ACO Name and Location

Caravan Health ACO 12 LLC
dba Wilderness Health ACO
7509 NW Tiffany Springs Parkway
Ste. 310
Kansas City, Missouri 64153

ACO Primary Contact

Primary Contact Name Desiree Brewer
Primary Contact Phone Number 916-542-4582
Primary Contact Email Address dbrewer@caravanhealth.com

Organizational Information

ACO participants:
ACO Participants ACO Participant in Joint Venture (Enter Y or N)
St. Luke’s Hospital of Duluth Y
International Falls Memorial Hospital Association Y
Community Memorial Hospital Association Y
Lake View Memorial Hospital, Inc. Y
MOOSE LAKE COMMUNITY HOSPITAL DISTRICT N
ORTHOPEDIC ASSOCIATES OF DULUTH, P.A. N
LABORATORY MEDICINE SPECIALISTS OF DULUTH N
Northland Gastroenterology, P. A. N
Range Foot & Ankle PLC N
 
 
ACO governing body:
Member Member’s Voting Power Membership Type ACO Participant TIN
Legal Business Name/DBA, if Applicable
Last Name First Name Title/Position
Terhaar Kim Secretary 1 ACO Participant Representative St. Luke’s Hospital of Duluth
Lohn Eric Board Member 1 ACO Participant Representative St. Luke’s Hospital of Duluth
Delfs Mike Board Member 0 ACO Participant Representative Mercy Hospital
Herstad Suzanne Board Member 0 ACO Participant Representative Orthopedic Associates of Duluth
Strange John Vice-Chairman 1 ACO Participant Representative St. Luke’s Hospital of Duluth
Ruberg Greg Chairman 1 ACO Participant Representative Lake View Memorial Hospital, Inc.
Breurer Rick Treasurer 1 ACO Participant Representative Community Memorial Hospital Association
Erickson Bonnie Secretary 1 ACO Participant Representative International Falls Memorial Hospital Association
Hall Ed Board Member 1 Medicare Beneficiary
Representative
 
 
Key ACO clinical and administrative leadership:
Greg Paris ACO Executive
Gary Peterson, MD Medical Director
Leeann Hastings Compliance Officer
Rayna Caplan Quality Assurance/Improvement Officer
 
Associated committees and committee leadership:
Committee Name Committee Leader Name and Position
Information Technology Committee Mike Kongsjord, Chairman
Care Coordination & Patient Engagement Committee Ben Bengtson, Chairman
Evidence-Based Medicine Committee Gary Peterson, Chairman
Finance Committee Eric Lohn, Chairman
Quality & Performance Improvement Committee Kathy Johnson, Chairman
 
Types of ACO participants, or combinations of participants, that formed the ACO:
  • Partnerships or joint venture arrangements between hospitals and ACO professionals
  • Hospital employing ACO professionals
  • Critical Access Hospital (CAH) billing under Method II
 

Shared Savings and Losses

Amount of Shared Savings/Losses
  • N/A
Shared Savings Distribution
  • N/A
 

Quality Performance Results

Our ACO did not participate in the Shared Savings Program in the previous performance year, therefore this section is not applicable at this time.

Payment Rule Waivers

  • No, our ACO does not use the SNF 3-Day Rule Waiver.
Arrangements Disclosed
 
The ACO Board of Managers for Caravan Health ACO 12 LLC (“Board”) has formally determined the following arrangements are reasonably related to the purposes of the Medicare Shared Savings Program (“MSSP”), as required for use of the MSSP ACO Participation Waiver:
 
Participant Support Arrangements
 
Under the applicable Participant Agreements between the ACO and the Participants listed above, certain Participants are designated as Principal Participants and others are Non-Principal Participants.  Under the Service Agreements between each Participant and Caravan Health, Inc., the Principal Participants have agreed to pay for certain ACO-related expenses of the Non-Principal Participants in their respective regions, including management fees owed by each Non-Principal Participant.  In each case, the fees and other expenses paid by the Principal Participants on behalf of the Non-Principal Participants will be set in advance, will not vary based on the volume or value of any referrals between the Principal Participants and Non-Principal Participants (except to the extent such referrals indirectly contribute to the earning of shared savings or shared losses as applicable).
 
Through a formal resolution dated March 16, 2018, the Board determined that these arrangements are reasonably related to the purposes of the Medicare Shared Savings Program because they facilitate the participation of the Non-Principal Participants in the Medicare Shared Savings Program, which: i) promotes the accountability of Non-Principal Participants for the quality, cost, and overall care for a Medicare patient population as described in the Shared Savings Program; ii) promotes the management and coordination of care for Medicare fee-for-service beneficiaries attributed to Non-Principal Participants through an ACO; and iii) encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery for patients, including Medicare beneficiaries, served by Non-Principal Participants.