MSSP

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

ACO Governing Body

Key ACO Clinical and Administrative Leadership 

ACO Executive: Kynda Wolfrum, RN, MSN

Medical Director: Ed Clarke, M.D.

Compliance Officer: Ryan Shirley

Quality Assurance/Improvement Officer: Sandra Robles-Caraveo

Associated Committees and Committee Leadership

Compliance Committee - Ryan Shirley, 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

• Fourth Agreement Period

  • Performance Year n/a, $ n/a

• Third Agreement Period

  • Performance Year n/a, $ n/a

• Second Agreement Period

  • Performance Year 2023, $11,105,925

  • 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:

• Fourth Agreement Period

  • Performance Year N/A

    • Proportion invested in infrastructure:

    • Proportion invested in redesigned care processes/resources:

    • Proportion of distribution to ACO participants:

• Third Agreement Period

  • Performance Year N/A

    • Proportion invested in infrastructure:

    • Proportion invested in redesigned care processes/resources:

    • Proportion of distribution to ACO participants:

• Second Agreement Period

  • Performance Year 2023

    • Proportion invested in infrastructure: 25%

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

    • Proportion of distribution to ACO participants: 50%

  • 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

2023 Quality Performance Results

Quality Performance results are based on CMS Web Interface

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

MSSP ACO PARTICIPATION WAIVER DISCLOSURE

The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain federal fraud and abuse laws that may otherwise limit innovation by accountable care organizations (ACOs) participating in the Medicare Shared Savings Program ACO Model (see “Final Waivers in Connection with the Shared Savings Program” (80 Fed. Reg. 66,726 (Oct. 29, 2015))). Pursuant to that notice, Banner Health Network (“Banner”) seeks waiver protection for the arrangement described below:

Banner has developed an incentive plan (the “Incentive Plan”) for certain eligible providers who are entities or individuals that have signed ACO participant agreement with Banner to become Medicare Shared Savings Program (“MSSP”) ACO Participants, as such term is defined in the regulations promulgated by CMS to implement the MSSP, as amended from time to time, under 42 C.F.R. 425.20 (“Eligible Providers”), to improve the quality, cost and coordination of care for Medicare beneficiaries assigned to the Banner MSSP ACO (“Banner MSSP ACO Beneficiaries”).

The Incentive Plan incentivizes certain Eligible Providers to earn payments for their performance on certain quality and utilization metrics to improve the quality, cost and coordination of care for Banner MSSP ACO Beneficiaries.