ACO Name and Location

Caravan Health ACO 16 LLC
dba Huntsville 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)
Marshall Medical Center North	N
Marshall Medical Center South	N
Pulmonary And Sleep Associates	N
Athens Limestone Health Services	N
TENNESSEE VALLEY PEDIATRIC SURGERY	N
Huntsville Hospital Pediatric Neurology	N
Seth D. Rayburn MD PC	N
Madison Surgical Associates	N
Neurology Consultants of Huntsville, P.C.	N
The Valley Foundation	N
Huntsville Hospital Madison Internal Medicine	N
Huntsville Hospital Internal Medicine	N
Healthcare Authority of The City of Huntsville	Y
Noel General Surgery PC	N
Athens and Limestone County Health Care Authority	N
CRNA Services of DGH	N
Athens Limestone Health Services Llc	N
Tennessee Valley Gynecologic Oncology Associates	N
NW ALABAMA PRACTICE MANAGEMENT, LLC	N
Huntsville Hospital Medical Clinic at Hampton Cove	N
Limestone Internal Medicine Center	N
Highlands Internal Medicine, Llc	N
HH OBSERVATON CENTER	N
Marshall Medical Center South Burson Urology	N
Marshall Medical Center North Medical Centers Behavioral Health Clinic	N
Marshall Medical Center North Medical Centers Behavioral Health Clinic	N
Valley Obstetrics & Womens Pelvic Health Center	N
Huntsville Hospital Palliative Care Services	N
Athens Limestone ER Physicians	N
Huntsville Hospital Surgical Associates of Madison	N
HH Health System – Morgan LLC	N
Capshaw Family Care	N
Tennessee Valley Family Medical	N
Rogersville Family Care	N
Limestone Urology Associates	N
Decatur Morgan Gastroentrology	N
DECATUR MORGAN INFECTIOUS DISEASES & TRAVEL MEDICINE	N
MedExpress Red Bay LLC	N
Athens Neurological	N
HARTSELLE FAMILY PRACTICE	N
HARTSELLE MED-PEDS	N
DECATUR MORGAN PRIMARY CARE	N
GROWING TOGETHER PEDIATRICS	N
DECATUR WOMENS HEALTHCARE	N
HH Digestive Disease Center	N
Alh Hospitalist	N
AthensLimestone Sleep Clinic	N
Medwest Clinic	N
Athens Family Medicine	N
HH Health System – Shoals LLC	N
Athens Limestone Pain Center	N
HH Surgical Associates – Robert Lancaster MD	N
HH PHYSICIAN CARE HAZEL GREEN	N
Koonce Surgical PC	N
DECATUR MORGAN NEUROLOGY	N
HH Health System- Athens Limestone LLC	Y
Milestone Pediatrics	N
HH HEALTH SYSTEM-MORGAN INC.	N
The Healthcare Authority of the City of Huntsville	Y
DECATUR MORGAN INTERNAL MEDICINE	N
The Health Care Authority Of The City Of Huntsville	Y
Rheumatology Associates of North Alabama	N
Tejanand Mulpur	N
Hazel Green Pediatrics	N
EMERGENCY PHYSICIANS GROUP	N
Iqbal Saeed MD LLC	N
Rama Nadella	N
Marshall Medical Center South Moore Obgyn Services	N
Marshall Medical Center South Medical Oncology Services	N
Decatur Morgan Hospitalist Group	N
Health Care Authority of The City of Huntsville	Y
Huntsville Hospital Lung Center	N
Huntsvile Hospital Anesthesia	N
TENNESSEE VALLEY PAIN CONSULTANTS, PC	N
Huntsville Hospital Endocrine and Diabetes Clinic	N
HUNTSVILLE HOSPITAL SPINE AND NEURO CENTER	N
Valley Internal Medicine	N
HH Heart Center LLC	N
NASH Physician Billing	N
HH Physician Care – Elkton Tennessee	N
Eastside Family Medicine	N
HH PHYSICIAN CARE-FAYETTEVILLE MEDICAL ASSOCIATES	N
Waddell Center Family Medicine	N
Marshall Medical Center South Manganaris Pulmonology	N
Marshall Medical Center South Diamond Hospital Services	N
Northeast Alabama Dermatology LLC	N
Elkmont Community Care	N
Medical East	N
Breast Care Center, P.C.	N
Northeast Alabama Vascular and Vein Specialist	N
Eyecare Associates, INC.	Y
William E Holcom, MD & Associates, INC	Y

 
 
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
Samz	Jeff	Chairman	1	ACO Participant Representative	Health Care Authority Of The City Of Huntsville
Chappell, MD	Robert	Secretary	1	ACO Participant Representative	Health Care Authority Of The City Of Huntsville
Powers	Kelli	Treasurer	1	ACO Participant Representative	Health Care Authority Of The City Of Huntsville
Doughty	Tracy	Vice-Chairman	1	ACO Participant Representative	Health Care Authority Of The City Of Huntsville
Corn	Rick	Board Member	1	ACO Participant Representative	Health Care Authority Of The City Of Huntsville
Storey	Paul	Board Member	1	ACO Participant Representative	HH Health System – Shoals LLC
Richardson	Nat	Board Member	1	ACO Participant Representative	HH Health System – Morgan LLC
Pryor	David	Board Member	1	ACO Participant Representative	HH Health System – Athens Limestone LLC
Arora, MD	Amit	Board Member	1	ACO Participant Representative	Health Care Authority Of The City Of Huntsville
Tabereaux, MD	Paul	Board Member	1	ACO Participant Representative	HH Heart Center LLC
W. Bentley, Jr.	Philip	Board Member	1	ACO Participant Representative	Health Care Authority Of The City Of Huntsville
Finch, MD	Dick	Board Member	1	Medicare Beneficiary Representative
Spillers	David	Board Member	1	ACO Participant Representative	Health Care Authority Of The City Of Huntsville
Hassen	Zia	Board Member	1	ACO Participant Representative	Independent
Smalligan	Roger	Board Member	1	ACO Participant Representative	Valley Foundation/UAB
Gore	Gary	Board Member	1	ACO Participant Representative	Marshall Medical Center
Morrison MD	James	ACO Medical Director	1	ACO Participant Representative	Health Care Authority Of The City Of Huntsville
Rush	Chris	Board Member	1	ACO Participant Representative	Hampton Cove
Spillers	David	Board Member	1	ACO Participant Representative	Hampton Cove

 
Key ACO clinical and administrative leadership:

Greg Paris	ACO Executive
James Morrison Jr., 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	Rick Corn, Chairman
Care Coordination & Patient Engagement Committee	Tracy Doughty, Chairman
Evidence-Based Medicine Committee	Dr. James Morrison, Chairman
Finance Committee	Kelli Powers, Chairman
Quality & Performance Improvement Committee	Dr. Robert Chappell, Chairman

 

Types of ACO participants, or combinations of participants, that formed the ACO:

• Critical Access Hospital (CAH) billing under Method II
• ACO professionals in a group practice arrangement
• Hospital employing ACO professionals
• Partnerships or joint venture arrangements between hospitals and ACO professionals
• Rural Health Clinic (RHC)

 

Shared Savings and Losses

Amount of Shared Savings/Losses

• First Agreement Period
  • Performance Year 2018, $3,479,397

 

Shared Savings Distribution

• First Agreement Period
  • Performance Year 2018
    • Proportion invested in infrastructure: Enter percent or dollar amount
    • Proportion invested in redesigned care processes/resources: Enter percent or dollar amount
    • Proportion of distribution to ACO participants: Enter percent or dollar amount

 

Quality Performance Results

2018 Quality Performance Results:

ACO#	Measure Name	Rate	ACO Mean
ACO-1	CAHPS: Getting Timely Care, Appointments, and Information	88.46	86.14
ACO-2	CAHPS: How Well Your Providers Communicate	94.97	93.93
ACO-3	CAHPS: Patients’ Rating of Provider	92.58	92.45
ACO-4	CAHPS: Access to Specialists	83.09	81.50
ACO-5	CAHPS: Health Promotion and Education	60.41	59.26
ACO-6	CAHPS: Shared Decision Making	59.35	61.94
ACO-7	CAHPS: Health Status/Functional Status	71.54	73.35
ACO-34	CAHPS: Stewardship of Patient Resources	30.50	26.26
ACO-8	Risk Standardized, All Condition Readmission	14.24	14.98
ACO-35	Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM)	17.78	18.59
ACO-36	All-Cause Unplanned Admissions for Patients with Diabetes	37.49	37.01
ACO-37	All-Cause Unplanned Admissions for Patients with Heart Failure	77.43	76.75
ACO-38	All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions	60.62	59.00
ACO-43	Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91)	2.19	1.98
ACO-11	Use of Certified EHR Technology	98.95	98.20
ACO-12	Medication Reconciliation Post-Discharge	66.56	85.91
ACO-13	Falls: Screening for Future Fall Risk	73.39	79.73
ACO-44	Use of Imaging Studies for Low Back Pain	58.62	64.36
ACO-14	Preventive Care and Screening: Influenza Immunization	78.88	72.71
ACO-15	Pneumonia Vaccination Status for Older Adults	72.22	75.97
ACO-16	Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up	72.24	76.83
ACO-17	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	80.00	72.81
ACO-18	Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan	50.20	66.74
ACO-19	Colorectal Cancer Screening	61.04	68.27
ACO-20	Breast Cancer Screening	72.58	71.96
ACO-42	Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	88.63	81.47
ACO-27	Diabetes Mellitus: Hemoglobin A1c Poor Control	25.00	15.51
ACO-41	Diabetes: Eye Exam	44.35	52.42
ACO-28	Hypertension (HTN): Controlling High Blood Pressure	63.20	73.10
ACO-30	Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet	91.13	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.

• For 2018 Quality Performance Results please visit: https://data.cms.gov/Special-Programs-Initiatives-Medicare-Shared-Savin/2018-Shared-Savings-Program-SSP-Accountable-Care-O/v47u-yq84/data

 
Note: In the Quality Performance Results file(s) above, search for “Caravan Health ACO 16 LLC” or “Huntsville ACO” to view the quality performance results. This ACO can also be found by using the ACO ID A3579 in the public use files on data.cms.gov.

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 16 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 November 21, 2017, 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.