MSSP
ACO Name and Location
Banner Health Network
2901 N Central
Suite 160
Phoenix, AZ 85012
ACO Primary Contact
Kynda Wolfrum, Sr. Director, Government Operations
Phone: 970-810-8706
Email: Kynda.Wolfrum@bannerhealth.com
Organizational Information
Sr. Director, Government Operations
ACO Participants | ACO Participant in Joint Venture (Enter Y or N) |
---|---|
Accredited Family Healthcare PC | N |
Adam S Nally DO PC | N |
Advent Internal Medicine PLLC | N |
Affiliated Internal Medicine Associates LLC | N |
Allied Medical Associates PLC | N |
Amardeep S Majhail MD PC | N |
Antonio T Uvas PLLC | N |
Antonio V Yu Jr MD PCNTONIO V YU JR MD PC | N |
Apex Internal Medicine PC | N |
Arizona Internal Medicine & Pediatrics Corp | N |
Arizona Internal Medicine Associates LLC | N |
Arizona Preferred Primary Care PLC | N |
Artisan Primary Care PLLC | N |
Banner - University Primary Care Physicians LLC | N |
Banner Health | N |
Banner Primary Care Physicians Arizona LLC | N |
Bendel Clinic PLLC | N |
Bestcare Internal Medicine PLLC | N |
Blair T Butterfield PC | N |
Brown Road Family Medicine PLLC | N |
Central Arizona Medical Associates | N |
Clinic for Chest Diseases PLLC | N |
Clinica La Familia PC | N |
Community Hospital Association Inc | N |
Consultants In Internal Medicine PC | N |
D & V Soni MD PC | N |
Deseret Family Medicine at Greenfield PLC | N |
Deseret Medical Associates PLC | N |
Desert Rose Medical Consultants PC | N |
Desert View Family Medicine PLLC | N |
Dipti Patel PLLC | N |
Drew Durbin DO PLLC | N |
Estrella Internal Medicine & Geriatrics Clinic PLC | N |
Estrella Specialty Medical Care PC | N |
Fala Medical Clinic PLLC | N |
Family First Physicians PLLC | N |
Good Years Family Medicine LLC | N |
Grand Canyon Family Medicine PC | N |
Greenfield Family Medicine LLC | N |
Healthy Life Family Medicine PLC | N |
Indigo Health Clinic PC | N |
Innovative Family Health Practices LLC | N |
Internal Medicine Physicians Associates PC | N |
Isha Gupta MD PLLC | N |
James G Lieber MD PLC | N |
Karen Leber | N |
Kyrene Internal Medicine PLLC | N |
Leading Healthcare Clinic of Goodyear LLC | N |
M Zuhdi Jasser MD PC | N |
Madhuri Dhupati MD & Associates PC | N |
Maxwell Group | N |
Medcubed PLLC | N |
Mesa Family Physicians PLC | N |
Michael B Bayless & Associates LLC | N |
Mohammad Jamil PC | N |
Monaliza Setudehnia MD PLLC | N |
Neena K Uppal MD PC | N |
Nestor N Nazareno MD PC | N |
Norterra Family Medicine PLLC | N |
Ofelia Popluca | N |
Patricia R Reiff MD PC | N |
Paul S. Charnetsky MD PC | N |
Pete S Coury MD PLLC | N |
Phoenix West Internal Medicine LLC | N |
Pinakin G Bhakta MD PC | N |
Pinnacle Family Medicine PLC | N |
Pradip Patel MD PC | N |
Raffy Safarian | N |
Sarita S Sharma MD Internal Medicine PLLC | N |
Scottsdale Primary Care PC | N |
Southwest Internal Medicine LLC | N |
Sun City Internal Medicine | N |
Sunrise Internal Medicine PC | N |
Sunrise Medical Associates LLC | N |
Surprise Medical Consultants LLC | N |
Tesai PLC | N |
Thompson Medical Group | N |
Valley Internal Medicine and Pediatrics PC | N |
Versatile Medicine PLLC | N |
Wabash Medical Associates PC | N |
Westside Internal Medicine PC | N |
Westside Primary Care Associates PLLC | N |
ACO Governing Body
Last Name | First Name | Title/Position | Member's Voting Power -Expressed as a percentage or number | Membership Type | ACO Participant Legal Business Name/DBA, if Applicable |
---|---|---|---|---|---|
Agnone | Frank | Physician | 1 | ACO Participant Representative | Internal Medicine Physicians Associates PC |
Bader | Karen | Physician | 1 | ACO Participant Representative | Desert View Family Medicine LLC |
Bessel | Marjorie | Banner CMO | 1 | ACO Participant Representative | Banner Health |
Birdi | Shiva | Physician | 1 | ACO Participant Representative | Banner Primary Care Physicians Arizona Llc |
Butterfield | Blair | Physician | 1 | ACO Participant Representative | Blair T Butterfield PC |
Caplan | Joseph | Physician | 1 | Other: Specialty Network | Joseph A Caplan MD PC DBA Cardiac Solutions |
TBD | TBD | TBD | 1 | ACO Participant Representative | Banner Health |
Perry | Amy | Banner COO | 1 | ACO Participant Representative | Banner Health |
Piette | Randy | Physician | 1 | ACO Participant Representative | Maxwell Group |
Ritchie | Thomas | Physician | 1 | Other: Specialty Network | Tri-City Cardiology |
Sodhi | Amandeep | Physician | 1 | ACO Participant Representative | Westside Internal Medicine |
Valenzuela | David | Physician | 1 | ACO Participant Representative | Banner Primary Care Physicians Arizona Llc |
Weissman | Jerry | Beneficiary | 1 | Medicare Beneficiary | Beneficiary |
Werner | Todd | Banner, President AZ Community Delivery | 1 | ACO Participant Representative | Banner Health |
Zismann | Nancy | BMG Chief Clinical Services Officer | 1 | ACO Participant Representative | Banner Primary Care Physicians Arizona Llc |
Key ACO Clinical and Administrative Leadership
ACO Executive: Chuck Lehn
Medical Director: Ed Clarke, M.D.
Compliance Officer: Sean Reneau
Quality Assurance/Improvement Officer: Sandra Robles-Caraveo
Associated Committees and Committee Leadership
Compliance Committee - Sean Reneau, 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
Shared Savings and Losses:
Amount of Shared Savings/Losses
-
Second Agreement Period
-
Performance Year 2022, $22,965,884
-
-
Performance Year 2021, $25,580,704
-
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 2022
-
Proportion invested in infrastructure: 25%
-
Proportion invested in redesigned care processes/resources: 25%
-
Proportion of distribution to ACO participants: 50%
-
-
Performance Year 2021
-
Proportion invested in infrastructure: 25%
-
Proportion invested in redesigned care processes/resources: 25%
-
Proportion of distribution to ACO participants: 50%
-
-
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
2022 Quality Performance Results
Quality Performance results are based on CMS Web Interface
Measure # | Measure Name | Rate | ACO Mean |
---|---|---|---|
Measure #001 | Diabetes: Hemoglobic A1c (BHA1c) Poor Control | 6.0 | 10.71 |
Measure #134 | Preventative Care and Screening: Screening for Depression and Follow-up Plan | 87.00 | 76.97 |
Measure #236 | Controlling High Blood Pressure | 76.65 | 76.16 |
Measure #318 | Falls: Screening for Future Fall Risk | 94.19 | 87.83 |
Measure #110 | Preventative Care and Screening: Influenza Immunization | 80.42 | 77.34 |
Measure #226 | Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention | 93.75 | 79.27 |
Measure #113 | Colorectal Cancer Screening | 80.88 | 75.32 |
Measure #112 | Breast Cancer Screening | 81.25 | 78.07 |
Measure #438 | Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | 86.02 | 86.37 |
Measure #370 | Depression Remission at Twelve Months | 22.22 | 16.03 |
Measure #479 | Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups [1]. | 0.01418 | 0.151 |
Measure #484 | Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions [1] | 25.47 | 30.97 |
[1] A lower performance rate corresponds to higher quality.
Please note the Quality ID#: 370 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size.
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.