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 ParticipantsACO Participant in Joint Venture
(Enter Y or N)
Adam S. Nally, D.O., P.C. N
Affiliated Internal Medicine Associates LLC N
Antonio T Uvas PLLC N
Antonio V Yu JR MD PC N
Arizona Internal Medicine & Pediatrics Corp N
Arizona Preferred Primary Care, OLC N
Artisan Primary Care PLLC N
Accredited Family Healthcare PC N
Advent Internal Medicine PLLC N
Apex Internal Medicine, P.C. N
Arizona Internal Medicine Associates LLC N
Banner --University Primary Care Physicians LLC N
Banner Health N
Banner Primar Care Physicians Arizona LLC 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
Community Hospital Association Inc N
Consultants In Internal Medicine PC N
D & V Soni MD PC N
Deseret Medical Associates PLC N
Dan Hoag, D.O., 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 P C N
Family First Physicians PLLC N
Gold Canyon Internal Medicine N
Grand Canyon Family Medicine PC N
Good Years Family Medicine LLC N
Greenfield Family Medicine LLC N
Healthy Life Corporation N
Healthy Life Family Medicine PLc N
Isha Gupta MD PLLC N
Indigo Health Clinic PC N
Innovative Family Health Practices LLC N
Internal Medicine Physicians Associates PC N
James G Lieber MD PLC N
John Prieve DO a Professional Corporation N
Jared Dayton Do Pc N
Joe Hayashi Pc N
Jones Family Medicine & Pain Centers Pllc N
Karen Leber N
Kyrene Internal Medicine PLLC N
M Zuhdi Jasser MD PC N
Madhuri Dhupati M.D. & Associates PC N
Maxwell Group N
Mesa Family Physicians, Plc N
Mohammad Jamil PC N
Medcubed PLLC N
Michael B Bayless & Associates LLC N
Monaliza Setudehnia MD PLLC N
Nestor N. Nazareno MD PC N
Norterra Family Medicine PLLC N
Ofelia Popluca N
Patricia R Reiff MD PC N
Paul S. Charnetsky, M.D. P.C. 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
Richard F Fowler MD Pc N
S P Gill MD PC N
Sarita S. Sharma, M.D., Internal Medicine P.L.L.C N
Sunrise Medical Associates LLC N
San Tan Primary Care PC N
Scottsdale Primary Care Pc N
Southwest Internal Medicine LLC N
Sun City Internal Medicine N
Sunrise Internal Medicine PC N
Sunset Family Physicians P.C. N
Valley Internal Medicine and Pediatrics PC N
Westside Internal Medicine PC N
Wabash Medical Associates P C N

 

ACO Governing Body

 

Last NameFirst NameTitle/PositionMember's Voting Power -Expressed as a percentage or numberMembership TypeACO 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 Chief Clinical Officer & Physician 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
Crispin Nancy Medicare Beneficiary 1 Medicare Beneficiary  
Fowler Richard Physician 1 ACO Participant Representative Richard F Fowler Md Pc
Gregory Joe BMG Western Region Admin Region & Physician 1 ACO Participant Representative Banner Primary Care Physicians Arizona Llc
Laraway Dennis Banner Chief Financial Officer 1 ACO Participant Representative Banner Health
Perry Amy President & Chief Operating Officer 1 ACO Participant Representative Banner Health
Piette Randy Physician 1 ACO Participant Representative Maxwell Group
Ritchie Thomas Physician 1 Other Tri-City Cardiology
Sodhi Amandeep Physician 1 ACO Participant Representative Westside Internal Medicine
Valenzuela David BMG AZ East Admin Region & Physician 1 ACO Participant Representative Banner Primary Care Physicians Arizona Llc
Warner Todd Banner President, AZ Community Delivery 1 ACO Participant Representative Banner Health
Zismann Nancy BMG Chief Clinical Services Other 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: 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
ACO#Measure NameRateACO Mean
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Pevention Quality Indicator (PQI#91) 0.88 0.95
ACO-13 Falls: Screening for Future Fall Risk 94.00 84.97
ACO-14 Preventive Care and Screening: Influenza Immunization 85.61 76.03
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 92.31 81.67
ACO-18 Preventive Care and Screening: Screening for Depression and Follow-up Plan 74.23 71.46
ACO-19 Colorectal Cancer Screening 84.78 72.59
ACO-20 Breast Cancer Screening 86.43 74.05
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 82.27 83.37
ACO-27 Diabetes: Hemoglobin A1c Poor Control (>9%) 4.53 14.70
ACO-28 Controlling High Blood Pressure 73.45 72.87

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.