Primary Partner Care

Medicare Shared Savings Program ACO

Accountable Care Organization (ACO) Name and Location
Primary PartnerCare ACO Independent Practice Association, Inc.
Previous Legal Business Entity Name: Primary PartnerCare Associates IPA, Inc.
1010 Northern Boulevard, Suite 328
Great Neck, NY 11021
ACO Primary Contact
Primary Contact Name: Marion Davis, CEO
Primary Contact Phone Number: 516-233-2484
Primary Contact Email Address: mdavis@primarypartnercare.com
Organizational Information
ACO Participants – 2022

ACO Participants ACO Participant in Joint Venture (Enter Y or N)
Antonio Corona

N

Benjamin Z. Arbesfeld, MD, PC

N

Ebenezer Odoom, MD, PC N
Ihor Magun MD N
Joseph A. Mackey, M.D.

N

Long Beach Family Medicine, PC

N

North Shore Gastroenterology Associates

N

Primary PartnerCare Physicians, PLLC N
Scott V. Rankin M.D. P.C.

N

Woo Sup Kim MD PC N

ACO Governing Body

Member

Member’s Voting Power (Percentage)

Membership Type

ACO Participant TIN Legal Business Name/DBA, if Applicable

First Name

Last Name

Title/Position

Harry Jacob Chief Medical Officer & Director

10%

ACO Physician Primary PartnerCare Physicians, PLLC
Lawrence Crafa Treasurer & Director

10%

ACO Physician Primary PartnerCare Physicians, PLLC
Leslie Sean Ramsammy Director

10%

ACO Physician Primary PartnerCare Physicians, PLLC
William Duke Director

10%

ACO Physician Primary PartnerCare Physicians, PLLC
Jack Mann Director

10%

ACO Physician Primary PartnerCare Physicians, PLLC
James Stallone Director

10%

ACO Physician Primary PartnerCare Physicians, PLLC
Aretha Persaud Director

10%

ACO Physician Primary PartnerCare Physicians, PLLC
Donato Balsamo Director

10%

ACO Physician Primary PartnerCare Physicians, PLLC
Marion Davis Chief Executive Officer & Director

10%

Other
Robert Caldwell Director

0%

Other
James DeBonet Director

10%

Beneficiary Representative

 

Key ACO Clinical and Administrative Leadership

ACO Executive: Marion Davis
Medical Director: Harry Jacob, MD
Compliance Officer: Charles Davis
Quality Assurance / Improvement Officer: James Stallone, DO

 

Associated Commitees and Committee Leadership

Committee Name Committee Leader Name and Position
Quality Improvement James Stallone, DO, Chair
Medical Management Harry Jacob, MD, Chair
Credentialing/Recredentialing Harry Jacob, MD, Chair
Advanced AfterCare Ryan Cahill, DO, Chair

 

Types of ACO Participant, or Combinations of Participants, that Formed the ACO:

  • • Networks of individual practices of ACO professionals

Shared Savings and Losses

Third Agreement Period

  • • Performance Year 2021, $5,209,182
  • • Performance Year 2020, $4,911,631

Second Agreement Period

  • • Performance Year 2019, $5,527,430
  • • Performance Year 2018, $7,383,593
  • • Performance Year 2017, $4,979,555

First Agreement Period

  • • Performance Year 2016, $0
  • • Performance Year 2015, $0
  • • Performance Year 2014, $0

 

Shared Savings Distribution

Third Agreement Period

  • • Performance Year 2021
    • - Proportion invested in infrastructure: %
    • - Proportion invested in redesigned care processes/resources: %
    • - Proportion of distribution to ACO participants: %
  • • Performance Year 2020
    • - Proportion invested in infrastructure: 35%
    • - Proportion invested in redesigned care processes/resources: 15%
    • - Proportion of distribution to ACO participants: 50%

Second Agreement Period

  • • Performance Year 2019
    • - Proportion invested in infrastructure: 32%
    • - Proportion invested in redesigned care processes/resources: 18%
    • - Proportion of distribution to ACO participants: 50%
  • • Performance Year 2018
    • - Proportion invested in infrastructure: 36%
    • - Proportion invested in redesigned care processes/resources: 14%
    • - Proportion of distribution to ACO participants: 50%
  • • Performance Year 2017
    • - Proportion invested in infrastructure: 28%
    • - Proportion invested in redesigned care processes/resources: 22%
    • - Proportion of distribution to ACO participants: 50%

First Agreement Period

  • • Performance Year 2016
    • - Proportion invested in infrastructure: N/A
    • - Proportion invested in redesigned care processes/resources: N/A
    • - Proportion of distribution to ACO participants: N/A
  • • Performance Year 2015
    • - Proportion invested in infrastructure: N/A
    • - Proportion invested in redesigned care processes/resources: N/A
    • - Proportion of distribution to ACO participants: N/A
  • • Performance Year 2014
    • - 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

2021 Quality Performance Results:

NOTE: Quality Perfomance Results are based on the CMS Web Interface

Measure # Measure Name Rate ACO Mean
001 Diabetes: Hemoglobin A1c (HbA1c) Poor Control 4.29 12.46
134 Preventative Care and Screening: Screening for Depression and Follow-up Plan 99.13 74.38
236 Controlling High Blood Pressure 94.76 74.87
318 Falls: Screening for Future Fall Risk 99.17 87.03
110 Preventative Care and Screening: Influenza Immunization 98.43 80.52
226 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention 100.00 80.97
113 Colorectal Cancer Screening 92.03 73.63
112 Breast Cancer Screening 88.36 75.11
438 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 100.00 84.24
479 Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups 0.1511 0.1540
MCC1 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions for ACOs (MCC) 32.50 33.99
CAHPS-1 Getting Timely Care, Appointments, and Information 88.65 84.67
CAHPS-2 How Well Providers Communicate 95.67 93.56
CAHPS-3 Patient’s Rating of Provider 94.18 92.19
CAHPS-4 Access to Specialists 81.73 78.80
CAHPS-5 Health Promotion and Education 66.13 61.61
CAHPS-6 Shared Decision Making 66.68 60.89
CAHPS-7 Health Status and Functional Status 71.02 71.78
CAHPS-8 Care Coordination 88.01 85.66
CAHPS-9 Courteous and Helpful Office Staff 93.91 91.88
CAHPS-11 Stewardship of Patient Resources 27.70 24.71

Please note, the Quality ID#: 370 (Depression Remission at 12 Months) Quality Measure is not inclued in public reporting due to low sample size.

For previous years’ Financial and Quality Performance Results, please visit data.cms.gov

Payment Rule Waivers

  • • No, our ACO does not use the SNF 3-Day Rule Waiver.
  • • Yes, our ACO clinicians provide telehealth services using the flexibilities under 42 CFR § 425.612(f) and 42 CFR § 425.613.

 

Fraud and Abuse Waivers

Primary PartnerCare ACO Independent Practice Association, Inc. (“ACO”) is a Medicare Shared Savings Program ACO. The Secretary of the Department of Health and Human Services has provided four waivers of federal fraud and abuse laws in connection with the Medicare Shared Savings Program. The ACO Board of Directors has made a bona fide determination that an arrangement with Quest Diagnostics as described below is reasonably related to the purpose of the Medicare Shared Savings Program, and has authorized such arrangement. The collaboration is related to the purposes of the Medicare Shared Savings Program because it promotes accountability for the quality, cost and overall care for a Medicare population by managing and coordinating care for Medicare beneficiaries, and encouraging investment in infrastructure and redesigned care processes for high quality and efficient service delivery for Medicare beneficiaries. Specifically, ACO is seeking ACO Participation Waiver protection for its arrangement with Quest Diagnostics to:

  • • Promote evidence-based medicine and patient engagement.
  • • Meet the requirements for reporting quality and cost measures coordinating care.
  • • Establish clinical and administrative systems.
  • • Meet the clinical integration requirements of the Medicare Shared Savings Program.
  • • Evaluate the health needs of the ACO’s aligned population.
  • • Communicate clinical knowledge and evidence based medicine to Medicare beneficiaries.
  • • Develop standards for beneficiary access and communication, including beneficiary access to medical records.

 

For general questions or additional information about Accountable Care Organizations, please visit
www.medicare.gov/acos.html or call 1-800 MEDICARE (1-800-633-4227). TTY Users should call
1-877-487-2048.