MSSP

MSSP

ACO Name and Location

Banner Health Network
2901 N Central
Suite 160
Phoenix, AZ 85012

ACO Primary Contact

Nicole Dorsey, ACO Senior Manager
Phone: (602)-418-7175
Email: Nicole.Dorsey@bannerhealth.com

Organizational Information

ACO Governing Body

Key ACO Clinical and Administrative Leadership 

ACO Executive: Chuck Lehn

Medical Director: Ed Clarke, M.D.

Compliance Officer: Adam Barker

Quality Assurance/Improvement Officer: Sandra Robles-Caraveo

Associated Committees and Committee Leadership

Compliance Committee - Adam Barker, Compliance Officer

Medical Executive Committee - Dr. Ed Clarke, VP, CMO Insurance Division

Types of ACO Participants, or Combinations of Participants,that formed the ACO

• Networks of individual practices of ACO professionals

• Partnerships or joint venture arrangements between hospitals and ACO professionals

Shared Savings and Losses:

Amount of Shared Savings/Losses

• Second Agreement Period

  • Performance Year 2020, $12,893,795.33

• Performance Year 2019, $3,908,104

• First Agreement Period

  • Performance Year 2019, $3,908,104

  • Performance Year 2018, $4,471,259

  • Performance Year 2017, $0

Note: Our ACO participated in multiple performance years during Calendar Year 2019. Shared savings/losses amount reported for Performance Year 2019 therefore represents net shared savings or losses across all performance years in 2019 and is shown under all agreement periods in which the ACO operated during Calendar Year 2019.

Shared Savings Distribution:

• Second Agreement Period

  • Performance Year 2020

    • Proportion invested in infrastructure: 25%

    • Proportion invested in redesigned care processes/resources: 25%

    • Proportion of distribution to ACO participants: 50%

• Performance Year 2019

  • Proportion invested in infrastructure: 25%

  • Proportion invested in redesigned care processes/resources: 25%

  • Proportion of distribution to ACO participants: 50%

• First Agreement Period

  • Performance Year 2019

    • Proportion invested in infrastructure: 25%

    • Proportion invested in redesigned care processes/resources: 25%

    • Proportion of distribution to ACO participants: 50%

Note: Our ACO participated in multiple performance years during Calendar Year 2019. Distribution of shared savings reported for Performance Year 2019 therefore represents the distribution of the net shared savings across all performance years in 2019 and is shown under all agreement periods in which the ACO operated during Calendar Year 2019.

Quality Performance Results

2020 Quality Performance Results

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size. The Centers for Medicare & Medicaid Services (CMS) also waived the requirement for ACOs to field a CAHPS for ACOs survey for PY 2020 through the Physician Fee Schedule Final Rule for Calendar Year 2021. Additionally, CMS reverted ACO-8 Risk-Standardized, All Condition Readmission and ACO-38 Risk-Standardized Acute Admission Rates for Patients with Multiple Chronic Conditions to pay-for-reporting, given the impact of the coronavirus disease 2019 (COVID-19) public health emergency (PHE) on these measures

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

Banner Health Network ACO Participation Waiver

Background:

The Centers for Medicare and Medicaid Services and the U.S. Department of Health and Human Services’ Office of Inspector General have made available waivers of certain federal fraud and abuse laws in connection with the operation of the accountable care organizations (“ACOs”) that have entered into a participation agreement under the Medicare Shared Savings Program (“MSSP”).

Program Name:

Banner Health Network MSSP 2021 Incentive Program for Wet AMD

All Parties Involved:

Banner Health Network, Inc. (BHN)

Advanced Retina & Eye Cancer Center

Associated Retina Consultants

Arizona Retina and Vitreous Consultants

Phoenix Retina Associates

Arizona Macular Degeneration

Carrott Eye Center

Arizona Retina Associates

Date Program Will Begin:

July 1, 2021

Description of Arrangement:

BHN developed an incentive plan to reward ophthalmology practices that tend to see a significant volume of MSSP beneficiaries. Under the incentive plan, the participating practices agree to consider using lower cost, but equally efficacious, vascular endothelial growth factor modulating medications (VEGF) to treat AMD and other similar conditions when clinically appropriate. The program is intended to assist BHN in meeting the MSSP objectives of providing quality care and lowering costs to both CMS and to the beneficiary.  BHN will track individual performance as well as relative performance to determine if objectives are being met by participants. When goals are met, BHN will provide financial incentives to the participants.

Items, Services, Facilities or Goods Covered by the Arrangement:

Financial incentives paid to ophthalmology practices.

Date and Manner of Governing Body’s Authorization:

Approved by the BHN Board of Directors on November 19, 2020.  The BHN Board of Directors made a bona fide determination that the Banner Health Network MSSP 2021 Incentive Program for Wet AMD is reasonably related to the purposes of MSSP and will improve the care delivered to BHN’s Medicare beneficiaries.