Medicare Shared Savings Program

Mission Health Partners, Inc.
509 Biltmore Avenue Asheville, North Carolina 28801

ACO Primary Contact
Primary Contact Name Amanda Gerlach
Primary Contact Phone Number 828-213-5384
Primary Contact Email Address amanda.gerlach@msj.org
Organizational Information
ACO Participants ACO Participant in Joint Venture (Enter Y or N)
Steven Cahan N
Charles J. McGraw MD, LTD N
Appalachian Foot & Ankle Associates PA N
Moore Foot & Ankle Specialists, PA N
Apple Valley Family Medicine PA N
Chad Smoker MD PC N
October Road, Inc. N
Charles J. DePaolo, M.D, P.A. N
ABC Pediatrics of Asheville PA N
Asheville Medicine & Pediatrics Ltd N
Vickery Family Medicine, Pllc N
Forest Dermatology, PA N
North Buncombe Family Medicine, P.A. N
Appalachian Regional Medical Associates, Inc. N
STMD LLC N
Wellspring Family Practice, PA N
Carolina Mountain Gastroenterology Endoscopy Center, LLC N
Mission Medical Associates Inc. N
Blue Sky Pediatrics Asheville PA N
Dry Ridge Family Medicine PLLC N
Chad Smoker N
Hazelwood Family Medicine, PLLC N
UWH of North Carolina, LLP N
Our Family Doctor, PLLC N
John Baker N
Highlands-Cashiers Physician Services Inc N
Cannon Family Health, PLLC N
Trillium Family Medicine, PLLC N
WNC Birth Center N
Asheville Podiatry Associates PA N
Park Hill Medicine, PA N
Appalachian Mountain Community Health Centers N
Brie Folkner MD PC N
Asheville Gynecology & Wellness Pllc N
Allan Nash N
Highlands-Cashiers Hospital, Inc. N
Watauga Medical Center, Inc. N
Charles A. Cannon, Jr., Memorial Hospital, Inc. N
Mission Hospitals Inc N
Transylvania Community Hospital, Inc. N
The McDowell Hospital Inc. N
Asheville Radiology Associates, PA N
Carolina Internal Medicine Associates, PA N
Asheville Pediatric Associates N
ALLCARE CLINICAL ASSOCIATES PA N
W.N.C. Ear Nose Throat Head and Neck Surgeons, PA N
Hendersonville Pediatrics, P.A. N
Blue Ridge Regional Hospital Inc. N
Mountain Area Health Education Center, Inc. N
Clay Comprehensive Health Services, Inc. N
Bakersville Community Medical Clinic, Incorporated N
Haywood Pediatric and Adolescent Medicine Group, P.A. N
Sylva Family Practice, PA N
Digestive Health Partners Pa N
The Family Health Centers, PA N
Mountain Kidney & Hypertension Associates, P.A. N
Allan Nash N
Mountain Radiation Oncology, P.A. N
Carolina Ophthalmology, PA N
Asheville Plastic Surgery PA N
Asheville Endocrinology Consultants, PA N
Pathologists Medical Laboratory, P.A. N
Asheville Arthritis and Osteoporosis Center, P.A. N
James J. Caserio, M.D., PA N
Asheville Internal Medicine, P.A. N
Mountain Docs Family Medicine P.A N
Community Family Practice, PA N
Asheville Children's Medical Center PA N
Murphy Medical Center, Inc. N
Western North Carolina Community Health Services, Inc. N
The Pisgah Institute for Psychotherapy & Education PA N
Andrews Internal Medicine PA N
Franklin Family Practice, PA N
Transylvania Physician Services Inc N
Asheville Eye Associates PLLC N
Mountain Area Pediatric Associates, P.A. N
Carolina Mountain Emergency Medicine PA N
Community CarePartners, Inc. N
Steven L Cahan MD PA N
Henderson County Hospital Corporation N
Primary Eye Care Associates, OD, PA N
MOUNTAIN AREA PATHOLOGY PA N
East Asheville Family Health Care P.A. N
WNC INTERNAL MEDICINE, PLLC N
MemoryCare N
Carolina Hand and Sports Medicine, P.A. N
Mountain Diabetes And Endocrine Center PLLC N
Brosnan Eye Associates N
Angel Medical Center, Inc. N
Brie Folkner N
Don Jablonski DO PA N
Radiation Therapy Associates Of Western North Carolina, Pa N
Krishna Internal Medicine, P.C. N
French Broad Pediatric Associates N
Mission Community Anesthesiology Specialists LLC N
Halvorson Plastic Surgery, PA N
Plastic Surgery of Asheville, PA N
What's An Accountable Care Organization (ACO)?
  • ACOs are groups of doctors and other healthcare providers who voluntarily work together with Medicare to give you high quality service and care at the right time in the right setting.
  • Your doctor has agreed to participate in a Medicare Shared Savings Program ACO and to work closely with other doctors and healthcare providers in the ACO to coordinate care for Medicare beneficiaries, like yourself, who have traditional Medicare.
  • The ACO may share in any savings that result from providing you with high quality and more coordinated care.
ACOs Don't Change Your Medicare Benefits
  • An ACO is not a Medicare Advantage plan or an HMO plan.
  • If you have traditional Medicare, you still have the right to see any doctor or hospital who accepts Medicare at any time.
  • We may continue to recommend that you see particular doctors for your specific health needs, but it's always your choice about what doctors you see or hospitals you visit.
How Will An ACO Help My Doctor Coordinate My Care?
  • You benefit because your doctors will be part of a better coordinated team.
  • You may not have to fill out as many medical forms that ask for the same information.
  • Each of your doctors will not only know about the health issues they've treated, they will have a more complete picture of your health through talking with your other doctors.

If you have questions or concerns, you can talk with your physician at any time. You can also visit www.medicare.gov/acos.html or call 1-800-MEDICARE. TTY users should call 1-877-486-2048.

ACO Governing Body
Member Member's Voting Power Membership Type ACO Participant TIN Legal Business Name/DBA, if Applicable
Last Name First Name Title / Position
Baumgarten Alan Director Class I ACO Participant Representative The Family Health Centers, PA
Buys Elizabeth Director Class I ACO Participant Representative Mountain Area Health Education Center
Heck Jeffrey Director and Vice Chair Class I ACO Participant Representative Mountain Area Health Education Center
Kubitschek Kenneth Director Class I ACO Participant Representative Carolina Internal Medicine Associates
Love Scott Director Class I ACO Participant Representative ABC Pediatrics of Asheville PA
Mahaffey Danielle Director Class I ACO Participant Representative Appalachian Regional Healthcare
Moore Robert Dir and Chair Class I ACO Participant Representative North Buncombe Family Medicine
Moreadith Jeffrey Director Class I ACO Participant Representative Mission Medical Associates
Pagano Nunzio Director Class I ACO Participant Representative Asheville Internal Medicine
Russell Amy Director Class I ACO Participant Representative Mountain Area Health Education Center
Tomkins Calvin Director Class I ACO Participant Representative Asheville Pediatrics Associates
Weizman Michael Director Class I ACO Participant Representative Our Family Doctor
Ball John Director Class II ACO Participant Representative N/A
Franklin David Director Class II ACO Participant Representative Mission Medical Associates
Garrett John Director Class II Community Stakeholder Representative N/A
Gwynne Marc Director Class II ACO Participant Representative Henderson County Hospital Assoc
Hathaway William Director Class II ACO Participant Representative Mission Hospital
Hoggard Green Jill Director Class II ACO Participant Representative Mission Medical Associates
Mims Susan Director Class II ACO Participant Representative Mission Medical Associates, Inc.
Malloy Marc Director Class II ACO Participant Representative Mission Hospital
Gerlach Amanda Ex Officio Non Voting Member Executive Director N/A
Key ACO Administrative Leadership
Amanda Gerlach ACO Executive
Calvin Tomkins Asst. Medical Director
Gwen McKinney Compliance Officer
Calvin Tomkins Quality Assurance/Improvement Officer
Associated Committees and Committee Leadership
Committee Name Committee Leader Name and Position
Finance Committee Dr. Alan Baumgarten
Quality Committee Dr. Calvin Tomkins

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

  • Partnerships or joint venture arrangements between hospitals and ACO professionals
  • Critical Access Hospital (CAH) billing under Method II
  • Federally Qualified Health Center (FQHC)
  • Rural Health Clinic (RHC)

Shared Savings and Losses

Amount of Shared Savings/Losses
  • First Agreement Period
    • Performance Year 2016, $5,375,365
    • Performance Year 2015, $0
Shared Savings Distribution
  • First Agreement Period
    • Performance Year 2016
      • Proportion invested in infrastructure: 10%
      • Proportion invested in redesigned care processes/resources: 45%
      • Proportion of distribution to ACO participants: 45%
    • Performance Year 2015
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A
2016 Quality Performance Results
ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 83.57 80.51
ACO-2 CAHPS: How Well Your Providers Communicate 93.54 93.01
ACO-3 CAHPS: Patients’ Rating of Provider 91.80 92.25
ACO-4 CAHPS: Access to Specialists 84.00 83.49
ACO-5 CAHPS: Health Promotion and Education 63.08 60.32
ACO-6 CAHPS: Shared Decision Making 78.99 75.40
ACO-7 CAHPS: Health Status/Functional Status 70.33 72.30
ACO-34 CAHPS: Stewardship of Patient Resources 28.85 26.97
ACO-8 Risk Standardized, All Condition Readmission 13.15 14.70
ACO-35 Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM) 16.20 18.17
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes 44.08 53.20
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 64.55 75.23
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 50.97 59.81
ACO-9 Ambulatory Sensitive Condition Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5) 4.89 9.27
ACO-10 Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8) 12.28 14.53
ACO-11 Percent of PCPs who Successfully Meet Meaningful Use Requirements 98.68 82.72
ACO-39 Documentation of Current Medications in the Medical Record 84.80 87.54
ACO-13 Falls: Screening for Future Fall Risk 69.54 64.04
ACO-14 Preventive Care and Screening: Influenza Immunization 76.39 68.32
ACO-15 Pneumonia Vaccination Status for Older Adults 78.39 69.21
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up 73.60 74.45
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 95.36 90.98
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 58.97 53.63
ACO-19 Colorectal Cancer Screening 68.09 61.52
ACO-20 Breast Cancer Screening 72.79 67.61
ACO-21 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 84.73 76.79
ACO-42 Statin therapy for the Prevention and Treatment of Cardiovascular Disease 76.28 77.72
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 14.38 18.24
ACO-41 Diabetes: Eye Exam 55.18 44.94
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 67.84 70.69
ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 89.44 85.05
ACO-31 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 85.34 88.67
ACO-33 Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%) 73.93 79.67
Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low samples.
Note: In the Quality Performance Results file(s) above, search for “Mission Health Partners, Inc.” to view the quality performance results. This ACO can also be found by using the ACO ID A39107 in the public use files on data.cms.gov.

Payment Rule Waivers

  • No, our ACO does not use the SNF 3-Day Rule Waiver.

Waivers:

To further the purposes of the Medicare Shared Savings Program and the clinical integration efforts of Mission Health Partners, Inc., and its participants, Mission Health Partners, Inc. Board of Directors has approved the following participation waivers and authorizes the provision of the following items/services for all network participants and their employed providers:
  • Clinical Documentation Integrity "CDI" services which will include documentation specificity queries, code reviews, data analysis and education on findings related to documentation requirements and tools to support processes.  These services will ensure that accurate documentation and code capture is at the most appropriate level of specificity to support patient condition identification and the appropriate delivery of quality care.
  • Mission Health Partners, Inc. (“MHP”) has implemented a Telepsychiatry Program that will provide tablets and software, free of charge, to selected MHP member primary care practices. The Program will allow the selected primary care practices to facilitate telepsychiatry visits in their offices for their patients through telemedicine equipment. Using telemedicine will reduce the need and costs for patients to travel for psychiatric care.  If successful, the piloted program will expand into other practices in the near future.
  • A common electronic platform that will enhance clinical integration required under the MSSP and will promote accountability for quality, cost and overall care of the Medicare population.  An integrated or shared electronic health record system (“EHR”) will facilitate high quality medical care for beneficiaries, increase MHP participant access to beneficiary medical records and clinical information specific to beneficiaries, facilitate the communication and coordination of care across the continuum, reduce the number of disparate patient records, improve quality reporting capabilities, and increase patient engagement.
  • ICD-10 training modules and readiness checklists which will be covered as part of the MHP Participation Fee. The express purpose of this provision is to facilitate an accurate transition to the revised medical classification system and aid in coding improvements to increase quality and decrease cost of care according to the requirements of the Medicare Shared Savings Program.
  • A Quality Incentive Program that is designed to incentivize quality improvement behaviors among network providers, set a culture of communication and collaboration, build infrastructure and establish goodwill by providing financial incentives to providers who meet or exceed pre-established connectivity, reporting and quality metrics.  The Quality Incentive Program will contribute to the promotion of high quality and efficient care to network patients by encouraging providers to adhere to quality metrics and facilitate management and coordination of care.
  • QlikView, a quality improvement tool which offers an online analytics dashboard that gives network providers access to patient-level quality data, will increase the quality of care provided to their patients by targeting patients who need a specific screening.  This tool will also ensure that providers complete reporting on all quality measures for each tier threshold in a timely and efficient manner.  QlikView supports the provision of high quality and efficient care for MHP’s beneficiary population at a lower cost.
To further the purposes of the Medicare Shared Savings Program and the clinical integration efforts of Mission Health Partners, Inc., and its participants, Mission Health Partners, Inc. Board of Directors has approved the following patient incentive waivers and authorizes the provision of the following items/services for all network participants and their employed providers:
  • Mission Health Partners, Inc. (“MHP”) is implementing a program designed to assist high-risk patients with transportation to appointments for follow-up care (the “Program”).  The Program will advance MHP’s clinical goals by helping patients adhere to a treatment or drug regime, follow-up care plan, or to facilitate management of a chronic disease.  The Program will improve access to primary care by facilitating transportation which would eliminate the need for more expensive intervention and/or Emergency Room visits.

Additional Information

For additional information or general beneficiary questions, please visit www.medicare.gov/acos.html. You can also call 1-800-MEDICARE (1-800-633-4227 (TTY users should call 1-877-486-2048)) for questions about Accountable Care Organizations.

Hours of Operation: Monday through Friday 8 a.m. - 5 p.m.