Accountable Care Organization

ORGANIZATIONAL INFORMATION about this ACO

ACO NAME AND LOCATION

Michiana Accountable Care Organization, LLC / DBA South Bend Clinic Accountable Care
211 North Eddy St.
South Bend, Indiana 46617

ACO PRIMARY CONTACT

Primary Contact Name Kelly Macken-Marble
Primary Contact Phone Number 574-237-9201
Primary Contact Email Address kmarble@nullsouthbendclinic.com

ORGANIZATIONAL INFORMATION

ACO participants:

ACO Participants ACO Participant in Joint Venture (Enter Y or N)
South Bend Clinic N

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
Oppman, MD Robert President 12.5% ACO Participant representative Michiana Accountable Care Organization, LLC / DBA South Bend Clinic Accountable Care
Niespodziany, DPM Jeffrey Vice President 12.5% ACO Participant representative Michiana Accountable Care Organization, LLC / DBA South Bend Clinic Accountable Care
Isaacson, MD David Treasurer 12.5% ACO Participant representative Michiana Accountable Care Organization, LLC / DBA The South Bend Clinic Accountable Care
Casetti, MD Alfredo Secretary 12.5% ACO Participant representative Michiana Accountable Care Organization, LLC / DBA South Bend Clinic Accountable Care
Brier, MD Daniel Trustee 12.5% ACO Participant representative Michiana Accountable Care Organization, LLC / DBA South Bend Clinic Accountable Care
Crowell, MD Steven Trustee 12.5% ACO Participant representative Michiana Accountable Care Organization, LLC / DBA South Bend Clinic Accountable Care
Scott, MD Bradley Trustee 12.5% ACO Participant representative Michiana Accountable Care Organization, LLC / DBA South Bend Clinic Accountable Care
Wills Martyn Trustee 12.5% Medicare Beneficiary representative

 

Key ACO clinical and administrative leadership:

Kelly Macken-Marble ACO Executive
Nels Leininger Medical Director
Christine Saitz Compliance Officer
Nels Leininger Quality Assurance/Improvement Officer

 

Associated committees and committee leadership:

Committee Name Committee Leader Name and Position
Population Health Committee Robert Oppman, MD – Chair
Quality Improvement/Peer Review/Compliance Committee Brian Carter, MD – Chair
Finance Committee Alfredo Casetti, MD – Chair

 

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

  • ACO professionals in a group practice arrangement

 

SHARED SAVINGS AND LOSSES

Amount of Shared Savings/Losses

  • First Agreement Period
  • Performance Year 2016, $0
  • Performance Year 2015, $0
  • Performance Year 2014, $1,311,439

Shared Savings Distribution

  • First Agreement Period

Performance Year 2016

  • 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 2015

  • 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 2014

  • Proportion invested in infrastructure: 10%
  • Proportion invested in redesigned care processes/resources: 0%
  • Proportion of distribution to ACO participants: 90%

 

QUALITY PERFORMANCE RESULTS

2016 Quality Performance Results:

ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 80.62 80.51
ACO-2 CAHPS: How Well Your Providers Communicate 92.31 93.01
ACO-3 CAHPS: Patients’ Rating of Provider 92.17 92.25
ACO-4 CAHPS: Access to Specialists 86.18 83.49
ACO-5 CAHPS: Health Promotion and Education 58.64 60.32
ACO-6 CAHPS: Shared Decision Making 72.93 75.40
ACO-7 CAHPS: Health Status/Functional Status 73.39 72.30
ACO-34 CAHPS: Stewardship of Patient Resources 31.16 26.97
ACO-8 Risk Standardized, All Condition Readmission 13.92 14.70
ACO-35 Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM) 16.84 18.17
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes 44.14 53.20
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 65.55 75.23
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 52.07 59.81
ACO-9 Ambulatory Sensitive Condition Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5) 7.96 9.27
ACO-10 Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8) 11.85 14.53
ACO-11 Percent of PCPs who Successfully Meet Meaningful Use Requirements 100.00 82.72
ACO-39 Documentation of Current Medications in the Medical Record 92.45 87.54
ACO-13 Falls: Screening for Future Fall Risk 30.17 64.04
ACO-14 Preventive Care and Screening: Influenza Immunization 70.61 68.32
ACO-15 Pneumonia Vaccination Status for Older Adults 83.06 69.21
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up 44.78 74.45
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 86.29 90.98
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 20.41 53.63
ACO-19 Colorectal Cancer Screening 72.18 61.52
ACO-20 Breast Cancer Screening 79.44 67.61
ACO-21 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 63.81 76.79
ACO-42 Statin therapy for the Prevention and Treatment of Cardiovascular Disease 82.72 77.72
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 10.48 18.24
ACO-41 Diabetes: Eye Exam 60.48 44.94
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 67.34 70.69
ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 88.31 85.05
ACO-31 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 82.35 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%)

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 “Michiana Accountable Care Organization, LLC” or “South Bend Clinic Accountable Care” to view the quality performance results. This ACO can also be found by using the ACO ID A08611 in the public use files on data.cms.gov.

PAYMENT RULE WAIVERS

  • Yes, our ACO does use the SNF 3-Day Rule Waiver.

What is an ACO?

An Accountable Care Organization (ACO) is a group of physicians and other healthcare providers who agree to work together with Medicare to give you the best possible care. ACOs may take different approaches to giving you coordinated care. Some ACOs may have special nurses that help you set up appointments or make sure your medications are in order when you enter or leave a hospital. Other ACOs may help your doctors get you equipment for monitoring your medical conditions better at home, if you need it. Most ACOs use advanced systems that let them more carefully coordinate your care, and make sure your doctor has the most up-to-date information about your health.

The goal of the ACO is to support your doctor in caring for you by making sure they have the most up-to-date information about your health and your care. For you, this means your doctors communicate better with each other, and avoid having duplicate tests or answering the questions over and over. Working together, your doctors can do more to follow your health, make sure you get the best possible care, and may hire additional staff to meet your unique care needs, depending on what works best for you.

Doctors and other healthcare providers choose to participate in an ACO because they’re committed to providing you with a better care experience. They may also be rewarded for offering you better, more coordinated care. If your doctor chooses to participate in an ACO, you will be notified either in person or by letter.

An ACO isn’t the same as a Medicare Advantage Plan or Health Maintenance Organization (HMO).

You’re still in Original Medicare and your Medicare benefits, services, rights and protection won’t change. And you still have the right to use any doctor or hospital that accepts Medicare at any time, the same way you do now.

To contact MEDICARE 1-800-633-4227

TTY users 1-877-486-2048

To contact South Bend Clinic Accountable Care 1-574-204-6825

You can still choose any doctor

Your Medicare benefits won’t be limited because your doctor is part of
an ACO. You still have the right to choose any hospital or doctor that
accepts Medicare, at any time, even if that hospital or doctor isn’t a part
of an ACO. Your doctor may make recommendations, but it’s always your
choice on what doctors or hospitals you use.

An ACO is NOT a Health Maintenance Organization (HMO), managed care, or an insurance company

An ACO is a group of doctors, hospitals, and other health care providers
who communicate with you and with each other to make sure you get
the care you need when you’re sick and the support you need to get and
stay healthy. Unlike HMOs, managed care, and some insurance plans, an
ACO can’t tell you which health care providers to see or hospital to visit,
and can’t limit your Medicare benefits. Also, only people with Original
Medicare can be assigned to an ACO. You can’t be assigned to an ACO
if you have a Medicare Advantage Plan (like an HMO or a Preferred
Provider Organization).

How to know if your doctor participates in an ACO

Doctors or health care providers who choose to participate in
an ACO must display a poster that notifies you of your doctor’s
participation in an ACO. It also informs you of your option to decline
sharing your health care information by calling 1-800-MEDICARE
(1-800-633-4227). TTY users should call 1-877-486-2048.
If you aren’t sure if your doctor or health care provider is participating
in a Medicare ACO, ask him or her during your visit. For general
information about ACOs, call 1-800-MEDICARE.

What to expect if your doctor is in an ACO

When your health care providers participate in an ACO, you should
see better, more coordinated care over time. With an ACO, you’re the
center of care, and your satisfaction is one of the goals. Over time, you
may notice that:

  • You don’t have to fill out as many medical forms that ask for the
    same information.
  • The health care providers that you see all know what’s going on with
    your health because they communicate with each other.
  • You don’t need to repeat medical tests because your results are
    shared among your health care team.
  • The providers participating in the ACO will work with you to make
    sure their health care decisions reflect your preferences.

Know your rights if your doctor is an ACO

You’ll continue to have the same rights all people with Medicare get.
To help you to get the best-coordinated and highest quality care,
Medicare will share certain information about your medical care with
your doctor’s ACO, including medical conditions, prescriptions, and
visits to the doctor unless you have called 1-800-MEDICARE to tell
Medicare not to share your health care information with your doctor’s
ACO or other ACOs. This information is important to help the ACO
keep up with your medical needs and track how well the ACO is
doing to keep you healthy.

Also, you may get a follow-up survey to ask about your experiences as
a patient of a doctor who’s participating in an ACO. You’ll get a letter
to let you know the survey is genuine. The ACO will use your feedback
to help make sure you get high quality care.
ACOs are required to respect your privacy so you have the option
to tell us not to share your health care information. You must call
1-800-MEDICARE (1-800-633-4227) to tell Medicare not to share
information about your care with your doctor’s ACO or any other
ACO. TTY users should call 1-877-486-2048. Unless you take this step,
your medical information will be shared with your doctor’s ACO for
purposes of care coordination and quality improvement.
Your medical information will be protected

Your medical information will be protected

Federal law protects the privacy and security of your medical
information. The group of doctors, hospitals, and other health care
providers in the ACO working together on your behalf will be able to
read your medical records, along with other office staff authorized to
help coordinate your care. Each of your health care providers won’t
only know about the health issues that they’ve treated, they’ll have a
more complete picture of your health by sharing information with
your other health care providers.

Contact your doctor’s office for more information about how they
protect your medical information, or call 1-800-MEDICARE to learn
more about how Medicare protects your medical information.

Where you can find more information about ACOs:

For more information about ACOs:

  • Visit CMS.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/
  • Visit Medicare.gov/manage-your-health/coordinating-your-care/accountable-care-organizations.html.
  • Talk to your doctor.
  • Call 1-800-MEDICARE.