Accountable Care Organization (ACO) Report

ACO Name & Location
MUSC Health Alliance, LLC
1 Poston Road, Suite 350
Charleston, SC 29407

ACO Primary Contact
Sam Guerin
843-996-6845
guerinmb@musc.edu

Organizational Information

ACO Participants	ACO Participant in Joint Venture (Y or N)
Carolina Family Care Inc	N
Coulter Clinic	N
Medical University Hospital Authority	N
MUSC Affiliate Physicians	N
MUSC Community Physicians	N
University Medical Associates	N

 

 ACO Governing Body 

Last Name	First Name	Member Title/Position	Member's Voting Power – Expressed as a percentage of number	Membership Type	ACO Participant Legal Business Name, if Applicable
David	Louder	Member	0	ACO Participant Representative	Medical University Hospital Authority
Diann	Krywko	Member	12.5%	ACO Participant Representative	MUSC Community Physicians
Doug	Lischke	Member	12.5%	ACO Participant Representative	Medical University Hospital Authority
Fred	Borelli	Member	12.5%	ACO Participant Representative	MUSC Community Physicians
Gene	Hong	Member	12.5%	ACO Participant Representative	MUSC Community Physicians
Kellie	Mendoza	Member	0	ACO Participant Representative	MUSC Community Physicians
Matt	Severance	Member	12.5%	ACO Participant Representative	Medical University Hospital Authority
Joan	Ustin	Member	12.5%	Medicare Beneficiary Representative	N/A
Pat	Cawley	Member	12.5%	ACO Participant Representative	Medical University Hospital Authority
Vanessa	Diaz	Member	12.5%	ACO Participant Representative	Medical University Hospital Authority
Wade	Lamb	Member	0%	ACO Participant Representative	Medical University Hospital Authority

Key ACO Clinical & Administrative Leadership

• ACO Executive: David Louder, MD
• Medical Director: Wade Lamb, MD
• Compliance Officer: Kellie Mendoza
• Quality Assurance/Improvement Officer: Danielle Scheurer, MD

Associated Committees & Committee Leadership

• Executive Committee: Patrick Cawley, MD, Chair
• Finance & Contracting Committee: Fred Borelli & Karyn Rae, Co-Chairs
• Clinical Transformation & Quality: Patrick Cawley, MD & Danielle Scheurer, Co-Chairs
• Affiliations & Compliance Committee: Ozgur Gencdur & Kellie Mendoza, Co-Chairs
• IT& Analytics Committee: Peggy Jenny & Blair Shannon, Co-Chairs

Types of ACO Participants, or Combinations of Participants, That Formed the ACO:

• ACO professionals in a group practice arrangement
• Hospital employing ACO professionals
• Networks of individual practices of ACO professionals

Shared Savings & Losses 

Amount of Shared Savings/Losses

• Second Agreement Period
  • Performance Year 2021, -$1,681,481
  • Performance Year 2020, $2,556,655
• First Agreement Period
  
  • Performance Year 2019, $918,132
  • Performance Year 2018, -$269,779
  • Performance Year 2017, -$291,310

Shared Savings Distribution

• Second Agreement Period
  
  • Performance Year 2021
    
    • Proportion invested in infrastructure: N/A
    • Proportion invested in redesigned care processes/resources: N/A
    • Proportion of distribution to ACO participants: N/A
  • Performance Year 2020
    
    • Proportion invested in infrastructure: 20%
    • Proportion invested in redesigned care processes/resources: 20%
    • Proportion of distribution to ACO participants: 60%
• First Agreement Period
  
  • Performance Year 2019
    
    • Proportion invested in infrastructure: 20%
    • Proportion invested in redesigned care processes/resources: 20%
    • Proportion of distribution to ACO participants: 60%
  • Performance Year 2018
    
    • N/A
  • Performance Year 2017
    
    • N/A

Quality Performance Results

 2021 Quality Performance Results:

ACO#	Measure Name	Rate	ACO Mean
318	Falls: Screening for Future Fall Risk	98.84	87.03
110	Preventive Care and Screening: Influenza Immunization	91.08	80.52
226	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	87.88	80.97
134	Preventive Care and Screening: Screening for Depression and Follow-Up Plan	97.72	74.38
113	Colorectal Cancer Screening	73.22	73.63
112	Breast Cancer Screening	80.60	75.11
001	Diabetes Mellitus: Hemoglobin A1c Poor Control	10.46	12.46
236	Hypertension (HTN): Controlling High Blood Pressure	73.85	74.87
438	Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	84.76	84.24
479	Hospital Wide, 30 day, All Cause Unplanned Readmission (HWR) Rate fpr MIPS Groups	0.1605	0.1540
MCC1	All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions for ACOs (MCC)	35.84	33.99
CAHPS-1	Getting Timely Care, Appointments, and Information	82.05	84.67
CAHPS-2	How Well Providers Communicate	92.84	93.56
CAHPS-3	Patient’s Rating of Provider	91.51	92.19
CAHPS-4	Access to Specialists	78.14	78.80
CAHPS-5	Health Promotion and Education	62.58	61.61
CAHPS-6	Shared Decision Making	61.14	60.89
CAHPS-7	Health Status and Functional Status	74.26	71.78
CAHPS-8	Care Coordination	84.90	85.66
CAHPS-9	Courteous and Helpful Office Staff	91.04	91.88
CAHPS-11	Stewardship of Patient Resources	27.07	24.71

"Please note, the Quality ID #: 370 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size.”

For Previous Years’ Financial and Quality Performance Results, Please Visit data.cms.gov.

Payment Rule Waivers

• Skilled Nursing Facility (SNF) 3-Day Rule Waiver:
  • Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.612.
• Waiver for Payment for Telehealth Services:

  Our ACO clinicians provide telehealth services using the flexibilities under 42 CFR § 425.612(f) and 42 CFR § 425.613.