Shared savings program
ACO name and location
ProHealth Solutions, LLC
N17W24100 Riverwood Drive
Waukesha, WI 53188
ACO primary contact
Peter Bacon
262-696-0475
peter.bacon@phci.org
Organizational information
ACO participants:
|
ACO participant name
|
ACO participant in joint venture
|
|
Anex, SC
|
N
|
|
Anthony Hoang, MD, SC
|
N
|
|
Apogee Medical Group Waukesha, SC
|
N
|
| Central Otologic, LTD |
N
|
|
CJ Hussussian, MD, SC
|
N
|
|
Doenier Family Medicine, SC
|
N
|
|
Emergency Medical Associates, LLP
|
N
|
|
Foot and Ankle Associates of WI, LTD
|
N
|
|
Gastroenterology Specialists, SC
|
N
|
|
Infectious Disease Specialists of SE WI, SC
|
N
|
|
Jane Neumann
|
N
|
|
Lake Country Emergency Physicians
|
N
|
|
Lake Country Pediatrics, SC
|
N
|
|
Lake Country Plastic and Hand Surgery, SC
|
N
|
|
Louis Noto, MD, SC
|
N
|
|
Maple Medical, SC
|
N
|
|
Mary M Milbrath, MD, SC
|
N
|
|
Medical Eye Associates, SC
|
N
|
|
Milwaukee GI Specialists, SC
|
N
|
|
Moreland Ear Nose & Throat Group, LTD
|
N
|
|
Moreland OB-GYN Associates, SC
|
N
|
|
Nephrology Associates, SC
|
N
|
|
Nezih Z. Hasanoglu, DO, SC
|
N
|
|
Orthopaedic Associates of Wisconsin, SC
|
N
|
|
Paul B. Doenier, MD, SC
|
N
|
|
ProHealth Medical Group, Inc.
|
N
|
|
Radiology Waukesha, SC
|
N
|
|
Richard Neils
|
N
|
|
Thomas G Korkos, MD, SC
|
N
|
|
Timothy G McAvoy, MD, SC
|
N
|
|
Urology Associates, LTD, SC
|
N
|
|
Waukesha Surgical Specialists, SC
|
N
|
|
West Suburban Ctr For Arthritis
|
N
|
|
Womens Health Care, SC
|
N
|
ACO governing body:
| Member first name |
Member last name
|
Member title or position
|
Member's voting power (expressed as a percentage) |
Membership type
|
ACO participant legal business name, if applicable
|
|
Chris
|
Davies |
Chairperson
|
8.333%
|
ACO participant representative
|
Waukesha Surgical Specialists, SC
|
|
Vicki
|
Dallmann-Papke
|
Vice chairperson
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Susan
|
Edwards
|
President
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Christopher
|
Kilian
|
Vice president
|
8.333%
|
ACO participant representative
|
Orthopaedic Associates of Wisconsin, SC
|
|
Allison
|
Nelson
|
Secretary
|
8.333%
|
ACO participant representative
|
Moreland OB-GYN Associates, SC
|
|
Peter
|
Bacon
|
Board member
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Mary
|
Baer
|
Medicare beneficiary representative and consumer advocate
|
0%
|
Medicare beneficiary representative
|
N/A
|
|
Matt
|
Biebel
|
Board member
|
8.333%
|
Other
|
N/A
|
|
Arthur
|
Coffey
|
Board member
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Andy
|
Gutierrez
|
Treasurer
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Ken
|
Price
|
Board member
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Brad
|
Treichel
|
Board member
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Tim
|
Westlake
|
Board member
|
8.333%
|
ACO participant representative
|
Lake Country Emergency Physicians
|
Key ACO clinical and administrative leadership:
ACO executive: Peter Bacon
Medical director: Arthur Coffey
Compliance officer: Lynn Wojnowski
Quality assurance and improvement officer: Vicki Dallmann-Papke
Associated committees and committee leadership:
|
Committee name
|
Committee leader name and position
|
|
ProHealth Solutions Board of Managers
|
Chris Davies, chairperson
|
|
ProHealth Solutions Credentialing and Peer Review Committee
|
Matt Biebel, chairperson
|
|
ProHealth Solutions Finance
|
Andy Gutierrez, chairperson
|
Types of ACO participants, or combinations of participants, that formed the ACO:
ACO professionals in group practice arrangements
Shared savings and losses:
Second agreement period
Performance year 2023: $196,511.66
Shared savings distribution:
Second agreement period
Performance year 2023: $196,511.66
Proportion invested in infrastructure: 40%
Proportion invested in redesigned care processes and resources: N/A
Proportion of distribution to ACO participants: 60%
Quality performance results:
2023 quality performance results:
| Measure number |
Measure name |
Collection type |
Rate |
ACO mean |
| Quality 001 |
Diabetes: Hemoglobin A1c (HBA1c) poor control |
CMS web interface |
5.06 |
9.84 |
| Quality 134 |
Preventive care and screening: Depression and follow-up plan |
CMS web interface |
84.19 |
80.97 |
|
Quality 236
|
Controlling high blood pressure |
CMS web interface |
83.87 |
77.80 |
|
Quality 318
|
Falls: Screening for future fall risk |
CMS web interface |
89.25 |
89.42 |
|
Quality 110
|
Preventive care and screening: Influenza immunization |
CMS web interface |
70.31 |
70.76 |
|
Quality 226
|
Preventive care and screening: Tobacco use screening and cessation intervention |
CMS web interface |
77.27 |
79.29 |
|
Quality 113
|
Colorectal cancer screening |
CMS web interface |
87.30 |
77.14 |
|
Quality 112
|
Breast cancer screening |
CMS web interface |
90.20 |
80.36 |
|
Quality 438
|
Statin therapy for the prevention and treatment of cardiovascular disease |
CMS web interface |
90.08 |
87.05 |
|
Quality 370
|
Depression remission at twelve months |
CMS web interface |
4.11 |
16.58
|
|
Quality 479
|
Hospital-wide, 30-day, all-cause unplanned readmission (HWR) rate for MIPS groups |
Administrative claims |
0.1573 |
0.1553 |
|
Quality 484
|
Clinician and clinician group risk-standardized hospital admission rates for patients with multiple chronic conditions |
Administrative claims |
... |
35.39 |
|
CAHPS 1
|
Getting timely care, appointments and information |
CAHPS for MIPS |
82.51 |
83.68 |
| CAHPS 2 |
How well providers communicate
|
CAHPS for MIPS |
94.48 |
93.69 |
|
CAHPS 3
|
Patient's rating of provider |
CAHPS for MIPS |
92.98 |
92.14 |
|
CAHPS 4
|
Access to specialists |
CAHPS for MIPS |
74.22 |
75.97 |
|
CAHPS 5
|
Health promotion and education |
CAHPS for MIPS |
68.41 |
63.93 |
|
CAHPS 6
|
Sharing decision making |
CAHPS for MIPS |
56.55 |
61.60 |
|
CAHPS 7
|
Health status and functional status |
CAHPS for MIPS |
78.45 |
74.12 |
|
CAHPS 8
|
Care coordination |
CAHPS for MIPS |
87.28 |
85.77 |
|
CAHPS 9
|
Courteous and helpful office staff |
CAHPS for MIPS |
93.60 |
92.31 |
|
CAHPS 11
|
Stewardship of patient resources |
CAHPS for MIPS |
26.42 |
26.69 |
|
|
|
|
|
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
