Attention Medicare Beneficiaries:
If you received a letter in the mail from CoxHealth Accountable Care with a Buffalo Grove, Ill., return address, please do not disregard this letter. This letter contains important information about benefits you may receive. Please note that both CoxHealth and the mailing vendor comply with all federal HIPAA laws and your information will be kept private.
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.
Participating & Preferred Providers
ACO Participants & Preferred Provider Joint Ventures
CoxHealth is currently reviewing joint ventures with Next Generation Participants and Preferred Providers. As of 1/31/2018, there are no joint ventures.
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, Charmian, CoxHealth Joint Operations Committee |
| Bryan Finke, 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 | Jerry Jared, CoxHealth |
| Norm Mechlin, MD, CoxHealth | Piper Schulte, CoxHealth |
| Louis Krenn, MD, CoxHealth | Jake McWay, CoxHealth |
| James Ceaser, MD, CoxHealth | David Raney, CoxHealth |
| Max Buetow, CoxHealth | Robert Ferguson, CoxHealth |
Shared Savings & Losses
The ACO’s governing board will determine a methodology for the sharing of savings if and when any gains are achieved. CoxHealth Accountable Care has not received any Shared Savings payments to date. If we are able to receive any financial gains from this ACO initiative in the future, these gains would be used to cover the costs that we have already incurred and to support ongoing healthcare delivery.
| 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) | TBD |
| Aggregate Amount of Shared Savings/Losses Performance Year 2 (2019) | TBD |
| Aggregate Amount of Shared Savings/Losses Performance Year 3 (2020) | TBD |
| How Shared Savings are Distributed | |
|---|---|
| How Shared Savings are Distributed Shared Savings distributed to Next Generation Participants and Preferred Providers: | |
| How Shared Savings are Distributed Performance Year 1 (2018) | TBD |
| How Shared Savings are Distributed Performance Year 2 (2019) | TBD |
| How Shared Savings are Distributed Performance Year 3 (2020) | TBD |
Quality Performance Results
| Measure | Description | 2108 Results |
|---|---|---|
| Measure ACO-1 | Description CAHPS: Getting Timely Care, Appointments, and Information | 2108 Results TBD |
| Measure ACO-2 | Description CAHPS: How Well Your Providers Communicate | 2108 Results TBD |
| Measure ACO-3 | Description CAHPS: Patients’ Rating of Provider | 2108 Results TBD |
| Measure ACO-4 | Description CAHPS: Access to Specialists | 2108 Results TBD |
| Measure ACO-5 | Description CAHPS: Health Promotion and Education | 2108 Results TBD |
| Measure ACO-6 | Description CAHPS: Shared Decision Making | 2108 Results TBD |
| Measure ACO-7 | Description CAHPS: Health Status/Functional Status | 2108 Results TBD |
| Measure ACO-34 | Description CAHPS: Stewardship of Patient Resources | 2108 Results TBD |
| Measure ACO-8 | Description Risk-Standardized, All Condition Readmission | 2108 Results TBD |
| Measure ACO-35 | Description Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) | 2108 Results TBD |
| Measure ACO-36 | Description All-Cause Unplanned Admissions for Patients with Diabetes | 2108 Results TBD |
| Measure ACO-37 | Description All-Cause Unplanned Admissions for Patients with Heart Failure | 2108 Results TBD |
| Measure ACO-38 | Description Chronic Conditions | 2108 Results TBD |
| Measure ACO-43 | Description Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91) | 2108 Results TBD |
| Measure ACO-12 | Description Medication Reconciliation Post-Discharge | 2108 Results TBD |
| Measure ACO-13 | Description Falls: Screening for Future Fall Risk | 2108 Results TBD |
| Measure ACO-44 | Description Use of Imaging Studies for Low Back Pain | 2108 Results TBD |
| Measure ACO-14 | Description Preventive Care and Screening: Influenza Immunization | 2108 Results TBD |
| Measure ACO-15 | Description Pneumonia Vaccination Status for Older Adults | 2108 Results TBD |
| Measure ACO-16 | Description Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up | 2108 Results TBD |
| Measure ACO-17 | Description Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 2108 Results TBD |
| Measure ACO-18 | Description Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan | 2108 Results TBD |
| Measure ACO-19 | Description Colorectal Cancer Screening | 2108 Results TBD |
| Measure ACO-20 | Description Breast Cancer Screening | 2108 Results TBD |
| Measure ACO-42 | Description Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | 2108 Results TBD |
| Measure ACO-40 | Description Depression Remission at Twelve Months | 2108 Results TBD |
| Measure Diabetes Composite ACO-27 and- 41 | Description ACO - 27: Hemoglobin A1c Poor Control ACO - 41: Diabetes—Eye Exam | 2108 Results TBD |
| Measure ACO-28 | Description Hypertension (HTN): Controlling High Blood Pressure | 2108 Results TBD |
| Measure ACO-30 | Description Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic | 2108 Results TBD |