Public Reporting

ACO Name and Location

Prisma Health Upstate Network, LLC
300 East McBee Ave.
Suite 402, 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)

ACO ParticipantsACO Participant in Joint Venture
John HumeniukN
Carolina SurgeryN
Greenville Kidney Care LLCN
Oconee Kidney Center LLCN
Greenwood UrologicalN
Upstate Plastic SurgeryN
Newberry County Memorial HospitalN
Dermatology Associates, P.A.N
Greenwood Ear Nose And Throat Assoc PaN
Upper Savannah Radiological Associates, PAN
Gastroenterology Associates, PAN
Allergic Disease & Asthma Center PaN
Bruce A Marshall MD PAN
Newberry Internal Medicine LLCN
Piedmont Retina Assoc PaN
Oconee Surgery, PAN
Digestive Disease Group PAN
The Greenwood Endoscopy Center, IncN
Palmetto Bone & Joint, PAN
Anesthesiology of Greenwood PAN
Greenville Endoscopy CenterN
Carolina Nephrology PAN
Jervey Eye Group, PAN
Foothills Family Medicine of Westminster PAN
GHS Partners in Health, Inc.N
Primary Care Associates, PCN
Carolinas Center for Advanced Management of Pain PAN
Golden Corner Family PracN
Greenville Dermatology LLCN
Pathology Associates of GreenvilleN
Pathology Consultants, Inc.N
Abbeville County Memorial HospitalN
Greenville Health SystemN
Clemson Eye, PAN
Partners In Health – Rural HealthN
Jervey Eye Center, LLCN
Newberry Family Health Center, PAN
The Center for Advanced Eye CareN
Pelham Family Practice, LLCN
HHD Enterprises LLCN
Oakview Medical Associates LLCN
Doctor for Life, LLCN
Upstate Affiliate OrganizationN
PIEDMONT PULMONARY MEDICINE LLCN
HILLCREST EYECARE, PAN
UPSTATE PODIATRY GROUP PAN
EASLEY HEAD & NECK SURGERY PAN
ANDERSON HEART P CN
APEX ALLERGY & IMMUNOLOGY, P.C.N
GREENVILLE PROAXIS THERAPY LLCN
PS121 MANAGEMENT PAN
ACCELERATED PHYSICAL THERAPYN
CAROLINA FAMILY MEDICINE OF LAURENS COUNTY PAN
GREENWOOD GENETICS CENTER, INC.N
SHRINERS HOSPITALS FOR CHILDRENN
BELLA VISION LLCN
Foot Clinic of South Carolina LLCN
New Haven Medical Services, PAN
The Surgery And Laser Center At Professional ParkN
John HumeniukY
Zachary SeymourN
Upstate Medical Associates PAN
Carolina Pulmonary & Sleep Disorder, LLCN
Carolina Lung & Sleep Center LlcN
Palmetto Internal Medicine & Primary CareN
Highlands Center for Women, P.A.N
Baptist Easley HospitalN

ACO Governing Body

Board of Managers

Member

Last Name

Member

First Name

Member

Title/Position

Member’s Voting Power (Expressed as a percentage or number)Membership TypeACO Participant Legal Business Name and D/B/A, if applicable
ChangCathyVoting Member1ACO Participant RepresentativeUpstate Affiliate Organization
DarbyWilliamVoting Member1ACO Participant RepresentativeChildren’s Medical Center
GoldsmithDrewVoting Member1ACO Participant RepresentativeUpstate Affiliate Organization
GreenVincentVoting Member1ACO Participant RepresentativeUpstate Affiliate Organization
KomeHunterVoting Member1ACO Participant RepresentativeUpstate Affiliate Organization
EMPTYEMPTYVoting Member1ACO Participant RepresentativeEMPTY
PaysingerAlanChair1ACO Participant RepresentativeNewberry Internal Medicine, LLC
PedenSTVoting Member1Medicare Beneficiary RepresentativeCommunity Stakeholder
ShulerConradVoting Member1ACO Participant RepresentativeUpstate Affiliate Organization
ShustermanBlakeVoting Member1ACO Participant RepresentativeCarolina Nephrology, PA
SpringhartPatrickSecretary1ACO Participant RepresentativeUpstate Affiliate Organization
WiperDonaldVice Chair1ACO Participant RepresentativeUpstate Affiliate Organization

Key ACO Clinical and Administrative Leadership

ACO Executive: Kim Roberts

Medical Director: William Gerard, MD

Compliance Officer: Scott Pietras, JD

Quality Assurance/Improvement Officer: Molly Nichols

Associated committees and committee leadership

Committee Name

Committee Leader Name and Position

Compliance Committee

Scott Pietras, JD, Chair

Finance CommitteeVince Green, MD, Chair

Network Participation Committee

Laurie Theriot Roley, 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 2020, $0
    • 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 2020
      • 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 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%

Quality Performance Results

2020 Quality Performance Results

ACO Quality Measure Number

Measure NameRateACO Mean
ACO-43Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91))0.880.95
ACO-13Falls: Screening for Future Fall Risk97.9284.97
ACO-14Preventive Care and Screening: Influenza Immunization85.1476.03
ACO-17Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention94.1281.67
ACO-18Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan87.5071.46
ACO-19Colorectal Cancer Screening80.9072.59
ACO-20Breast Cancer Screening81.0474.05
ACO-42Statin Therapy for the Prevention and Treatment of Cardiovascular Disease73.2583.37
ACO-27Diabetes Mellitus: Hemoglobin A1c Poor Control11.6514.70
ACO-28Hypertension (HTN): Controlling High Blood Pressure64.96

72.87

“Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size. The Centers for Medicare & Medicaid Services (CMS) also waived the requirement for ACOs to field a CAHPS for ACOs survey for PY 2020 through the Physician Fee Schedule Final Rule for Calendar Year 2021. Additionally, CMS reverted ACO-8 Risk-Standardized, All Condition Readmission and ACO-38 Risk-Standardized Acute Admission Rates for Patients with Multiple Chronic Conditions to pay-for-reporting, given the impact of the coronavirus disease 2019 (COVID-19) public health emergency (PHE) on these measures.”

 

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.

 

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.

Contact Center:

  • Parties to the arrangement: ACO Participants
  • Date of arrangement: 09/01/2021
  • Items, services, goods, or facility provided: Provide affiliated ACO participants services to facilitate quality improvement through enhanced network clinical integration and collaboration, which, in turn, will maximize opportunities for care coordination, adherence to standardized care protocols, promote adoption of evidence-based medicine guidelines, and improvements in quality. Examples include central scheduling, after hours physician call center, and nurse triage.
  • Date and nature of any amendments to the arrangement, if applicable: N/A

 

Education and Training:

  • Parties to the arrangement: ACO Participants
  • Date of arrangement: 09/01/2021
  • Items, services, goods, or facility provided: Provide affiliated ACO participants various education and training opportunities to align and support clinicians and staff in providing quality care across MSSP beneficiaries. Examples include office & billing staff education, provider CME, education using SIM center, CPR, BLS/ALS, etc. training, annual safety/compliance training
  • Date and nature of any amendments to the arrangement, if applicable: N/A

 

Technical Solutions/IT Support:

  • Parties to the arrangement: ACO Participants
  • Date of arrangement: 09/01/2021
  • Items, services, goods, or facility provided: Provide affiliated ACO participants with Information Technology solutions to facilitate quality improvement through enhanced network clinical integration and collaboration, which, in turn, will maximize opportunities for care coordination, adherence to care protocols, acceleration of care redesign processes, avoidance of potential gaps or delays in care, promotion of efficient service delivery for MSSP patients and other Network patients, and improvements in quality measures. Examples include EHR Solution (Epic Community Connect), TelemedIQ, Kyruuus Online Scheduling, Telemedicine/Telehealth Solution, Referral Solution, Gaps in Care Patient Text Messaging, and Patient Satisfaction/Experience Tool.
  • Date and nature of any amendments to the arrangement, if applicable: N/A

 

Physician Services Recruiting Arrangement:

  • Parties to the arrangement: ACO Participants
  • Date of arrangement: 09/01/2021
  • Items, services, goods, or facility provided: Provide affiliated ACO participants support related to identification, selection and retention of quality physicians to meet the need of the community. Recruiting services may include: the ongoing evaluation of physician needs of the community; identification of prospective physician candidates; interview coordination, support and assistance; and assistance in contract negotiations and document development as requested.
  • Date and nature of any amendments to the arrangement, if applicable: N/A

 

Supply Chain Management Services:

  • Parties to the arrangement: ACO Participants
  • Date of arrangement: 09/01/2021
  • Items, services, goods, or facility provided: Provide affiliated ACO participants certain supply chain management services for and on behalf of the practice. Examples include a group purchasing organization (GPO) that, among other things, negotiates, directly and through third parties, vendor and distributor agreements on behalf of the practices.
  • Date and nature of any amendments to the arrangement, if applicable: N/A