield. Mount Auburn Cambridge (Mass.) Independent Practice Association. Partnered with Mount Auburn Hospital, the Mount Auburn Cambridge IPA is a Medicare Pioneer ACO. In its first year of operation in 2012, the ACO reduced spending by 3.4 percent. Approximately 500 physicians participate in the ACO. The ACO is affiliated with Mount Auburn Hospital and Cambridge Health Alliance. National Rural ACO (Nevada City, Calif.). The National Rural ACO began participating in the Medicare Share Savings Program in It consists of nine hospitals across three states: Indiana, Michigan and California. The NRACO was formed so rural organizations could overcome the high start-up costs and the MSSP's requirement for ACOs to cover at least 5,000 Medicare beneficiaries, which the organizations could not have met on their own. NCH Healthcare System (Naples, Fla.). In 2012, NCH Healthcare System, a nonprofit two-hospital system, signed an ACO agreement with Florida Blue that shifts from fee-for-service reimbursement to value-based reimbursement. The agreement includes the NCH Healthcare Group, which is made up of 64 physicians and 25 nurse practitioners and physician assistants. NH Accountable Care Partners (Concord, N.H.). Dover, N.H.-based Wentworth-Douglass Hospital and Southern New Hampshire Health System in Nashua joined Concord (N.H.) Hospital and Manchester, N.H.-based Elliot Hospital to form this ACO, which covers more than 40,000 Medicare beneficiaries. NH Accountable Care Partners includes more than 1,000 healthcare providers. NorthShore University HealthSystem (Evanston, Ill.). NorthShore University HealthSystem is a Medicaid accountable care entity, a model of care delivery finalized by Illinois lawmakers in The ACE will treat up to 45,000 patients. Northeast Medical Group (New Haven, Conn.). Northeast Medical Group, a physician group affiliated with Yale New Haven Health System, announced collaborative care agreement in May with Aetna. The group also formed an ACO with Cigna in fall 2012, covering approximately 18,000 people. Northwest Ohio ACO (Toledo). The Toledo Clinic and the University of Toledo Physicians teamed up to form the Northwest Ohio ACO, which was accepted by CMS as a Medicare Shared Savings ACO in January The Toledo Clinic is a group of about 140 physicians in 35 specialties. UT Physicians, affiliated with the University of Toledo Medical Center, has about 160 physicians. Norton Healthcare (Louisville, Ky.). In November 2010, Norton partnered with insurer Humana to create the first ACO in the Louisville area. Norton Healthcare is a nonprofit system comprised of five Louisville hospitals with approximately 2,300 physicians on staff. The ACO was launched as part of the Brookings-Dartmouth ACO Learning Network. Novant Health (Winston-Salem, N.C.). Novant Health launched a collaborative accountable care initiative with Cigna in April Novant Health is a 15-hospital system with a medical group comprised of more than 1,100 physicians. This CAC initiative is one of Cigna's largest, covering more than 60,000 members.

6 Ochsner Accountable Care Network (New Orleans). The Ochsner Accountable Care Network is an ACO that spans Louisiana and includes seven hospitals, 38 health centers and more than 900 physicians. The organization was named a Medicare Shared Savings Program participant in January 2013 and covers about 21,000 Medicare beneficiaries. OhioHealth (Columbus). Health4 is a clinically integrated healthcare delivery model co-owned by The Medical Group of Ohio and OhioHealth. The ACO was formed in 2011 through a collaboration between the providers and Ohio-based health insurer Medical Mutual. It covers 34 counties and is comprised of about 2,300 physicians. In 2012, Health4 launched a pay-for-quality initiative with Cigna, which covers more than 17,000 Cigna enrollees. In March, Health4 also announced a new accountable care agreement with Humana that will serve 41,000 Medicare Advantage members. OneCare Vermont (Colchester, Vt.). OneCare Vermont was created jointly by Dartmouth-Hitchcock in Lebanon, N.H., and Fletcher Allen Health Care in Burlington, Vt. It coordinates care for about 42,000 of the state's 118,000 Medicare beneficiaries. The ACO joined the Medicare Shared Savings Program in January Orlando (Fla.) Health. Orlando Health, a nonprofit eight-hospital system, and its affiliated medical group Physician Associates joined the Medicare Shared Savings Program in January The ACO, called the Collaborative Care of Florida, aims at a new model for healthcare and looks to increase quality and reduce costs. OSF Healthcare System (Peoria, Ill.). OSF Healthcare System's medical centers, physicians, advanced care practitioners and home care services comprise the OSF Healthcare System Pioneer ACO. The ACO, a participant in CMS' Pioneer ACO program, improved quality of care while reducing costs by 1 percent for its Medicare beneficiaries in OSF Healthcare has a physician network consisting of more than 600 PCPs, specialists and advanced practitioners. Park Nicollet Health Services (Minneapolis). Park Nicollet is one of CMS' first 32 Pioneer ACOs, but was involved in accountable care efforts before CMS named it to the program late in The system previously participated in CMS' five-year Physician Group Practice Demonstration, and in its fifth year, Park Nicollet achieved benchmark performance on all 32 quality measures. Park Nicollet has more than 1,000 physicians on staff and includes the 426-bed Park Nicollet Methodist Hospital, 29 multispecialty clinics, a research foundation and an international diabetes center. Partners HealthCare (Boston). The integrated system of Partners HealthCare, which includes Brigham and Women's Hospital and Massachusetts General Hospital, is one of the original 32 and remaining 23 Medicare Pioneer ACOs. Partners HealthCare covers about 52,000 Medicare patients in its Pioneer ACO, and the system earned $14.4 million in shared savings after its first performance year in Penn Medicine (Philadelphia). Penn Medicine is comprised of several hospitals, including the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center and Pennsylvania Hospital, all in Philadelphia. Penn Medicine joined a pay-for-performance and accountable care payment model with Independence Blue Cross in IBC rewards Penn Medicine's hospitals and physicians for their adherence to evidence-based guidelines and reductions in hospital-acquired infections and readmissions. Piedmont Physicians Group (Atlanta). Part of nonprofit Piedmont Healthcare, Piedmont Physicians Group launched a pilot ACO with Cigna in July The ACO covers about 10,000 people in Cigna health plans. Under the pilot, Cigna pays the providers of Piedmont Physicians Group which includes more than 100 primary care physicians as usual for medical services, along with an additional fee for care coordination and medical home services. Physicians also get bonus payments if they meet targets for better quality and lower costs. ProMedica (Toledo, Ohio). In 2012, ProMedica began participating in the Medicare Shared Savings Program as an ACO. The ACO includes approximately 237 providers from ProMedica Physicians who serve more than 14,000 patients. The ACO was built on ProMedica's patientcentered medical home care model, which was recognized by the National Committee for Quality Assurance. Renaissance Medical Management Company (Wayne, Pa.). Founded in 1998, Renaissance Medical Management is an independent practice association owned and managed by primary care physicians in Southeastern Pennsylvania. In late 2011, the IPA was selected by CMS to participate in the Pioneer ACO program. The IPA includes more than 200 primary care physicians across five counties. Robert Wood Johnson Partners (New Brunswick, N.J.). Robert Wood Johnson University Hospital and Health System in New Brunswick collaborated with Piscataway Township, N.J.-based Rutgers University for the creation of an ACO called the Robert Wood Johnson Partners, which began participating in the Medicare Shared Savings Program in late The organization involves academic researchers working with physicians to bring the strengths of a major research university to its patients. Rochester (N.Y.) General Health System ACO. Rochester General Health System ACO was formed in July 2013 and joined the Medicare Shared Savings Program in It is a partnership between Rochester General Health System and the Greater Rochester Independent Practice Association, which includes more than 960 physicians. Additionally, the ACO entered into a five-year ACO agreement with Excellus BlueCross BlueShield in January That agreement covers about 110,000 patients. Scott & White Healthcare Walgreens Well Network (Temple, Texas). Scott & White Healthcare Walgreens Well Network joined the Medicare Shared Savings Program in January The ACO is a partnership between drug retailing chain Walgreens and Scott & White Healthcare, a physician-owned multispecialty medical group practice. Scott & White is now part of Baylor Scott & White Health.

7 Scottsdale (Ariz.) Health Partners. Scottsdale Health Partners, a clinically integrated network, is a joint venture between Scottsdale Healthcare and Scottsdale Physician Organization, which includes more than 500 community physicians. SHP partnered with Cigna for a collaborative accountable care initiative in 2013 and became a Medicare Shared Savings Program ACO in Sharp HealthCare ACO (San Diego). Sharp HealthCare was selected as a Medicare Pioneer ACO in The ACO, which includes seven hospitals and two medical groups, serves more than 32,000 Medicare beneficiaries. In its first performance year in 2012, Sharp's ACO did not achieve enough savings to share in them with CMS. SSM ACO (St. Louis). The SSM ACO, formed by SSM Health Care, joined the Medicare Shared Savings Program in SSM Health Care also joined Missouri Anthem Blue Cross and Blue Shield's patient-centered care program this year, creating an accountable care model to help Anthem members manage their chronic conditions and improve their health. St. John Providence Health System (Warren, Mich.). St. John Providence Health System formed St. John Providence Partners in Care in 2011 as a 50/50 partnership with The Physician Alliance, a physician organization with more than 2,300 physicians, to pursue ACO contracts. The ACO joined the Medicare Shared Savings Program in St. Joseph Health System (Orange, Calif.). In 2011, St. Joseph Health partnered with Blue Shield of California for an ACO covering about 30,000 Blue Shield HMO members in Orange County. The ACO includes three hospitals, the St. Joseph Home Health Ministry, three affiliated physician networks and three medical groups. St. Luke's Clinic Coordinated Care (Boise, Idaho). St. Luke's Clinic Coordinated Care joined the Medicare Shared Savings Program in January It was the first Idaho-based ACO accepted into the program. The ACO is a joint venture between the St. Luke's Health System's hospitals and physicians. Steward Promise (Boston). Steward Promise is the one of the remaining 23 Medicare Pioneer ACOs. It's the ACO of Steward Health Care Network, which is the second largest physician network in Massachusetts and affiliated with Boston-based Steward Health Care System. SHCN includes 2,800 providers who treat more than one million patients annually. Steward Promise was able to deliver savings in its first reporting year in Tenet Healthcare (Dallas). Tenet Healthcare has several ACO agreements in different states. In 2012, the for-profit system signed a national, multi-year accountable care agreement with Cigna for healthcare services owned and operated by Tenet subsidiaries. In 2013, Tenet announced a partnership with Blue Cross and Blue Shield of Texas for a statewide ACO that will be available to BCBSTX PPO patients starting Jan. 1, This year, Tenet struck a partnership with Florida Blue for an ACO covering about 10,000 Florida Blue members. Tenet also has an ACO agreement with Blue Shield of California. Texas Health Resources (Arlington). Texas Health Resources started its ACO journey with North Texas Specialty Physicians for a Pioneer ACO called Plus; however, it became one of the nine ACOs to exit the program in The system and Texas Health Physicians Group are still involved in accountable care efforts with commercial payers. They partnered with Cigna for a collaborative accountable care initiative in 2014, and Texas Health Resources also has ACO agreements with Aetna and Blue Cross Blue Shield of Texas. Triad HealthCare Network (Greensboro, N.C.). The Triad HealthCare Network is a partnership between community physicians and Greensboro-based Cone Health System. THN became a member of the Medicare Shared Savings Program in July The organization is comprised of 850 physicians, 360 of which are employed by Cone Health. Trinity Pioneer ACO (Fort Dodge, Iowa). This Medicare Pioneer ACO is anchored by Trinity Regional Medical Center, UnityPoint Clinic-Fort Dodge Region, Berryhill Center and UnityPoint at Home-Fort Dodge Region. Trinity Pioneer ACO is the most rural of the Pioneer ACOs with one of the smallest population bases. It did not generate enough savings to share in them with Medicare in its first performance year in UCLA Health (Los Angeles). UCLA Health is currently participating in two ACO models. It joined the Medicare Shared Savings Program in January 2013 in an ACO that includes the system's hospitals and the UCLA Medical Group. Then, in October 2013, UCLA Medical Group joined Anthem Blue Cross' ACO network to care for Anthem PPO members who have two or more chronic conditions. UnityPoint Health Partners (West Des Moines, Iowa). UnityPoint Health Partners is a Medicare Shared Savings Program participant. The ACO includes hospitals, other facilities and provider groups from around Iowa, Illinois and Wisconsin. This year, UnityPoint Health Partners also joined with UnitedHealthcare for an ACO covering more than 36,000 UnitedHealthcare members. University Hospitals (Cleveland). University Hospitals boasts three main ACOs: a pediatric ACO, an employee ACO and a Medicare Shared Savings Program ACO. UH established its employee ACO in 2010 for roughly 25,000 employees and dependents. It joined the MSSP in 2012, and that ACO includes six medical centers, a rehabilitation hospital and 20 outpatient centers. The pediatric ACO, UH Rainbow Care Connection, helps manage the health of 200,000 children in the area, one-third of whom are on Medicaid. The Physician Organization of Michigan ACO (Ann Arbor). This Medicare Shared Savings ACO added more than 2,900 physicians to its network this year, bringing its provider total to 5,700. It covers about 120,000 Medicare beneficiaries. POM ACO started as a joint venture between University of Michigan Health System and eight physician groups. It took on members of the University of Michigan Pioneer ACO,

8 which dropped out of CMS' Pioneer ACO program in 2013, as well as providers from Midland, Mich.-based MidMichigan Health, the nonprofit health system affiliated with U-M Health System. UW Health ACO (Madison, Wis.). UW Health ACO is a partnership between University of Wisconsin Health physicians, clinics, hospitals and medical school. It joined the Medicare Shared Savings Program in January Jonathan Jaffery, MD, serves as president and CEO of the ACO. VirtuaCare ACO (Marlton, N.J.). VirtuaCare ACO is the Medicare Shared Savings ACO of Virtua, a four-hospital system in southern New Jersey. VirtuaCare joined the MSSP program in January VirtuaCare ACO was also one of seven ACOs to enter a collaborative relationship with SilverScript Insurance Company, a subsidiary of CVS Caremark, in June. The alliance is intended to upgrade pharmacy care for patients with Medicare Part D coverage. Copyright ASC COMMUNICATIONS Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

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