ACO Public Reporting Information

ACO Name and Location

Seton Accountable Care Organization, Inc. (Seton ACO)
1345 Philomena, Suite 362
Austin, Texas 78723

ACO Primary Contact

Amy Miller
512-324-9999, Ext. 17362
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Organizational Information

ACO Participants

  • Austin Regional Clinic, P.A. (ARC)
    One of Central Texas’ largest multi-specialty health care groups, Austin Regional Clinic’s focus  is  on primary care—family practice, pediatrics and general internal medicine.  ARC emphasizes the importance of long-term doctor/patient relationships and the coordination of care.
  • Lone Star Circle of Care (LSCC)
    A nonprofit federal qualified health center, LSCC is committed to the pursuit of community-wide access to behaviorally enhanced, patient-centered health care that provides accountable care for all patients, focusing on the underserved.
  • Adult Inpatient Medical Services (AIMS)
    AIMS is a group of Internal Medicine physicians who are based at Seton Healthcare Family hospitals full-time. They provide 24-hour coverage in the hospital and do not have outpatient medical offices.  Referred  to as hospitalists, they treat only patients who have been admitted to a hospital and report a patient’s condition and progress back to their primary care physician.  The hospitalists arrange the patient’s total hospital care from admission to discharge.  After the patient leaves the hospital, their regular primary care doctor resumes their care.
  • Capital Medical Clinic, LLP
    Capital Medical Clinic is a private medical group practice of specialists in Internal Medicine located in Austin, Texas. Internists receive specialized training in the diagnosis and nonsurgical treatment of a broad spectrum of diseases. All physicians have been certified by the American Board of Internal Medicine.

No participants are involved in a joint venture between ACO professionals and hospitals.

ACO Governing Body

Key ACO Clinical and Administrative Leadership, Associated Committees and Committee Leadership

Seton ACO Governance and Leadership Structure Diagram

Identification of the types of ACO participants or combinations of participants that formed the ACO

  • ACO professionals in a group practice arrangement
  • Networks of individual practices of ACO professionals
  • Federally Qualified Health Center (FQHC)

Shared Savings and Losses

Amount of Shared Savings and Losses

  • Agreement period beginning 2014, Performance Year 2014: $5,178,082
  • Agreement period beginning 2014, Performance Year 2015: $0

Shared Savings Distribution

Agreement period beginning 2014, Performance Year 2014

  • Proportion invested in infrastructure: 30%
  • Invested in redesigned care processes/resources: 0%
  • Proportion of distribution to ACO Participants: 70%

Agreement period beginning 2014, Performance Year 2015

  • $0 for 2015 performance reporting period

Payment Rule Waivers

Our ACO does not utilize the SNF 3-Day Rule Waiver.

Quality Performance Results

Arrangements Subject to Waiver Protection

Federal law permits accountable care organizations such as Seton Accountable Care Organization (Seton ACO) to take advantage of a waiver of certain health care fraud and abuse laws in order to permit Seton ACO to more fully develop programs, initiatives and arrangements designed to manage, coordinate and promote accountability for the quality, patient safety, cost and overall care for patients.  In accordance with federal law, Seton ACO makes information about its arrangements for which waiver protection is sought publicly available.

Seton Accountable Care Organization, Inc. (Seton ACO) has entered into provider agreements with Austin Regional Clinic (ARC), Lone Star Circle of Care and Adult Inpatient Medical Services (AIMS) for the purpose of complying with MSSP obligations and requirements, as defined by 42 CFR 425.20, including quality assurance and improvement programs and adherence to evidenced-based clinical guidelines. In addition, Seton ACO has entered into an agreement with Covenant Management Systems/Austin ARIA for the provision of defined administrative and professional services for the MSSP program including data aggregation, patient outreach, nurse navigator services and advance care coordination services for high-risk patients.

As part of these agreements, Seton ACO has attested that:

  1. The ACO meets the requirements of 42 CFR 425.106 and 425.108 concerning its governance, leadership, and management.
  2. The ACO’s governing body has made and duly authorized a bona fide determination, consistent with the governing body members’ duty under 42 CFR 425.106(b)(3), that the arrangement is reasonably related to the purposes of the Medicare Shared Savings Program.
  3. Both the arrangement and its authorization by the governing body are documented.

Seton ACO also has entered into the following agreements:

  1. Seton Healthcare Family, Healthcare Collaborative and Central Texas OB/GYN Associates PLLC are parties to an arrangement of Seton Accountable Care Organization, Inc. (ACO) for which protection is sought under the Interim Final Waiver Rule issued in connection with the Medicare Shared Savings Program (MSSP) at 76 Fed. Reg. 67992 (Nov. 2, 2011), as extended as described at 79 Fed. Reg. 62356 (Oct. 17, 2014). This ACO-related arrangement involves the provision by Group of professional medical services in Williamson County, Texas, and physician coverage at Seton Medical Center Williamson. This arrangement went into effect on November 1, 2014 and currently remains in effect.
  2. Austin Regional Clinic, P.A. (ARC) and Adult Inpatient Medical Services d/b/a Seton Adult Inpatient Medical Services (SAIMS) are parties to an arrangement for which protection is sought under the Interim Final Waiver Rule issued in connection with the Medicare Shared Savings Program (MSSP) at 76 Fed. Reg. 67992 (Nov. 2, 2011), as extended as described at 79 Fed. Reg. 62356 (Oct. 17, 2014). This ACO-related arrangement involves the provision of professional medical services in Williamson County, Texas. This arrangement went into effect on September 8, 2014 and currently remains in effect.
  3. Austin Regional Clinic, P.A. (ARC) and Adult Inpatient Medical Services d/b/a Seton Adult Inpatient Medical Services (SAIMS) are parties to an arrangement for which protection is sought under the Interim Final Waiver Rule issued in connection with the Medicare Shared Savings Program (MSSP) at 76 Fed. Reg. 67992 (Nov. 2, 2011), as extended as described at 79 Fed. Reg. 62356 (Oct. 17, 2014). This ACO-related arrangement involves the provision of professional medical services in Central Austin, Texas, and physician coverage at Seton Medical Center Austin. This arrangement went into effect on November 1, 2014 and currently remains in effect.
  4. Seton Accountable Care Organization, Inc. (ACO), its ACO network providers and the following affiliates of ACO are parties to an arrangement of ACO for which protection is sought under the Interim Final Waiver Rule issued in connection with the Medicare Shared Savings Program (MSSP) at 76 Fed. Reg. 67992 (Nov. 2, 2011), as extended as described at 79 Fed. Reg. 62356 (Oct. 17, 2014): Seton Health Alliance (“SHA”), Dell Children’s Health Alliance (“DCHA”), Seton Healthcare Family (“Seton”), Seton Physician Hospital Network (“SPHN”), and Seton Insurance Services Corporation (“SISC”).
  5. This ACO-related arrangement consists of written contractual arrangements involving (1) the provision of clinically integrated physicians and physician groups, each of whom has made a contractual commitment to maintain a meaningful commitment to ACO’s mission to ensure its likely success and become accountable for the quality, cost, and overall care of patients, including, without limitation, Medicare beneficiaries and to participate in ACO’s provider network and other ACO programs and initiatives, (2) the provision of support services (e.g., personnel, etc.) by SHA to ACO, and (3) the contribution and support assistance provided by ACO affiliates Seton, SPHN and SISC in connection with the development and ongoing operation of ACO’s provider network.
  6. Aetna Health Inc. (“Aetna”), Seton ACO, Seton Health Alliance (“SHA”), Dell Children’s Health Alliance (“DCHA”) and Seton ACO’s participating network providers (the “ACO Network Providers”) are parties to an agreement relating to the provision of health care services by the ACO Network Providers to covered members under the following payor products: (i) the Aetna Whole Health Product and (ii) the shared savings agreement with Aetna and Williamson County for the employees and dependents of Williamson County.  This arrangement will be effective January 1, 2016 through December 31, 2016.
  7. Seton Health Plan (“SHP”), Seton ACO, SHA, DCHA and Seton ACO’s participating network providers (the “ACO Network Providers”) are parties to an agreement relating to the provision of health care services by the ACO Network Providers to covered members under a payor product covering employees and dependents of Acension’s health benefits plan.  This arrangement went into effect on January 1, 2015 and remains in effect.
  8. Ascension Health and Seton ACO are parties to an arrangement for the provision of items and services by Ascension Health to Seton ACO in connection with The Advisory Board Company’s Crimson Market Advantage Program, a business intelligence platform that provides technology and consulting in market referral patterns and opportunities for near and long term growth and is designed to analyze and communicate physician referral management data to optimize this function at member’s organization and support the member’s growth objectives.  This arrangement went into effect on June 26, 2015 and currently remains in effect.

The Seton ACO board believes that these arrangements are reasonably related to the purposes of the MSSP in that they will further one or more of the following purposes of the MSSP:

  1. Promoting accountability for the quality, cost, and overall care for a Medicare patient population as described in the MSSP.
  2. Managing and coordinating care for Medicare fee-for-service beneficiaries through an ACO.
  3. Encouraging investment in infrastructure and redesigned care processes for high quality and efficient service delivery for patients, including Medicare fee-for-service beneficiaries (“efficient service delivery” means appropriate reduction in costs to, or growth in, expenditures of the Medicare program, consistent with quality of care, physician medical judgment, and patient freedom of choice).”