What is the CoxHealth Next Generation Accountable Care Organization?
A Next Generation Accountable Care Organization (ACO) is a type of ACO model implemented through the Centers for Medicare and Medicaid Services’s (CMS's) Innovation Center. ACOs are groups of doctors, hospitals, and other health care providers that come together to provide coordinated, high quality care to their Medicare Fee-for-Service beneficiaries. Coordinated care helps ensure beneficiaries, especially the chronically ill or those who are hospitalized, get the right care at the right time, and avoid unneeded duplication of services such as lab tests and x-rays. The Next Generation Model offers different methodologies and financial arrangements with higher levels of risk and reward than current Medicare ACO initiatives. Please visit www.medicare.gov/acos.html or call 1-800-MEDICARE (1-800-633-4227 (TTY users should call 1-877-486-2048)) for questions or additional information about Next Generation Accountable Care Organizations.
ACO Participants & Preferred Provider Joint Ventures
There are no joint ventures between or among the ACO and its Participants and/or Preferred Providers.
Key Clinical & Administrative Leadership
| David Raney, VP CoxHealth Network and Business Development |
| Tracy Mitchell, MSHS, RN, CPHQ System Administrative Director, Population Health |
| Timothy Jones, MD, President Cox Medical Group |
| Julia Flax, MD, Medical Director CoxHealth Accountable Care |
ACO Governing Body
- Bryan Finke, MD, CoxHealth
- Tim Jones, DO, CoxHealth
- Julia Flax, MD, CoxHealth
- Shawn Usery, MD, CoxHealth
- Frank Romero, MD, CoxHealth
- Norm Mechlin, MD, CoxHealth
- Piper Schulte, Springfield Neurological Institute, LLC
- Jake McWay, CoxHealth
- David Raney, CoxHealth
- Max Buetow, CoxHealth
- Robert Ferguson, CoxHealth
- Jerry Jared, Community Member
Shared Savings & Losses
- The proportion of shared savings invested in infrastructure, redesigned care processes and other resources necessary to improve outcomes and reduce Medicare costs for beneficiaries
- The proportion of shared savings to be invested in infrastructure depends on the amount of shared savings received. Currently, the distribution policy covers operating expenses for the ACO including participant incentives for engagement and coordination of care before any shared savings are distributed to providers.
- The proportion of shared savings distributed to Next Generation Participants and Preferred Providers
- After covering the costs noted above, any remaining shared savings are split between CoxHealth Accountable Care and Participating Providers at a rate of 60% and 40%, respectively. Preferred Providers do not share in savings or loss associated with the Next Generation ACO.
| Aggregate Amount of Shared Savings/Losses | |
|---|---|
| Aggregate Amount of Shared Savings/Losses Shared savings invested in infrastructure, redesigned care processes, and other resources necessary to improve outcomes and reduce Medicare costs of beneficiaries: | |
| Aggregate Amount of Shared Savings/Losses Performance Year 1 (2018) | $2,161,053 |
| Aggregate Amount of Shared Savings/Losses Performance Year 2 (2019) | TBD |
| Aggregate Amount of Shared Savings/Losses Performance Year 3 (2020) | TBD |
Quality Performance Results
| Measure | Description | 2018 Results |
|---|---|---|
| Measure ACO-1 | Description CAHPS: Getting Timely Care, Appointments, and Information | 2018 Results 86.41 |
| Measure ACO-2 | Description CAHPS: How Well Your Providers Communicate | 2018 Results 91.83 |
| Measure ACO-3 | Description CAHPS: Patients’ Rating of Provider | 2018 Results 91.20 |
| Measure ACO-4 | Description CAHPS: Access to Specialists | 2018 Results 78.05 |
| Measure ACO-5 | Description CAHPS: Health Promotion and Education | 2018 Results 61.46 |
| Measure ACO-6 | Description CAHPS: Shared Decision Making | 2018 Results 68.53 |
| Measure ACO-7 | Description CAHPS: Health Status/Functional Status | 2018 Results 76.23 |
| Measure ACO-34 | Description CAHPS: Stewardship of Patient Resources | 2018 Results 23.97 |
| Measure ACO-8 | Description Risk-Standardized, All Condition Readmission | 2018 Results 15.37 |
| Measure ACO-35 | Description Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) | 2018 Results 19.77 |
| Measure ACO-36 | Description All-Cause Unplanned Admissions for Patients with Diabetes | 2018 Results 36.29 |
| Measure ACO-37 | Description All-Cause Unplanned Admissions for Patients with Heart Failure | 2018 Results 77.68 |
| Measure ACO-38 | Description Chronic Conditions | 2018 Results 58.29 |
| Measure ACO-43 | Description Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91) | 2018 Results 1.95 |
| Measure ACO-12 | Description Medication Reconciliation Post-Discharge | 2018 Results 84.01 |
| Measure ACO-13 | Description Falls: Screening for Future Fall Risk | 2018 Results 92.03 |
| Measure ACO-44 | Description Use of Imaging Studies for Low Back Pain | 2018 Results 61.11 |
| Measure ACO-14 | Description Preventive Care and Screening: Influenza Immunization | 2018 Results 63.70 |
| Measure ACO-15 | Description Pneumonia Vaccination Status for Older Adults | 2018 Results 90.80 |
| Measure ACO-16 | Description Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up | 2018 Results 61.47 |
| Measure ACO-17 | Description Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 2018 Results 53.85 |
| Measure ACO-18 | Description Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan | 2018 Results 82.07 |
| Measure ACO-19 | Description Colorectal Cancer Screening | 2018 Results 72.40 |
| Measure ACO-20 | Description Breast Cancer Screening | 2018 Results 71.54 |
| Measure ACO-42 | Description Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | 2018 Results 75.71 |
| Measure ACO-40 | Description Depression Remission at Twelve Months | 2018 Results 0 |
| Measure Diabetes Composite ACO-27 and- 41 | Description ACO-27: Hemoglobin A1c Poor Control ACO-41: Diabetes—Eye Exam | 2018 Results ACO-27: 12.40 ACO-41: 49.60 |
| Measure ACO-28 | Description Hypertension (HTN): Controlling High Blood Pressure | 2018 Results 70.80 |
| Measure ACO-30 | Description Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic | 2018 Results 93.15 |
ACO Voluntary Termination Notice
Effective 12/31/2020, CoxHealth Accountable Care will be voluntarily terminating participation in the Next Generation ACO (NGACO) Model. There are no changes to benefits for beneficiaries.
Beneficiaries:
- Can still go to any doctor, hospital or other provider that accepts Medicare. Nobody can restrict which providers they see.
- Are still in Original Medicare.
- Are still entitled to all the same Medicare services, benefits and protections.
- Actively working with a Nurse Care Manager from Population Health Services will continue to receive the same level of committed support.
If there are any questions, we ask that you please contact our ACO inbox at CoxHealthAccountableCare@CoxHealth.com.