A1077_PubDiscv12_0715_IA Approved 07/20/2015 pg. 1

Transcription

1 ACO Name and Location Accountable Care Coalition of Northwest Florida 2929 Langley Avenue Suite 204 Pensacola, Florida ACO Primary Contact Jeff Spight Composition of ACO A network of individual practices of ACO professionals, partnership or joint venture arrangements between hospitals and ACO professionals ACO Participants Banuelous Family Medicine, LLC Earl J Crosswright Md Pa Escambia Community Clinics Inc Flora L Cabreros MD PA Greater Gulf Coast Primary Care Llc Gulf Coast Physician Partners John G Brown P A Live Oak Medical Associates, P.A. Lourdes L Virtusio M D Family Practice Clinic Inc Manning Hanline Jr. MD Mark Elder DO PA Pace Blvd Family Practice Pa Panhandle Rural Health Incorporated Paul J Pandolfi MD Robert Flurry MD PA Teodoro K Ortega MD PA The Infectious Disease Grp Pa The Surgery Group Pa Warren L Herron Jr Md Pa William C Wilson DO PA William Howe William L Howe II Willis & Ling Md Pa Woodlands Medical Specialist PA A1077_PubDiscv12_0715_IA Approved 07/20/2015 pg. 1

2 Accountable Care Coalition of Northwest Florida Governing Body Jonathan Shannon, Voting Member, Chair, Collaborative Health Systems, LLC (CHS) Charles Trinchitella, Voting Member, Health First Network, Inc. Karen Snow, M.D., Voting Member, Greater Gulf Coast Primary Care, LLC David Bruce Young, M.D., Voting Member, Gulf Coast Physician Partners James Sid Clements, M.D., Voting Member, The Infectious Disease Group, PA Frank Brooks Hodnette Jr., M.D., Voting Member, The Surgery Group, PA William Zimmern, M.D., Voting Member, Live Oak Medical Associates, PA Warren Herron Jr., M.D., Voting Member, Warren L. Herron, Jr., M.D., PA William Whibbs, M.D., Voting Member, Vice Chair, Gulf Coast Physician Partners Allen Patton, M.D., Voting Member, Medicare Beneficiary Representative Accountable Care Coalition of Northwest Florida Committees and Key Leadership personnel Compliance & Ethics Subcommittee: David Gross, Chair Quality Improvement & Care Coordination Subcommittee: Frank Brooks Hodnette Jr., M.D., Chair Operations Oversight Subcommittee: Jonathan Shannon, Chair Medical Director: William Whibbs, M.D. Aggregate Amount of Shared Savings/Losses Performance Year 1: N/A Performance Year 2: <TBD> Performance Year 3: <TBD> How Shared Savings Are Distributed Reinvest in Infrastructure: <TBD>% Distribution to ACO Participants: <TBD>% o Primary Care Professionals: <TBD>% o Specialists: <TBD>% o Hospitals: <TBD>% pg. 2

3 Quality Performance Results Performance Measure Risk Standardized, All Conditions Readmissions (ACO-8) ASC Admissions: COPD or Asthma in Older Adults (ACO-9) ASC Admissions: Heart Failure (ACO-10) Percent of Primary Care Providers who Qualified for EHR Incentive Payment (ACO-11) 2012 Performance Summary Statistics ACO Performance Rate Mean Performance for All ACOS % 59.87% Performance Measure Risk Standardized, All Conditions Readmissions (ACO-8) ASC Admissions: COPD or Asthma in Older Adults (ACO-9) ASC Admissions: Heart Failure (ACO-10) Percent of Primary Care Providers who Qualified for EHR Incentive Payment (ACO-11) 2013 Performance Summary Statistics ACO Performance Rate Mean Performance for All ACOS % 66.21% pg. 3

4 ACO Participation Waiver Documentation Parties Involved: Accountable Care Coalition of Northwest Florida Start Date: June 2014 End Date: Sept Description/Purpose of the Arrangement: Practice Manager Annual Wellness Visit Challenge ( AWV Challenge ), titled I m Well Done, designed to stimulate awareness of the Medicare Annual Wellness Visit (AWV) available to Medicare beneficiaries and to support practice managers efforts to outreach to ACO beneficiaries in their practices and have their clinicians complete AWVs. The AWV Challenge invites practice managers of ACO participants to submit a short application that describes the effectiveness of their efforts relating to AWVs. The application will consist of four (4) questions that are designed to assess both qualitative and quantitative outcomes. Applications are graded on a scale of 0% 100%, with each answer worth 25% of the total grade. The questions are: Explain what your practice does to outreach to ACO beneficiaries and encourage such beneficiaries to have their AWV. What break out idea have you had that enables your practice to get more beneficiaries to come in to have an AWV? How do you know your efforts are working? Include metrics. For example, out of all the ACO beneficiaries in your practice, what percentage are well done (meaning, patients have completed their AWV)? Provide a brief story about your patients experience with the AWV, and why AWVs are beneficial, such as describing a positive outcome, or a before and after situation. Applications will be evaluated by the Management Committee of the ACO with input from the ACO Executive Director and staff from Collaborative Health Systems (CHS). The application with the highest grade, out of the pool of all applications received for the ACO, will be awarded a grand prize trip for two (2) to Orlando, FL; provided, (a) there must be at least three (3) unique applications from different ACO participants; and (b) the applicant s application score must be sixty-five percent (65%) or greater. Winners and their application responses may be publicized within the ACO community in order to build a culture of innovation and leadership. The AWC Challenge criteria may, in the ACO s sole discretion, be modified, with or without notice, at any time. The AWV Challenge will run from June September During this period, Executive Directors will meet with practices at monthly lunch n learns to encourage participation in the AWV Challenge, monitor AWV progress, and provide education about AWVs and other topics pertaining to the ACO, such as quality measures. The grand prize winner of the AWV challenge will be announced in October. pg. 4

5 Timing: AWV Challenge waiver approved by ACO Management Committee June 10 Monthly Lunch n Learns June 16 September 5 Launch AWV Challenge June 16 First Lunch n Learn June 16 July 11 Second Lunch n Learn July 14 August 8 Third Lunch n Learn August 11 Sept 5 Call for Entries September 2 Entries Closed September 15 Evaluation of AWV Challenge Entries September Winners announced October 1 Promote Winners October/November Winners trip to Orlando, FL Jan 22 25, 2015 Items, Services and/or goods included: CHS will administer the AWV Challenge on behalf of the ACO. Prizes and promotional items in support of the challenge consist of: I. Grand prize - trip for two to Universal Resorts, Orlando, Florida, Jan 22 25, 2015 (Thursday Sunday). What s included: two round trip coach plane tickets from winner s home city; transfer from airport to hotel and hotel to airport; 3 night hotel stay at Loews Portofino Bay Hotel at Universal Orlando, breakfast included; two 4-day Park to Park passes to Universal Studio Orlando s theme parks; pg. 5

6 up to 9 meals (Thursday, lunch, dinner, Friday, breakfast, lunch, dinner, Saturday, breakfast, lunch, dinner, Sunday breakfast). CHS will handle bookings directly with grand prize winner. Grand prize is non transferable. Must be 18 years of age or over to participate. II. Promotional items to support the AWV challenge. These items will be branded with the title of the AWV Challenge - I m Well Done - and will include pens, post-it note paper cubes, oven mitts and grill sets (to play on the words, well done ). Executive Director will distribute promotional items to Lunch N Learn attendees by random selection. Relation to Purposes of the Medicare Shared Savings Program: In order for this program to move forward, this Governing Body must make and duly authorize a bona fide determination, consistent with each member s duty under 42 CFR (b)(3), that the arrangement is reasonably related to one of the stated purposes of the Shared Savings Program. Please select at least one of the following and then describe how this program is reasonably related to that purpose: Promoting accountability for the quality, cost and overall care for a Medicare patient population as described in the Shared Savings Program, Managing and Coordinating care for Medicare Fee-For-Service beneficiaries through an ACO, or Encouraging investment in infrastructure and redesigned care processes for high quality and efficient service delivery for patients, including Medicare beneficiaries. The AWV Challenge supports the stated purpose by promoting Annual Wellness Visits which can: - help the ACO s efforts to complement and improve care processes for the ACO s Fee-For-Service population; - bolster the patient/provider relationship, improve patient engagement and provide a personalized prevention plan at no cost to the beneficiary; - provide an avenue to ensure ACOs are monitoring and retaining healthy beneficiaries in the ACO s assigned beneficiary population from year to year; - helps provide a baseline measurement for care coordination and to identify changes in medical condition of the beneficiaries over time. pg. 6