ACO Public Reporting Information

ACO Name and Location

Seton Accountable Care Organization, Inc.
Previous Names: Seton Health Alliance, Inc.
1345 Philomena Street
Suite 402
Austin, TX 78723

ACO Primary Contact

Amy Miller
512.324.1000 Ext.17362
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Organizational Information

ACO Participants:

ACO participantsACO Participant in Joint Venture
Seton Hospitalist ServiceN
Capital Medical Clinic, LLPN
Austin Regional Clinic, P.A.N
Lone Star Circle of CareN

ACO Governing Body:

Member LastnameMember FirstnameTitle/PositionMember's Voting PowerMembership TypeACO Participant Legal Business Name/DBA, if Applicable
BruceTrentCEO1ACO Participant RepresentativeSeton Hospitalist Service
Granzotti, MDMaria1ACO Participant RepresentativeSeton Hospitalist Service
HerndonScottTreasurer1ACO Participant RepresentativeSeton Hospitalist Service
Jesudass, MDSamsonChair1ACO Participant RepresentativeSeton Hospitalist Service
WilliamsMarinanVice President1ACO Participant RepresentativeSeton Hospitalist Service
Brinkman, MDDiane1ACO Participant RepresentativeAustin Regional Clinic, P.A.
Chenven, MDNorman1ACO Participant RepresentativeAustin Regional Clinic, P.A.
Daghestani, MDAnasPresident and CMO1ACO Participant RepresentativeAustin Regional Clinic, P.A.
SumnerLucy1ACO Participant RepresentativeAustin Regional Clinic, P.A.
Zdunek, DOJayVice Chair1ACO Participant RepresentativeAustin Regional Clinic, P.A.
Angelocci, MDTracy1ACO Participant RepresentativeLone Star Circle of Care
Kroll, MDKenneth1ACO Participant RepresentativeCapital Medical Clinic, LLP
Pirwitz, MDMark1Community Stakeholder RepresentativeN/A
GranberryGayle1Medicare Beneficiary RepresentativeN/A

Key ACO clinical and administrative leadership:

NameACO Leadership Position
Marinan WilliamsACO Executive
Anas Daghestani, MDMedical Director
Rebecca LovelaceCompliance Officer
Mandy Barber, LVN, CPC, CRCQuality Assurance/Improvement Officer

Associated committees and committee leadership:

Committee NameCommittee Leader Name and Position
Clinical Integration CommitteeTom Caven, MD, Chair
Membership and Credentialing CommitteeTom Caven, MD, Chair
Incentive Compensation and Contracting CommitteeKenneth Kroll, MD, Chair

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

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

Shared Savings and Losses

Amount of Shared Savings/Losses

  • Second Agreement Period
    • Performance Year 2018, $4,460,217
    • Performance Year 2017, $3,662,884
  • First Agreement Period
    • Performance Year 2016, $5,062,019
    • Performance Year 2015, $0
    • Performance Year 2014, $5,178,802

Shared Savings Distribution

  • Second Agreement Period
    • Performance Year 2018
      • Proportion invested in infrastructure: 21.9%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants: 78.1%
    • Performance Year 2017
      • Proportion invested in infrastructure: 20.5%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants: 79.5%
  • First Agreement Period
    • Performance Year 2016
      • Proportion invested in infrastructure: 23.5%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants: 76.5%
    • 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: 30%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants: 70%

Quality Performance Results

2018 Quality Performance Results:

ACO#Measure NameRateACO Mean
ACO-1CAHPS: Getting Timely Care, Appointments, and Information83.2386.14
ACO-2CAHPS: How Well Your Providers Communicate94.4293.93
ACO-3CAHPS: Patients' Rating of Provider93.1392.45
ACO-4CAHPS: Access to Specialists82.1381.50
ACO-5CAHPS: Health Promotion and Education59.0659.26
ACO-6CAHPS: Shared Decision Making60.4061.94
ACO-7CAHPS: Health Status/Functional Status73.9373.35
ACO-34CAHPS: Stewardship of Patient Resources23.8526.26
ACO-8Risk Standardized, All Condition Readmission15.2714.98
ACO-35Skilled Nursing Facility 30-day All-Cause Readmission Measure (SNFRM)17.1618.59
ACO-36All-Cause Unplanned Admissions for Patients with Diabetes33.5537.01
ACO-37All-Cause Unplanned Admissions for Patients with Heart Failure68.7176.75
ACO-38All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions52.6659.00
ACO-43Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91)1.761.98
ACO-11Use of Certified EHR Technology100.0097.66
ACO-12Medication Reconciliation Post-Discharge98.4685.91
ACO-13Falls: Screening for Future Fall Risk89.6979.73
ACO-44Use of Imaging Studies for Low Back Pain70.8364.36
ACO-14Preventive Care and Screening: Influenza Immunization77.5772.71
ACO-15Pneumonia Vaccination Status for Older Adults85.7875.97
ACO-16Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up73.8776.83
ACO-17Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention81.0872.81
ACO-18Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan72.1566.74
ACO-19Colorectal Cancer Screening75.6168.27
ACO-20Breast Cancer Screening83.8171.96
ACO-42Statin Therapy for the Prevention and Treatment of Cardiovascular Disease86.5181.47
ACO-27Diabetes Mellitus: Hemoglobin A1c Poor Control12.0815.51
ACO-41Diabetes: Eye Exam71.4852.42
ACO-28Hypertension (HTN): Controlling High Blood Pressure81.8873.10
ACO-30Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet92.2388.92

For Previous Years’ Financial and Quality Performance Results, please vist data.cms.gov.

Payment Rule Waivers

    • Skilled Nursing Facility (SNF) 3-Day Rule Waiver
      • No, our ACO does not use the SNF 3-Day Rule Waiver, pursuant to 42 CFR 425.612.
    • Waiver for Payment for Telehealth Services
      • No, our ACO clinicians do not provide telehealth services using the flexibilities under 42 CFR 425.612(f) and 42 CFR 425.613.

Seton Accountable Care Organization, Inc. Public Disclosure of Arrangements Protected Under the ACO Participation Waiver

 

Seton Accountable Care Organization, Inc. (the “ACO”) is currently participating in the Medicare Shared Savings Program (“MSSP”) pursuant to a Participation Agreement with the Centers for Medicare & Medicaid Services (“CMS”) initially entered into effective January 1, 2014 and renewed effective January 1, 2017 for a successive three-year term.

 

In accordance with the public disclosure requirement of the ACO Participation Waiver, the following describes arrangements involving the ACO and its ACO participants and ACO providers/suppliers for items, services, goods or facilities used to create, develop and/or operate the ACO, and also support the ACO in its efforts to achieve the goals of the MSSP, which are to: (i) improve the care management and coordination of care for Medicare beneficiaries assigned to the ACO; (ii) enhance its population health and quality improvement initiatives; and (iii) support efforts to design processes that promote accountability for the quality, cost and overall care delivered to ACO patients (the “MSSP Purposes”).

 

The ACO’s provider network (the “ACO Network”) is comprised of health care providers that have agreed to work together to, among other things, (i) participate in the MSSP through the ACO; (ii) participate in similar commercial programs and initiatives designed to manage, coordinate, and promote accountability for the quality, patient safety, cost, and overall care of patients; and (iii) provide medical and other services pursuant to contracts with third-party payers (“ACO Payor Contracts”), including ACO Payor Contracts that include value-­based care programs (individually, an “ACO Network Provider,” and collectively, the “ACO Network Providers”).

The providers that are included in the ACO’s MSSP Program as ACO Participants are:

Austin Regional Clinic

Capital Medical Clinic, LLP

Lone Star Circle of Care

Seton Hospitalist Service (Previous Name: Adult Inpatient Medical Services)

 

The ACO’s Board of Directors has duly authorized the arrangements below and made a bona fide determination that each arrangement is reasonably related to the purposes of the MSSP:

 

  1. Working with Seton Health Alliance (“SHA”), a Texas certified nonprofit health corporation and Dell Children’s Health Alliance (“DCHA”), a Texas certified nonprofit health corporation, the ACO (i) manages, coordinates, and promotes accountability for the quality, patient safety, cost, and overall care of patients, including without limitation, Medicare beneficiaries; (ii) receives and distributes shared savings from participation in the MSSP and similar programs and initiatives designed to manage, coordinate, and promote accountability for the quality, patient safety, cost, and overall care of patients; and (iii) serves as a network to arrange for the provision of medical and health services through contracts with providers, suppliers, third-party payers and employers (collectively, the “ACO Objectives”).The ACO Network Agreements (including, without limitation, the Panel Access Agreement with SHA, the Support Services Agreements between the ACO and SHA and the ACO and DCHA, the SHA PPA, the DCHA PPA and the ACO Network Participation Addenda) (i) collectively constitute an “ACO arrangement” for purposes of the MSSP Participation Waiver; (ii) such ACO arrangement is consistent with the ACO Objectives; (iii) will advance the ACO’s efforts to achieve the MSSP Goals; and (iv) is reasonably related to the MSSP Purposes.
  2. The compensation arrangements involving the ACO, SHA, DCHA and the participating ACO Network Providers under the ACO Payor Contracts with Aetna and Seton Health Plan: (i) each constitute an “ACO arrangement” for purposes of the MSSP ACO Participation Waiver, (ii) are consistent with the ACO Objectives, (iii) will advance the Corporation’s efforts to achieve the MSSP Goals and (iv) are reasonably related to the MSSP Purposes.
  3. Working with Seton Health Alliance (“SHA”), a Texas certified nonprofit health corporation, Dell Children’s Health Alliance (“DCHA”), a Texas certified nonprofit health corporation, and Providence Health Services of Waco d/b/a Care4Texans, LLC (“C4T”), a Texas limited liability company, the ACO: (i) manages, coordinates, and promotes accountability for the quality, patient safety, cost, and overall care of patients, including without limitation, Medicare beneficiaries; (ii) receives and distributes shared savings from participation in the MSSP and similar programs and initiatives designed to manage, coordinate, and promote accountability for the quality, patient safety, cost, and overall care of patients; and (iii) serves as a network to arrange for the provision of medical and health services through contracts with providers, suppliers, third-party payers and employers (collectively, the “ACO Objectives”).The ACO Network Agreements (including, without limitation, the Panel Access Agreement with SHA, the Support Services Agreements between the ACO and SHA, the ACO and DCHA and the ACO and C4T, the SHA PPA, the DCHA PPA, the C4T PPA and the ACO Network Participation Addenda) (i) collectively constitute an “ACO arrangement” for purposes of the MSSP Participation Waiver; (ii) such ACO arrangement is consistent with the ACO Objectives; (iii) will advance the ACO’s efforts to achieve the MSSP Goals; and (iv) is reasonably related to the MSSP Purposes.
  4. The Management and Professional Services Agreements with Austin Regional Clinic, PA, Capital Medical Clinic, LLP and Lone Star Circle of Care are consistent with the ACO Objectives and are reasonably related to the MSSP Purposes.