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)
- Greenwood Obstetrics & Gynecology Pa – N
- Carolinas Center for Advanced Management of Pain PA – N
- John Humeniuk – N
- Pathology Associates of Greenville – N
- Baptist Easley Hospital – N
- The Greenwood Endoscopy Center, Inc – N
- The Center for Advanced Eye Care – N
- Upstate Plastic Surgery – N
- Foothills Family Medicine of Westminster PA – N
- EASLEY HEAD & NECK SURGERY PA – N
- Foot Clinic of South Carolina LLC – N
- Greenwood Eye Clinic, P.A. – N
- The Surgery Center @ Self Memorial Hospital, Llc. – N
- Carolina Pulmonary & Sleep Disorder, LLC – N
- Carolina Pathology Associates, LLP – N
- Greenville Health System – N
- Greenville Kidney Care LLC – N
- Riley Family Practice Associates, Pa – N
- Doctor for Life, LLC – N
- Allergic Disease & Asthma Center Pa – N
- Montgomery & Riddle Eyecare, P.A. – N
- Highlands Center for Women, P.A. – N
- Digestive Disease Group PA – N
- Newberry Family Health Center, PA – N
- Greenwood Urological – N
- Jervey Eye Group, PA – N
- UPSTATE PODIATRY GROUP PA – N
- Greenwood Ear Nose And Throat Assoc Pa – N
- Regenesis Organization Community Health – N
- Upstate Medical Associates PA – N
- Abbeville County Memorial Hospital – N
- Carolina Integrative Medicine, PA – N
- Palmetto Bone & Joint, PA – N
- Oakview Medical Associates LLC – N
- Parkside Pediatrics, P.A. – N
- Gastroenterology Associates, PA – N
- Greenville Dermatology LLC – N
- Palmetto Internal Medicine & Primary Care – N
- Oconee Surgery, PA – N
- Jervey Eye Center, LLC – N
- Brio Medical, PC – N
- Carolina Nephrology PA – N
- HILLCREST EYECARE, PA – N
- Greenwood Center for Gynecology, LLC – N
- Newberry Internal Medicine LLC – N
- Turning Point Women’s Center, PA – N
- Carolina Surgery – N
- HHD Enterprises LLC – N
- Self Regional Healthcare – N
- Primary Care Associates, PC – N
- APEX ALLERGY & IMMUNOLOGY, P.C. – N
- The Surgery And Laser Center At Professional Park – N
- Golden Corner Family Prac – N
- Self Medical Group – N
- Piedmont Retina Assoc Pa – N
- Partners In Health – Rural Health – N
- Piedmont Neurology – N
- Greenville Endoscopy Center – N
- PIEDMONT PULMONARY MEDICINE LLC – N
- Dermatology Associates, P.A. – N
- Palmetto Surgery Associates, PA – N
- Zachary Seymour – N
- Bruce A Marshall MD PA – N
- Pathology Consultants, Inc. – N
- John Humeniuk – N
- Pelham Family Practice, LLC – N
- Newberry County Memorial Hospital – N
- GHS Partners in Health, Inc. – N
- ANDERSON HEART P C – N
- New Haven Medical Services, PA – N
- Upper Savannah Radiological Associates, PA – N
- Carolina Lung & Sleep Center Llc – N
- Clemson Eye, PA – N
- Oconee Kidney Center LLC – N
- Anesthesiology of Greenwood PA – N
- Upstate Affiliate Organization – N
ACO Governing Body
Board of Managers
Member | Member’s Voting Power –Expressed as a percentage or number | Membership Type | ACO Participant Legal Business Name/DBA, if Applicable | ||
Last Name | First Name | Title/Position | |||
Chang | Cathy | Voting Member | 1 | ACO Participant Representative | Prisma Health-Upstate |
Darby | William | Voting Member | 1 | ACO Participant Representative | Children’s Medical Center |
Goldsmith | Drew | Voting Member | 1 | ACO Participant Representative | Prisma Health-Upstate |
Green | Vincent | Voting Member | 1 | ACO Participant Representative | Prisma Health-Upstate |
Kome | Hunter | Voting Member | 1 | ACO Participant Representative | Prisma Health – Upstate |
Oxendine | Christopher | Voting Member | 1 | ACO Participant Representative | Abbeville Area Medical Center |
Paysinger | Alan | Chair | 1 | ACO Participant Representative | Newberry Internal Medicine |
Peden | ST | Voting Member | 1 | Medicare Beneficiary Representative | Community Stakeholder |
Shuler | Conrad | Voting Member | 1 | ACO Participant Representative | Oconee Medical Center |
Shusterman | Blake | Voting Member | 1 | ACO Participant Representative | Carolina Nephrology |
Springhart | Patrick | Secretary | 1 | ACO Participant Representative | Prisma Health-Upstate |
Wiper | Donald | Vice Chair | 1 | ACO Participant Representative | Prisma Health-Upstate |
Key ACO Clinical and Administrative Leadership
- William Gerard, MD – ACO Executive
- Peter Tilkemeier, MD – Medical Director
- Scott Pietras, JD – Compliance Officer
- Scott Hultstrand – Quality Assurance/Improvement Officer
Associated committees and committee leadership
- Compliance Committee: Scott Pietras, JD, Chair
- Finance Committee: Daniel Grover, MD, Chair
- Network Participation Committee: Pat Crawford, MD Chair
- Primary Care Committee: Rebecca Smith, 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
- Second Agreement Period
- Performance Year 2019, $0
- Performance Year 2018, $0
- First Agreement Period
- Performance Year 2017, $7,863,011
- Performance Year 2016, $9,657,590
- Performance Year 2015, $8,474,728
Shared Savings Distribution
- Second Agreement Period
- Performance Year 2019
- 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 2018
- Proportion invested in infrastructure: N/A
- Proportion invested in redesigned care processes/resources: N/A
- Proportion of distribution to ACO participants: N/A
- 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%
- Performance Year 2017
- Performance Year 2019
Types of ACO participants, or combinations of participants, that formed the ACO
2018 Quality Performance Results
ACO# | Measure Name | Rate | ACO Mean |
ACO-1 | CAHPS: Getting Timely Care, Appointments, and Information | 84.63 | 85.86 |
ACO-2 | CAHPS: How Well Your Providers Communicate | 94.25 | 94.11 |
ACO-3 | CAHPS: Patients’ Rating of Provider | 93.64 | 92.69 |
ACO-4 | CAHPS: Access to Specialists | 76.72 | 81.54 |
ACO-5 | CAHPS: Health Promotion and Education | 61.42 | 60.44 |
ACO-6 | CAHPS: Shared Decision Making | 66.67 | 62.78 |
ACO-7 | CAHPS: Health Status/Functional Status | 73.51 | 73.79 |
ACO-34 | CAHPS: Stewardship of Patient Resources | 27.47 | 26.17 |
ACO-45 | CAHPS: Courteous and Helpful Office Staff | 93.23 | 92.84 |
ACO-46 | CAHPS: Care Coordination | 87.61 | 86.89 |
ACO-8 | Risk Standardized, All Condition Readmission | 13.93 | 14.86 |
ACO-38 | All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions | 52.78 | 58.15 |
ACO-43 | Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) | 1.67 | 1.87 |
ACO-13 | Falls: Screening for Future Fall Risk | 97.05 | 84.04 |
ACO-14 | Preventive Care and Screening: Influenza Immunization | 83.33 | 74.77 |
ACO-17 | Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 92.86 | 78.04 |
ACO-18 | Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan | 88.80 | 70.40 |
ACO-19 | Colorectal Cancer Screening | 80.72 | 70.76 |
ACO-20 | Breast Cancer Screening | 78.29 | 73.84 |
ACO-42 | Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | 77.73 | 82.17 |
ACO-40 | Depression Remission at Twelve Months | 2.60 | 13.58 |
ACO-27 | Diabetes Mellitus: Hemoglobin A1c Poor Control | 9.68 | 13.88 |
ACO-28 | Hypertension (HTN): Controlling High Blood Pressure | 72.79 | 75.04 |
For Previous Years’ Financial and Quality Performance Results, please visit data.cms.gov.
Payment Rule Waivers
- Skilled Nursing Facility (SNF) 3-day Rule Waiver:
- Yes, our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR 425.612.
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