Public Reporting

ACO Name and Location

Prisma Health Upstate Network, LLC
300 East McBee Ave.
Suite 310, Greenville, SC 29601

ACO Primary Contact

Kim Roberts,
Executive Director
Kim.Roberts@prismahealth.org
864-797-7858

Organizational Information

ACO Participants and Participation in ACO Joint Venture, Yes (Y) or No (N)

  • Foot Clinic of South Carolina LLC – N
  • New Haven Medical Services, PA – N
  • The Surgery And Laser Center At Professional Park – N
  • Parkside Pediatrics, P.A. – N
  • Oconee Physician Practices – N
  • John Humeniuk – N
  • Zachary Seymour – N
  • Dr. Akhtar Hussain M.D. – N
  • Upstate Medical Associates PA – N
  • Carolina Pulmonary & Sleep Disorder, LLC – N
  • Carolina Lung & Sleep Center Llc – N
  • Self Medical Group – N
  • Palmetto Internal Medicine & Primary Care – N
  • Highlands Center for Women, P.A. – N
  • Baptist Easley Hospital – N
  • Carolina Surgery – N
  • PIEDMONT PULMONARY MEDICINE LLC – N
  • Carolina Integrative Medicine, PA – N
  • Greenville Kidney Care LLC – N
  • UPSTATE PODIATRY GROUP PA – N
  • Oconee Kidney Center LLC – N
  • Piedmont Neurology – N
  • Brio Medical, PC – N
  • Greenwood Urological – N
  • Upstate Plastic Surgery – N
  • Newberry County Memorial Hospital – N
  • Self Regional Healthcare – N
  • Oconee Medical Center – N
  • Greenville Anesthesiology, PA – N
  • Greenwood Obstetrics & Gynecology Pa – N
  • Dermatology Associates, P.A. – N
  • Greenwood Surgical Assoc – N
  • Greenwood Ear Nose And Throat Assoc Pa – N
  • Greenwood Eye Clinic, P.A. – N
  • Upper Savannah Radiological Associates, PA – N
  • Oconee Urology, PA – N
  • Gastroenterology Associates, PA – N
  • Allergic Disease & Asthma Center Pa – N
  • Bruce A Marshall MD PA – N
  • Newberry Internal Medicine LLC – N
  • Carolina Pathology Associates, LLP – N
  • EASLEY HEAD & NECK SURGERY PA – N
  • Laurens County Health Care System – N
  • Piedmont Retina Assoc Pa – N
  • Oconee Surgery, PA – N
  • Digestive Disease Group PA – N
  • The Greenwood Endoscopy Center, Inc – N
  • Due West Family Medicine – N
  • Laeklands Orthorpaedic Clinic – N
  • Palmetto Bone & Joint, PA – N
  • Riley Family Practice Associates, Pa – N
  • Anesthesiology of Greenwood PA – N
  • Greenville Endoscopy Center – N
  • Carolina Nephrology PA – N
  • Jervey Eye Group, PA – N
  • Foothills Family Medicine of Westminster PA – N
  • GHS Partners in Health, Inc. – N
  • Primary Care Associates, PC – N
  • Oncology and Hematology Associates of South Carolina, LLC – N
  • Carolinas Center for Advanced Management of Pain PA – N
  • Palmetto Surgery Associates, PA – N
  • Palmetto Family Medicine – N
  • Greenwood Center for Gynecology, LLC – N
  • Regenesis Organization Community Health – N
  • The Surgery Center @ Self Memorial Hospital, Llc. – N
  • Simpsonville Family Medicine, P.A. – N
  • Piedmont Cardiology Associates PA – N
  • Golden Corner Family Prac – N
  • Greenville Dermatology LLC – N
  • Montgomery & Riddle Eyecare, P.A. – N
  • Pathology Associates of Greenville – N
  • Pathology Consultants, Inc. – N
  • Turning Point Women’s Center, PA – N
  • Abbeville County Memorial Hospital – N
  • Clemson Eye, PA – N
  • Partners In Health – Rural Health – N
  • Jervey Eye Center, LLC – N
  • Newberry Family Health Center, PA – N
  • The Center for Advanced Eye Care – N
  • Pelham Family Practice, LLC – N
  • HHD Enterprises LLC – N
  • ANDERSON HEART P C – N
  • Oakview Medical Associates LLC – N
  • Doctor for Life, LLC – N
  • Prisma Health–Upstate  – N
  • APEX ALLERGY & IMMUNOLOGY, P.C. – N

ACO Governing Body

Board of Managers

  • Dr. Pat Marshall – Chair, Voting Member Power – 1, ACO Executive
  • Dr. James Pfeiffer—Vice Chair, Voting Member, Voting Member Power – 1, ACO Participant Representative, Self Regional Healthcare
  • Ms. Jeanne Ward—Voting Member, Voting Member Power – 1, ACO Participant Representative, Prisma Health
  • Dr. Meg Carter—Voting Member, Voting Member Power – 1, ACO Participant Representative, Tribe 513, PA
  • Dr. J. Drew Goldsmith—Voting Member, Voting Member Power – 1, ACO Participant Representative, Prisma Health–Upstate
  • Dr. Vincent Green—Voting Member, Voting Member Power – 1, ACO Participant Representative, Prisma Health–Upstate
  • Dr. George Haddad—Voting Member, Voting Member Power – 1, ACO Participant Representative, Prisma Health–Upstate
  • Dr. Logan Matthew—Voting Member, Voting Member Power – 1, ACO Participant Representative, Self Regional Healthcare
  • Dr. Alan J. Paysinger—Voting Member, Voting Member Power – 1, ACO Participant Representative, Newberry Internal Medicine
  • Mr. S.T. Peden—Voting Member, Voting Member Power – 1, Medicare Beneficiary Representative, Community Stakeholder
  • Dr. Conrad Shuler—Voting Member, Voting Member Power – 1, ACO Participant Representative, Prisma Health–Upstate
  • Dr. William Springhart—Voting Member, Voting Member Power – 1, ACO Participant Representative, Prisma Health–Upstate
  • Dr. Donald Wiper III—Voting Member, Voting Member Power – 1, ACO Participant Representative, Prisma Health–Upstate

Key ACO Clinical and Administrative Leadership

  • ACO Executive: Pat Marshall, MD
  • Medical Director: Peter Tilkmeier, MD
  • Compliance Officer: Scott Pietras, JD
  • Quality Assurance/Improvement Officer: Scott Hultstrand

Committees

  • Compliance Committee: Scott Pietras, JD, Chair
  • Finance Committee: Daniel Grover, MD,  Chair
  • Network Participation Committee: Pat Crawford, MD Chair
  • Primary Care Committee: Meg Carter, MD Chair
  • Quality and Care Delivery Committee: Peter Tilkemeier, MD Chair

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

  • Federally Qualified Health Centers (FQHC)
  • Hospitals employing ACO professionals
  • Partnerships or joint venture arrangements between hospitals and ACO professionals
  • Network individual practices of ACO professionals
  • Rural Health Clinics (RHC)

Shared Savings and Losses

Amount of Shared Savings/Losses

  • First Agreement Period
    • Agreement period beginning 2015, Performance Year 2017: $7,863,011
    • Agreement period beginning 2015, Performance Year 2016: $9,657,590
    • Agreement period beginning 2015, Performance Year 2015: $8,474,728

Shared Savings Distribution

  • First Agreement Period
      • Performance Year 2017
        • Proportion invested in infrastructure: 20%
        • Proportion invested in redesigned care processes/resources: 0%
        • Proportion of distribution to ACO participants: 80%
      • Performance Year 2016
        • Proportion invested in infrastructure: 20%
        • Proportion invested in redesigned care processes/resources: 0%
        • Proportion of distribution to ACO participants: 80%
      • Performance Year 2015
        • Proportion invested in infrastructure: 20%
        • Proportion invested in redesigned care processes/resources: 0%
        • Proportion of distribution to ACO participants: 80%

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

2017 Quality Performance Results

ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 82.87 80.60
ACO-2 CAHPS: How Well Your Providers Communicate 92.76 93.13
ACO-3 CAHPS: Patients’ Rating of Provider 92.17 92.31
ACO-4 CAHPS: Access to Specialists 83.86 83.32
ACO-5 CAHPS: Health Promotion and Education 61.11 62.30
ACO-6 CAHPS: Shared Decision Making 75.36 75.85
ACO-7 CAHPS: Health Status/Functional Status 73.07 73.05
ACO-34 CAHPS: Stewardship of Patient Resources 26.57 25.68
ACO-8 Risk Standardized, All Condition Readmission 13.94 15.01
ACO-35 Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM) 17.51 18.46
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 63.32 79.16
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 52.81 61.74
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 1.73 1.93
ACO-11 Use of Certified EHR Technology 100.00 98.48
ACO-12 Medication Reconciliation 6.69 75.32
ACO-13 Falls: Screening for Future Fall Risk 91.35 74.38
ACO-44 Imaging Studies for Low Back Pain 63.46 67.32
ACO-14 Preventive Care and Screening: Influenza Immunization 78.60 72.52
ACO-15 Pneumonia Vaccination Status for Older Adults 80.99 72.92
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up 71.14 70.69
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 83.94 90.48
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 71.60 61.98
ACO-19 Colorectal Cancer Screening 61.48 64.58
ACO-20 Breast Cancer Screening 63.81 70.05
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 78.90 79.89
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 12.35 16.74
ACO-41 Diabetes: Eye Exam 32.67 50.37
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 68.97 71.47
ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 92.77 86.86

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low samples and the ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes quality measure is not included in public reporting due to a non-material technical error.

Note: In the Quality Performance Results file(s) above, search for “Prisma Health Upstate Network, LLC” to view the quality performance results. This ACO can also be found by using the ACO ID A2575 in the public use files on data.cms.gov.

 

Payment Rule Waivers

  • Yes, our ACO does use the SNF 3-Day Rule Waiver.

Medicare Shared Savings Program Waiver Disclosures (arrangements for which waiver protection is sought)

The Centers for Medicare & Medicaid Services (CMS) has made available certain waivers of federal fraud and abuse laws in connection with the operation of an Accountable Care Organization (ACO) that has entered into a participation agreement under the Medicare Shared Savings Program (“MSSP”). In accordance with the public disclosure requirements of the ACO Participation Waiver, the following describes arrangements between MyHealth First Network, LLC (MyHFN) and its participants.

Population Health and Clinical Integration Payment Arrangement

The ACO has an arrangement in which it offers a technology platform for population health and clinical integration (“MyHFN PH/CI System”) that gathers, analyzes and reports on data regarding patient needs, the delivery of care, quality indicators, population health in local communities, and patient outcomes to its members including its physician members. MyHFN member hospitals support the costs of such system in the proportions that their communities represent in comparison to the entire service area population served by MyHFN.

Physician Performance Payment System Arrangement

The ACO has an arrangement in which it provides incentive compensation (the “Physician Performance Payment System”) that will compensate MyHFN physicians for their work in quality improvement and care coordination for MSSP Patients and other patients; and the Physician Performance Payment System will be funded by a portion of any MSSP shared savings payments.

MyHFN Board of Managers determined that the Physician Performance Payment System and the Population Health and Clinical Integration Support Arrangement are reasonably related to the purposes of the Medicare Shared Savings Program.  Furthermore, the MyHFN Board of Managers approved the Physician Performance Payment System and the Population Health and Clinical Integration Support Arrangement. The program commenced on January 1, 2015 and continues to be in effect.

Approved by MyHFN Board of Managers November 15, 2017.

Medicare Shared Savings Program Agreement

The MyHFN ACO has an Operating Agreement and a Code of Conduct (Collectively “Operating Documents”).  In addition to the Operating Documents, MyHFN has a Participation Agreement with each of its ACO Participants which allows all parties to participate in the CMS Medicare Shared Savings Program. The Agreement is designed to promote accountability for the cost and overall quality of care of patients by creating a high degree of interdependence and cooperation among participants and healthcare providers through an active and ongoing program of health care quality and efficiency initiatives.

The MyHFN Board of Managers determined that the MyHFN Medicare Shared Savings Program Agreement is reasonably related to the purposes of the CMS Medicare Shared Savings Program, and therefore, approved the MyHFN Medicare Shared Savings Program Agreement. The program commenced on January 1, 2015 and continues to be in effect.

Approved by MyHFN Board of Managers March 4, 2015