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

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
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
Beardsly Cassandra Executive Director 1 ACO Participant Representative St. Luke’s Hospital of Duluth
Lower Trina Non-Voting Member 0 ACO Participant Representative Mercy Hospital
Perterson Dr. Gary ACO Medical Director  0 ACO Participant Representative St. Luke's Hospital of Duluth
Nokels Kevin 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
Pastor Robert Board Member 1 ACO Participant Representative Rainy Lake Medical Center
Hall Ed Board Member 1 Medicare Beneficiary
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:

  • Critical Access Hospital (CAH) billing under Method II
  • Hospital employing ACO professionals
  • Partnerships or joint venture arrangements between hospitals and ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses

  • First Agreement Period
    • Performance Year 2018, $0

Shared Savings Distribution

  • First Agreement Period
    • Performance Year 2018
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A

Quality Performance Results

2018 Quality Performance Results:
ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 84.69 86.14
ACO-2 CAHPS: How Well Your Providers Communicate 95.15 93.93
ACO-3 CAHPS: Patients’ Rating of Provider 93.37 92.45
ACO-4 CAHPS: Access to Specialists 82.13 81.50
ACO-5 CAHPS: Health Promotion and Education 60.67 59.26
ACO-6 CAHPS: Shared Decision Making 62.70 61.94
ACO-7 CAHPS: Health Status/Functional Status 75.07 73.35
ACO-34 CAHPS: Stewardship of Patient Resources 22.82 26.26
ACO-8 Risk Standardized, All Condition Readmission 15.09 14.98
ACO-35 Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM) 18.34 18.59
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes 39.77 37.01
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 73.72 76.75
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 62.79 59.00
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91) 2.11 1.98
ACO-11 Use of Certified EHR Technology 100.00 98.20
ACO-12 Medication Reconciliation Post-Discharge 87.26 85.91
ACO-13 Falls: Screening for Future Fall Risk 53.63 79.73
ACO-44 Use of Imaging Studies for Low Back Pain 80.00 64.36
ACO-14 Preventive Care and Screening: Influenza Immunization 67.84 72.71
ACO-15 Pneumonia Vaccination Status for Older Adults 79.12 75.97
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up 26.61 76.83
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 15.79 72.81
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 52.82 66.74
ACO-19 Colorectal Cancer Screening 61.69 68.27
ACO-20 Breast Cancer Screening 65.32 71.96
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 82.52 81.47
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 14.92 15.51
ACO-41 Diabetes: Eye Exam 62.90 52.42
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 68.73 73.10
ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet 94.82 88.92
Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size.  
Note: In the Quality Performance Results file(s) above, search for “Caravan Health ACO 12 LLC” or “Wilderness Health ACO” to view the quality performance results. This ACO can also be found by using the ACO ID A3575 in the public use files on

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.
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