Public Reporting

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%

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