ACO Name and Location

Accountable Care Coalition of Southeast Wisconsin
4888 Loop Central Drive, Suite 700
Houston, TX 77081

ACO Primary Contact

Jeff Spight
Jeffery.Spight@UniversalAmerican.com
914-597-2073

ORGANIZATIONAL INFORMATION

ACO Participants

• Abdul G Durrani M.D., S.C.
• BARBARA A HUMMEL, MD SC
• Baylon Family Physicians, Ltd.
• Bruce A Luccas, MD, LLC
• C.M.M. Sundaram, M.D., SC
• Caine Inc
• Carolina G. Conti, M.D., S.C.
• Charles J Waisbren MD SC
• Clinica Latina, S.C.
• Clinica Panamericana LLC
• Compassionate Doctors Inc
• Davis Medical Clinic, SC
• Dr Turgut Zia SC
• DR. JOSEPH S KOSTRZEWSKI SC
• Drs Decheck and Mataczynski MD SC
• Drs. Khan & Almas
• Eddy D. Co, MD, SC
• Family Doctors SC
• Farzad Kamrani, MD.SC.
• GERALD L IGNACE INDIAN HEALTH CENTER INC
• Glenn Caine, DO
• Greater Milwaukee Center For Health and Wellness Inc.
• Heart Institute of Wisconsin S.C.
• HISPANIC MEDICAL CENTER, SC
• Independent Physicians of Wisconsin LLC
• Interpedia, S.C.
• James M. Bury, MD, Ltd.
• JEREMIAS B. VINLUAN M.d. S.c.
• Joan T. Harney Gnadt, MD, SC
• KARIM BAKHTIAR MD SC
• Katzoff Rihawi Sc
• Kaushalya Beniwal MD SC
• Kenosha Family Practice, S.C.
• Lee Medical Clinic SC
• Lingam V Kumar MD SC
• Lubsey Medical Clinic Inc
• Luma Healthcare, Inc
• MAGO MEDICAL INC
• Maqbool Arshad, MD
• Medpoint Family Care Center
• Milwaukee Cardiac Care LLC
• MILWAUKEE FAMILY PRACTICE SC
• Milwaukee Health Services, Inc.
• MILWAUKEE IMMEDIATE CARE CORPORATION
• Milwaukee Internal Medicine Associates Inc
• Ninette A. Nassif, M.D., S.C.
• Nova Medical Center LLC
• Oak Creek Urgent Care LLC
• Omni Family Medical SC
• Outreach Community Health Centers, Inc.
• Ozaukee Medical Group, LLC
• Paddock Lake Family Practice SC
• PEDIATRIC AND ADULT MEDICINE ASSOCIATES S.C.
• Primary Care of Milwaukee SC
• PROCARE MEDICAL GROUP SC
• Progressive Community Health Centers, Inc.
• Providence Family Medical Clinic S.C.
• Pulmonary & Critical Care Associates, SC
• Raed Hamed, MD
• Raymond W. Moy, MD SC
• Samara Services LLC
• Sami A Roumani MD
• Shabbar Sajjad MD SC
• Sheboygan Physicians Group S.C.
• Sixteenth Street Community Health Centers Inc
• SJK Geriatric & Pallative Care Inc.
• Suhas K Shelgikar MD SC
• Surya Medical Group SC
• TAHA MEDICAL CENTER
• THIENSVILLE FAMILY HEALTH CARE SC
• Thomas J Shewczyk MD SC
• Tosa Medical Group LLC
• West Allis Primary Care Physicians, S.C.

No participants are involved in a joint venture between ACO professionals and hospitals.

Accountable Care Coalition of Southeast Wisconsin Governing Body

• Waleed Najeeb, M.D., Chair, Voting Member, ACO Participant, Independent Physicians of Wisconsin
• Bruce Herman, M.D., Voting Member, ACO Participant, Ozaukee Medical Group, LLC
• Mohammad Q. Khan, M.D., Voting Member, ACO Participant, Independent Physicians of Wisconsin
• Mohammad Nwilati, M.D., Voting Member, ACO Participant, Procare Medical Group, S.C.
• Sami Roumani, M.D., Voting Member, ACO Participant, Roumani Medical Clinic
• Michael Johnson, M.D., Voting Member, ACO Participant, Sheboygan Physicians Group, SC
• Charles Waisbren, M.D., Voting Member, ACO Participant, Charles J. Waisbren, MD, SC
• C.M.M. Sundaram, M.D., Voting Member, ACO Participant, C.M.M. Sundaram, M.D., SC
• Lorri Havlovitz, Voting Member, Collaborative Health Systems, LLC (CHS)
• Victor Petrovs, Voting Member, Medicare Beneficiary Representative

 

Accountable Care Coalition of Southeast Wisconsin Key Clinical and Administrative Leadership

• ACO Executive: Jeff Spight
• Medical Director: Bruce Herman, M.D.
• Compliance Official: Michael Yount
• Quality Assurance/Improvement Officer: Bruce Herman, M.D.

 

Accountable Care Coalition of Southeast Wisconsin Associated Committees and Committee Leadership

• Care Coordination & Quality Improvement Subcommittee: Bruce Herman, M.D.
   

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

• A network of individual practices of ACO professionals

 

SHARED SAVINGS AND LOSSES

Amount of Shared Savings/Losses

• Agreement period beginning 2012, Performance Year 1: $8,671,679.22
• Agreement period beginning 2012, Performance Year 2014: $4,425,988.97
• Agreement period beginning 2012, Performance Year 2015: $7,873,056.18

 

Shared Savings Distribution

• Agreement period beginning 2012, Performance Year 1
  • Proportion invested in infrastructure: 37%
  • Proportion invested in redesigned care processes/resources: 26%
  • Proportion of distribution to ACO participants: 37%

• Agreement period beginning 2012, Performance Year 2014
  • Proportion invested in infrastructure: 38%
  • Proportion invested in redesigned care processes/resources: 24%
  • Proportion of distribution to ACO participants: 38%

• Agreement period beginning 2012, Performance Year 2015
  • Proportion invested in infrastructure: 40%
  • Proportion invested in redesigned care processes/resources: 20%
  • Proportion of distribution to ACO participants: 40%

 

Payment Rule Waiver

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

 

Quality Performance Results

• See 2015 Quality Performance Results Table here.
• See 2012-2014 Quality Performance Results Table here.

 

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ACO Waiver Documentation

Parties Involved: Start Date: Jan.1, 2017 EndDate:Dec31,2017
Accountable Care Coalition of Southeast Wisconsin
Medicare Fee-For-Service Beneficiaries (Beneficiaries)

Details of the Incentive Program:
The ACO will be providing first aid kits and insulated zipper bags to Beneficiaries. The first aid kits will be distributed to all Beneficiaries who receive an Annual Wellness Visit with an ACO Participant. They will be provided to the Beneficiary at the end of the Visit.
The insulated zipper bags will be provided to Beneficiaries identified by an ACO Participant as being treated with multiple medications during a regular office visit to improve medication reconciliation.
Participation in either incentive program will be at the discretion of each ACO Participant. However, upon agreeing to participate in one or both programs, the ACO Participant will provide the incentives to all eligible Beneficiaries.
What Items/Services are being provided?
First aid kit – appreciation for completing Annual Wellness Visit
Insulated zipper bag – to bring medications to each appointment
Who will receive the Items/Services?
Medicare Beneficiaries identified by an ACO Participant.
Under what conditions will they receive the Items/Services?
First aid kit: Will be provided to Beneficiaries who receive an Annual Wellness Visit from an ACO Participant.
Insulated zipper bags: Will be provided to Beneficiaries being treated with multiple medications during a regular office visit.
What is the value of each Item/Service?
The first aid kits cost under $2 each and the insulated zipper bags cost under $2 each.
Who is paying for the Item/Service?
The Accountable Care Coalition of Southeast Wisconsin, via Collaborative Health Systems (CHS). The cost will be reimbursed to CHS out of shared savings.

Describe the connection between the item/service being provided and the medical care of the beneficiary:
The first aid kit was intended to thank members for receiving preventive care, particularly the Annual Wellness Visit. The insulated zipper bags are intended to assist Beneficiaries with medication management and assist providers to complete accurate medication reconciliation.

Select one or more of the following criteria and explain how this item/service fits within that category:
☒The Item/Service is for preventive care:
☒The Item/Service is used to advance the clinical goal of:
  ☒Adherence to a treatment/drug regime: Will help the Beneficiary with medication management and help providers complete medication reconciliation.
  ☒Adherence to a follow-up care plan:
  ☒Management of a chronic disease or condition: Will ensure that the Beneficiary is stabilizing or improving his/her chronic conditions by achieving optimal results from treatments given as prescribed by their provider.

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Authorization by Governing Body

Method of Authorization (select one): Date: January 12, 2017
☐ Unanimous Written Consent
☒ Governing Body Vote documented accordingly in the meeting minutes

 

ACO Waiver Documentation

Start Date: January 1, 2017 End Date: December 31,2017

Parties Involved:
The Accountable Care Coalition of Southeast Wisconsin (The ACO)
Clinical Guard (vendor) and Batteries Plus (vendor)
COPD beneficiaries as identified below

Details of the Incentive Program:
The ACO would like to provide fingertip Pulse Oximeters to ACO Beneficiaries who have Chronic Obstructive Pulmonary Disease (COPD), and are at risk for COPD exacerbation.
ACCSW has 1,795 COPD beneficiaries (which is a higher percentage than other SSPs). ACCSW experienced 16.39 discharges per 1,000 Beneficiaries for COPD in 2011 (other SSPs averaged 10.97 COPD discharges per 1,000).
Encouraging beneficiaries to utilize a fingertip pulse oximeter daily will allow for early detection of decreased oxygen rate or increased pulse rate. For COPD patients, the decreased oxygen or increased pulse rates indicates potential COPD exacerbation. Early detection of this exacerbation will allow the ACO Participant an opportunity to treat with medications (antibiotics and/or oral steroids) at home and may prevent the need for an emergency room visit or hospitalization.
Units will be labeled with appropriate distributing ACO PCP or pulmonologist name and phone number along with ACO phone number. A business card for the respective Care Coordinator, unit directions, and COPD symptoms will be included for each unit Care Coordination will maintain provider office contact information for urgent responses to changes in health. Provider offices will put the batteries into the unit at time of disbursement, educate ACO Beneficiary on how to use the unit, and explain the care plan (when/frequency beneficiary needs to call Care Coordination).
Beneficiary will sign Acknowledgment Form accepting the unit, including serial number (in case of recall), contact information for beneficiary, provider, and Care Coordination, and care plan. One comprehensive page allows provider to fax to Care Coordination and increase beneficiary engagement.
ACO PCP or pulmonologist will inform Care Coordination when unit was dispersed to include date dispersed, beneficiary name/addr/ph# and care plan.
ACO will maintain careful tracking of units, outreach activities, and will follow with claims data to determine results of pilot.

What Items/Services are being provided?
Fingertip Pulse Oximeters to measure oxygen levels and pulse rates.

Who will receive the Items/Services?
ACO Participants that are PCPs or Pulmonologists will make the determination and provide the Pulse Oximeters to Chronic Obstructive Pulmonary Disease (COPD) Beneficiaries who are deemed by the provider to be at risk. Examples beneficiaries who would be deemed to be at risk are those who have been previously hospitalized (ER or IP) for COPD exacerbation and may be on steroids, using inhalers, or on oxygen.

Under what conditions will they received the Items/Services?
ACO Beneficiaries must be willing to report daily/weekly with a Care Coordinator, as determined by the provider, to report oxygen and pulse rates. Care Coordinator will report changes in oxygen and pulse rates, along with other symptoms of exacerbation, to the provider. If a decreased oxygen level or an increased pulse rate is identified, the Care Coordinator will work with the ACO Beneficiary to schedule an appointment with the PCP or Pulmonologist.

What is the cost/value of each Item/Service?
The ACO is planning to use Clinical Guard to obtain the Pulse Oximeters. This vendor was chosen as they provided the lowest cost for a unit that we believe is reliable and will be easy for beneficiaries to use. The retail value of each unit through that vendor is $22.95. Clinical Guard has agreed to a 15% volume discount, making each unit $19.51.
To remove potential barriers of usage, the ACO will also supply the two AAA batteries required for each unit. The ACO is planning to use Batteries Plus who has agreed to a cost of $37.44 per case of 96 AAA batteries.

Who is paying for the Item/Service?
As a partner in the ACO, Collaborative Health Systems will pay the upfront costs associated with purchasing the units, with the intent of using the ACO shared savings to cover the expense.

Describe the connection between the item/service being provided and the medical care of the beneficiary:
Fingertip pulse oximeters allow for daily monitoring of oxygen and pulse rates for beneficiaries who have been diagnosed with COPD. This monitoring is vital to early detection of COPD exacerbation, which could lead to emergency situations and hospitalization. Encouraging beneficiaries to utilize a fingertip pulse oximeter daily will allow for early detection of decreased oxygen rate or increased pulse rate. For COPD patients, the decreased oxygen or increased pulse rates indicates potential COPD exacerbation. Early detection of this exacerbation will allow the provider an opportunity to treat with medications (antibiotics and oral steroids) at home and may prevent the need for an emergency room visit or hospitalization.

Select one or more of the following criteria and explain how this item/service fits within that category:
☐The Item/Service is for preventive care:
☐The Item/Service is used to advance the clinical goal of:
☐Adherence to a treatment/drug regime:
☐Adherence to a follow-up care plan:
☒Management of a chronic disease or condition:

Encouraging beneficiaries to utilize a fingertip pulse oximeter daily will allow for early detection of decreased oxygen rate or increased pulse rate. For COPD patients, the decreased oxygen or increased pulse rates indicates potential COPD exacerbation. Early detection of this exacerbation will allow the provider an opportunity to treat with medications (antibiotics and oral steroids) at home and may prevent the need for an emergency room visit or hospitalization.

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Authorization by Governing Body

Method of Authorization (select one): Date:January 12, 2017
☐ Unanimous Written Consent
☒ Governing Body Vote documented accordingly in the meeting minutes

 

ACO Documentation

Parties Involved: Start Date: January 1, 2017 End Date: September 30, 2017
Accountable Care Coalition of Southeast Wisconsin
Collaborative Health Systems

Description/Purpose of the Arrangement:
To facilitate the capture of comprehensive and consistent data set relating to the ACO quality measures, CHS has developed, and the ACO has adopted, a documentation template (“Detailed Quality Measures Checklist”) to meet the requirements of 2017 GPRO reporting. This document is to be completed by the ACO Participant or provider/supplier during a beneficiary encounter or retrospectively, by capturing ACO quality measures collected in a previous visit.
The Detailed Quality Measures Checklist details the documentation requirements necessary to meet the standards established by CMS for the preventative care services included in the quality measurements for the ACO.
Recognizing the administrative burden of completing the Detailed Quality Measures Checklist, CHS, on behalf of the ACO, will pay the provider as follows:The payment will be an ACO expense as described in the agreement between the ACO and CHS.
Items, Services and/or goods included:
This administrative fee covers the cost of outreach, scheduling and logistics, and reporting to CHS.
Financial/Economic Terms:

• $50.00 for each completed Quality Detailed Checklist entered directly into Lumiata PatientLink 360.
• $25.00 for each completed Quality Detailed Checklist that has to be entered on behalf of the provider office into Lumiata PatientLink 360 by the Care Coordination team.
• $50.00 for each completed Quality Detailed Checklist entered directly into Lumiata PatientLink 360 for a beneficiary that is newly qualified for an AWV during October 1, 2016 through December 31, 2016.

Relation to Purposes of the Medicare Shared Savings Program
This reimbursement will support the complete and accurate data collection of the quality measures. This data will be used to ascertain the health status of the individual, identify any gaps in care, needed clinical interventions, additional disease education, care plan development and tracking, as well as, engage the beneficiary in the active participation of their care and identify opportunities for improved care coordination.
With expanded and more specific data collection, care processes will be initiated earlier and more consistently. An increasingly robust quality measures collection process is in itself a redesigned care process that will improve the care of the individual, reduce costs and improve the health of the population the ACO serves.

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Authorization by Governing Body

Method of Authorization (select one): Date: January 12, 2017
☐ Unanimous Written Consent
☒ Governing Body Vote documented accordingly in the meeting minutes

Arrangements Disclosed

REQUIRED PUBLIC DISCLOSURE FOR THE ACO PARTICIPATION WAIVER

The Accountable Care Coalition of Southeast Wisconsin (the “ACO”) participates in the Medicare Shared Savings Program (“MSSP”) under a contract with the Centers for Medicare & Medicaid Services (“CMS“). The Secretary of the Department of Health and Human Services has provided certain waivers of federal fraud and abuse laws in connection with the MSSP. On June 27, 2016, the Management Committee of the ACO met at a duly called meeting to discuss an arrangement with Lifeline Community Healthcare, LLC (“Lifeline”) under which Lifeline will provide a grant of funds to assist the ACO’s efforts with respect to the MSSP. Consistent with 42 CFR 425.106(b)(3), after discussing the proposed arrangement with Lifeline, the Management Committee made a bona fide determination that an arrangement with Lifeline as described below is reasonably related to the purpose of the MSSP and authorized such arrangement. The collaboration is related to the purposes of the MSSP as it augments the ACO’s ability to:

• Promote evidence-based medicine and patient engagement;
• Meet the requirements for reporting quality and cost measures coordinating care;
• Establish clinical and administrative systems;
• Meet the clinical integration requirements of the Medicare Shared Savings Program;
• Evaluate the health needs of the ACO’s aligned population;
• Communicate clinical knowledge and evidence based medicine to Medicare beneficiaries; and
• Develop standards for beneficiary access and communication, including beneficiary access to medical records.

 

REQUIRED PUBLIC DISCLOSURE FOR THE ACO PARTICIPATION WAIVER

The Accountable Care Coalition of Southeast Wisconsin, LLC (the “ACO”) participates in the Medicare Shared Savings Program (“MSSP”) under a contract with the Centers for Medicare & Medicaid Services (“CMS“). The Secretary of the Department of Health and Human Services has provided certain waivers of federal fraud and abuse laws in connection with the MSSP. On August 1, 2016, the Management Committee after previous discussions authorized, via unanimous written consent, an arrangement with Curant Health Georgia, LLC and Curant Health Florida, LLC (collectively “Curant”) under which Curant will provide a grant of funds to assist the ACO’s efforts with respect to the MSSP. Consistent with 42 CFR 425.106(b)(3), after discussing the proposed arrangement with Curant, the Management Committee made a bona fide determination that an arrangement with Curant as described below is reasonably related to the purpose of the MSSP and authorized such arrangement. The collaboration is related to the purposes of the MSSP as it augments the ACO’s ability to:

• Promote evidence-based medicine and patient engagement;
• Meet the requirements for reporting quality and cost measures coordinating care;
• Establish clinical and administrative systems;
• Meet the clinical integration requirements of the Medicare Shared Savings Program;
• Evaluate the health needs of the ACO’s aligned population;
• Communicate clinical knowledge and evidence based medicine to Medicare beneficiaries; and
• Develop standards for beneficiary access and communication, including beneficiary access to medical records.

 

REQUIRED PUBLIC DISCLOSURE FOR THE ACO PARTICIPATION WAIVER

The Accountable Care Coalition of Southeast Wisconsin, LLC (the “ACO”) participates in the Medicare Shared Savings Program (“MSSP”) under a contract with the Centers for Medicare & Medicaid Services (“CMS“). The Secretary of the Department of Health and Human Services has provided certain waivers of federal fraud and abuse laws in connection with the MSSP. On April 20, 2017, the Management Committee met at a duly called meeting to discuss an arrangement with Quest Diagnostics (collectively “Quest”) under which Quest will provide a grant of funds to assist the ACO’s efforts with respect to the MSSP. Consistent with 42 CFR 425.106(b)(3), after discussing the proposed arrangement with Quest, the Management Committee made a bona fide determination that an arrangement with Quest as described below is reasonably related to the purpose of the MSSP and authorized such arrangement. The collaboration is related to the purposes of the MSSP as it augments the ACO’s ability to:

• Promote evidence-based medicine and patient engagement;
• Meet the requirements for reporting quality and cost measures coordinating care;
• Establish clinical and administrative systems;
• Meet the clinical integration requirements of the Medicare Shared Savings Program;
• Evaluate the health needs of the ACO’s aligned population;
• Communicate clinical knowledge and evidence based medicine to Medicare beneficiaries; and
• Develop standards for beneficiary access and communication, including beneficiary access to medical records.

 

A1083_PubDiscv27_0817_IA Approved 8/21/2017