Types of ACO Participants, or Combinations of Participants, that formed the ACO

• Networks of individual practices of ACO professionals
• Networks of Individual practices of ACO professionals
• Partnerships or joint venture arrangements between integrated care networks and ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses:

• Second Agreement Period
  • Performance Year 2023, $ 7,998,546.23
  • Performance Year 2022, $ 4,180,487.23
  • Performance Year 2021, $ 4,441,123.86
  • Performance Year 2020, $ 3,997,054.67

• First Agreement
  • Performance Year 2019, $ 2,929,207.96
  • Performance Year 2018, $ 0.00
  • Performance Year 2017, $ 0.00

Shared Savings Distribution:

• Second Agreement Period
  • Performance Year 2023
  • Proportion invested in infrastructure: 27%
  • Proportion invested in redesigned care processes/resources: 7%
  • Proportion of distribution to ACO participants: 66%
  • Performance Year 2022
  • Proportion invested in infrastructure: 27%
  • Proportion invested in redesigned care processes/resources: 7%
  • Proportion of distribution to ACO participants: 66%
  • Performance Year 2021
  • Proportion invested in infrastructure: 27%
  • Proportion invested in redesigned care processes/resources: 7%
  • Proportion of distribution to ACO participants: 66%
• First Agreement Period
  • Performance Year 2019
  • Proportion invested in infrastructure: 30%
  • Proportion invested in redesigned care processes/resources: 10%
  • Proportion of distribution to ACO participants: 60%
  • Performance Year 2017-2018
  • Proportion invested in infrastructure: NA%
  • Proportion invested in redesigned care processes/resources: NA%
  • Proportion of distribution to ACO participants: NA%
    
    

• 2022 Quality Performance Results:

Quality performance results are based on Web Interface collection type.

Footnotes:

[1] A lower performance rate corresponds to higher quality.

[2] CAHPS for MIPS Survey is a composite measure, so numerator and denominator values are not applicable (N/A). The Reported Performance Rate column shows the CAHPS for MIPS Survey composite score. The CAHPS for MIPS Survey composite score is calculated as the average number of points across scored Summary Survey Measures (SSMs). Refer to Table 5 for details on CAHPS for MIPS Survey performance.

[3] For PY 2023, the CMS Web Interface measures Quality ID#: 438 and Quality ID#: 370 do not have benchmarks, and therefore, were not scored. They are, however, required to be reported in order to complete the Web Interface measure set. If they are not reported, the CMS Web Interface measure set denominator is increased by 10 points for each measure that is not reported, resulting in a lower health equity adjusted quality performance score. For more information, refer to the Performance Year 2023 APM Performance Pathway: CMS Web Interface Measure Benchmarks for ACOs:

For previous years’ Financial and Quality Performance Results, please visit: Data.cms.gov

Payment Rule Waivers

• Skilled Nursing Facility (SNF) 3-Day Rule Waiver: NA
• Payment for Telehealth Services:
  • Our ACO clinicians provide telehealth services using the flexibilities under 42 CFR § 425.612(f) and 42 CFR § 425.613.
    
    

Fraud and Abuse Waivers

• ACO Pre-Participation Waiver: NA
• ACO Participation Waiver:

The following information describes each arrangement for which our ACO seeks protection under the ACO Participation Waiver, including any material amendment or modification to a disclosed arrangement.

Home Health Partnership 

Parties to the arrangement: Prime Care Managers, LLC (ACO) and One Source Home Care, LLC dba Prime Care Managers Home Health (Home Health Agency)

• Date of arrangement: 06/12/2024

• Items, services, goods, or facility provided: The home health agency will provide the following services and support as part of the collaboration:
  • Skilled nursing services for post-acute patients, with a focus on early detection of clinical deterioration.
  • Remote monitoring tools (e.g., weight scales, pulse oximeters, and blood pressure monitors) to manage chronic conditions like CHF and COPD.
  • Physical therapy and rehabilitation services for mobility improvement and fall prevention.
  • Care coordination and patient education to support adherence to treatment plans and reduce readmission risks.
  • Identification and mitigation of social determinants of health (SDoH), such as lack of resources or poor living conditions, through tailored interventions.
  • Telehealth visits for high-risk patients to ensure timely access to care and prevent unnecessary utilization.
  • Collaboration on transitional care management (TCM) protocols for high-risk, homebound populations.
  • Participation in risk management strategies focused on monitoring and supporting patients in RIM 5-8 categories, ensuring timely interventions and reducing acute care events.
• Financial Arrangement:
  The ACO agrees to fund or share costs related to:
  • Procurement and maintenance of remote monitoring equipment.
  • Training for home health staff on ACO-aligned protocols and risk management strategies.
  • Shared savings incentives based on achieving quality benchmarks and reducing readmission rates.
    
    

I. Purpose of the Arrangement

This arrangement is intended to:

1. Support the ACO’s mission to improve the quality of care and patient outcomes.
2. Reduce unnecessary hospital readmissions and emergency department visits.
3. Enhance patient care transitions from acute to post-acute settings.
4. Integrate home health services into the ACO’s coordinated care model.
5. Implement risk management strategies tailored to high-risk, homebound populations.
   
   

II. Approval and Compliance

This arrangement has been reviewed and approved by the ACO’s governing body as necessary and directly related to achieving the goals of the MSSP. The governing body certifies that:

1. The arrangement is reasonably related to the ACO’s quality improvement and cost reduction objectives.
2. It complies with all MSSP requirements and does not result in overutilization or unnecessary services.
3. The arrangement is transparent and will be publicly disclosed as required.
   
   

III. Public Disclosure

This waiver and the details of the arrangement have been publicly disclosed in accordance with MSSP regulations. The disclosure includes all material terms, amendments, and related financial arrangements.

Hospice Partnership

Parties to the arrangement: Prime Care Managers, LLC (ACO) and Prime Care Hospice, LLC.

• Date of arrangement: 06/12/2024

• Prime Care Hospice, LLC will provide the following services and support as part of the collaboration:
  • Early identification and transition of end-stage patients to hospice care, ensuring appropriate timing of services.
  • Comprehensive hospice care services, including pain management, emotional support, and end-of-life planning.
  • Collaboration with the ACO care team to align care plans with patient and family goals.
  • Education and support for patients and families regarding hospice benefits and services.
  • Data sharing with the ACO to enhance population health analytics for end-stage patient management.
  • Participation in care management protocols for patients in RIM 7-8 categories to ensure smooth transitions and optimal care.
  • Assistance in addressing social determinants of health (SDoH) that may impact patients’ ability to access hospice services.
• Financial Arrangement:
  The ACO agrees to fund or share costs related to:
  • Training programs for hospice staff on ACO-aligned protocols for end-stage patient care.
  • Shared savings incentives based on achieving MSSP quality metrics related to hospice utilization and patient satisfaction.
  • Collaboration tools and technology to streamline transitions from acute or home health settings to hospice care.
    
    

I. Purpose of the Arrangement

This arrangement is intended to:

1. Support the ACO’s mission to improve the quality of care and patient outcomes.
2. Ensure early and seamless transitions to hospice care for end-stage patients.
3. Enhance care coordination and communication between the ACO and hospice services.
4. Address social, emotional, and clinical needs of patients in the final stages of life.
5. Improve population health outcomes by managing RIM 7-8 categories effectively.
6. Achieve MSSP quality benchmarks through proactive end-of-life care planning and patient-centered services.
   
   

II. Approval and Compliance

This arrangement has been reviewed and approved by the ACO’s governing body as necessary and directly related to achieving the goals of the MSSP. The governing body certifies that:

1. The arrangement is reasonably related to the ACO’s quality improvement and cost reduction objectives.
2. It complies with all MSSP requirements and does not result in overutilization or unnecessary services.
3. The arrangement is transparent and will be publicly disclosed as required.
   
   

III. Public Disclosure

This waiver and the details of the arrangement have been publicly disclosed in accordance with MSSP regulations. The disclosure includes all material terms, amendments, and related financial arrangements.

Outpatient Physical Therapy Partnership

Parties to the arrangement: Prime Care Managers, LLC (ACO) and Longview Outpatient Physical Therapy, LLC(CORE)

• Date of arrangement: 06/12/2024

• Items, Services, Goods, or Facilities Provided:
  The outpatient physical therapy provider will offer the following services and support as part of the collaboration:
  • Physical therapy services for post-acute and chronic care patients to improve mobility and functional independence.
  • Specialized therapy for patients recovering from orthopedic surgery or stroke.
  • Balance and fall prevention programs tailored for high-risk, elderly populations.
  • Patient education on exercises and lifestyle modifications to prevent complications and improve health outcomes.
  • Collaboration on care plans for patients in RIM 3-6 categories, focusing on reducing readmission risks and addressing pre-acute risk factors.
  • Targeted intervention for rising-risk populations identified through RIM 2 and RIM 4 scores, emphasizing early detection of potential health deterioration.
  • Data sharing with the ACO’s care team to enhance patient monitoring, especially for population health strategies that focus on identifying and addressing pre-acute risks.
  • Participation in transitional care management (TCM) protocols, ensuring continuity of care for patients transitioning from acute to outpatient settings.
• Financial Arrangement:
  The ACO agrees to fund or share costs related to:
  • Equipment and facilities required for advanced physical therapy treatments.
  • Training programs for therapy staff to align with ACO protocols and quality benchmarks.
  • Incentives based on achieving MSSP quality metrics and patient satisfaction scores.
    
    

I. Purpose of the Arrangement

This arrangement is intended to:

1. Support the ACO’s mission to improve the quality of care and patient outcomes.
2. Enhance mobility and functionality for patients requiring outpatient physical therapy services.
3. Reduce unnecessary hospital readmissions and emergency department visits.
4. Facilitate seamless transitions of care for post-acute and chronic care patients.
5. Address pre-acute risk factors through physical therapy interventions, focusing on prevention and mitigation of adverse events.
6. Provide proactive support for rising-risk patients in RIM 2 and RIM 4 categories, with a goal of delaying or preventing progression to higher-risk levels.
7. Implement collaborative care strategies to improve quality metrics under the MSSP.
   
   

II. Approval and Compliance

This arrangement has been reviewed and approved by the ACO’s governing body as necessary and directly related to achieving the goals of the MSSP. The governing body certifies that:

1. The arrangement is reasonably related to the ACO’s quality improvement and cost reduction objectives.
2. It complies with all MSSP requirements and does not result in overutilization or unnecessary services.
3. The arrangement is transparent and will be publicly disclosed as required.
   
   

III. Public Disclosure

This waiver and the details of the arrangement have been publicly disclosed in accordance with MSSP regulations. The disclosure includes all material terms, amendments, and related financial arrangements