Shared Savings Program Public Reporting

ACO Governing Body:

Key ACO Clinical and Administrative Leadership:

ACO Executive: John Woods

Medical Director: Kirin Zaveri

Compliance Officer: John Woods

Quality Assurance/Improvement Officer: Kenneth Cranor

Associated Committees and Committee Leadership: 

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

Networks of individual practices of ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses:

• Third Agreement Period      

• Performance Year 2023, $5,219,502.95 

• Performance Year 2022, $7.057,891 

• Performance Year 2021, $8,405,088 

• Performance Year 2020, $8,025,380 

• Performance Year 2019/2019A, $10,686,872

   

• Second Agreement Period 

• Performance Year 2018, $5,712,042 

• Performance Year 2017, $3,292,526 

• Performance Year 2016, $2,459,316

   

• First Agreement Period 

• Performance Year 2015, $1,662,988 

• Performance Year 2014, $3,133,900 

• Performance Year 2013, $4,721,981 

Shared Savings Distribution:

• Third Agreement Period

• Performance Year 2023 

• • Proportion invested in infrastructure: 20% 

• • Proportion invested in redesigned care processes/resources: 24% 

• • Proportion of distribution to ACO participants: 56%

• Performance Year 2022 

• • Proportion invested in infrastructure: 15% 

• • Proportion invested in redesigned care processes/resources: 29% 

• • Proportion of distribution to ACO participants: 56%

     

• Performance Year 2021 

• • Proportion invested in infrastructure: 15% 

• • Proportion invested in redesigned care processes/resources: 29% 

• • Proportion of distribution to ACO participants: 56%

     

• Performance Year 2020  

• • Proportion invested in infrastructure: 15% 

• • Proportion invested in redesigned care processes/resources: 28% 

• • Proportion of distribution to ACO participants: 57%

     

• Performance Year 2019/2019A 

• • Proportion invested in infrastructure: 15% 

• • Proportion invested in redesigned care processes/resources: 25% 

• • Proportion of distribution to ACO participants: 60%

     

• Second Agreement Period

   

• Performance Year 2018 

• • Proportion invested in infrastructure: 15% 

• • Proportion invested in redesigned care processes/resources: 23% 

• • Proportion of distribution to ACO participants: 62%

     

• Performance Year 2017 

• • Proportion invested in infrastructure: 10% 

• • Proportion invested in redesigned care processes/resources: 5% 

• • Proportion of distribution to ACO participants: 85%

     

• Performance Year 2016 

• • Proportion invested in infrastructure: 10% 

• • Proportion invested in redesigned care processes/resources: 5% 

• • Proportion of distribution to ACO participants: 85%

     

• First Agreement Period

   

• Performance Year 2015 

• • Proportion invested in infrastructure: 10% 

• • Proportion invested in redesigned care processes/resources: 5% 

• • Proportion of distribution to ACO participants: 85%

     

• Performance Year 2014 

• • Proportion invested in infrastructure: 10% 

• • Proportion invested in redesigned care processes/resources: 5% 

• • Proportion of distribution to ACO participants: 85%

     

• Performance Year 2013 

• • Proportion invested in infrastructure: 10% 

• • Proportion invested in redesigned care processes/resources: 5% 

• • Proportion of distribution to ACO participants: 85% 

2023 Quality Performance Results:

Quality performance results are based on CMS Web Interface.

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. 

   

  Fraud and Abuse Waivers 

  • 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.   

  [For each arrangement, provide the following information:  

  • • Parties to the arrangement: The Physicians Alliance LLC ACO and LabCorp  
  • • Date of arrangement: 07/01/2020 
  • • Items, services, goods, or facility provided: Data Reporting Systems 
  • • Date and nature of any amendments to the arrangement, if applicable: No Amendments 

     

  Agreement with LabCorp:   

  The parties to the arrangement include TP-ACO and Laboratory Corporation of America Holdings and its subsidiaries (“LabCorp”). The agreements are effective as of January 07/01/2020. Under the agreements, the parties will coordinate with each other to meet requirements for reporting quality and cost measures, establish clinical decision support programs to support chronic disease management and population health strategies, and evaluate and address the health needs of TP-ACO’s patient population. LabCorp will make available laboratory testing services to TP-ACO’s providers, and TP-ACO will integrate and use this information in TP-ACO’s data analytics programs, reporting measures, and care coordination and intervention strategies. The agreements include a series of potential grants to develop infrastructure and redesigning care processes to allow for high quality and efficient service delivery for patients whereby TP-ACO must meet certain quality metrics to be eligible. This arrangement allows the parties to promote accountability for the quality, cost, and overall care for TP-ACO’s patients and manage and coordinate care for these individuals. With respect to this arrangement above, TP-ACO’s governing body has made and duly authorized a bona fide determination that the arrangement is reasonably related to the purposes of the Medicare Shared Savings Program.