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 – 2023

ACO Participants ACO Participant in Joint Venture
(Enter Y or N)
Benjamin Z. Arbesfeld, MD, PC N
Ebenezer Odoom, MD, PC N
Ihor Magun MD N
Long Beach Family Medicine, PC N
North Shore Gastroenterology Associates N
Primary PartnerCare Physicians, PLLC N
Scott V. Rankin MD, PC N
Woo Sup Kim MD PC N

 

ACO Governing Body

First Name Last Name Title/Position Member’s Voting Power (Percentage) Membership Type ACO Participant TIN Legal Business Name/DBA,if Applicable
Harry Jacob Chief Medical Officer & Director 14.29% ACO Physician Primary PartnerCare Physicians, PLLC
Lawrence Crafa Treasurer & Director 14.29% ACO Physician Primary PartnerCarePhysicians, PLLC
James Stallone Director 14.29% ACO Physician Primary PartnerCarePhysicians, PLLC
Aretha Persaud Director 14.29% ACO Physician Primary PartnerCare Physicians, PLLC
Donato Balsamo Director 14.29% ACO Physician Primary PartnerCarePhysicians, PLLC
Marion Davis Chief Executive Officer & Director 14.29% Other
TBD TBD Medicare Beneficiary 14.29% Other

 

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 2022, $6,060,262
  • 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 Proportion invested in infrastructure Proportion invested in redesigned care processes/ resources Proportion of distribution to ACO participants
Third Agreement Period 2022 35% 15% 50%
2021 35% 15% 50%
2020 35% 15% 50%
Second Agreement Period 2019 32% 18% 50%
2018 36% 14% 50%
2017 28% 22% 50%
First Agreement Period 2016 N/A N/A N/A
2015 N/A N/A N/A
2014 N/A N/A N/A

Quality Performance Results

2022 Quality Performance Results: Quality performance results are based on CMS Web Interface

Measure # Measure Name Rate ACO Mean
001 Diabetes: Hemoglobin A1c (HbA1c) Poor Control 6.12 10.71
134 Preventative Care and Screening: Screening for Depression and Follow-up Plan 96.34 76.97
236 Controlling High Blood Pressure 93.87 76.16
318 Falls: Screening for Future Fall Risk 97.58 87.83
110 Preventative Care and Screening: Influenza Immunization 96.86 77.34
226 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention 96.55 79.27
113 Colorectal Cancer Screening 93.98 75.32
112 Breast Cancer Screening 90.11 78.07
438 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 93.59 86.37
370 Depression Remission at Twelve Months 0.00 16.03
479 Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups 0.1395 0.1510
484 Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions 25.71 30.97
CAHPS-1 Getting Timely Care, Appointments, and Information 90.79 84.67
CAHPS-2 How Well Providers Communicate 95.67 93.56
CAHPS-3 Patient’s Rating of Provider 94.49 92.06
CAHPS-4 Access to Specialists 81.60 77.00
CAHPS-5 Health Promotion and Education 71.12 62.68
CAHPS-6 Shared Decision Making 67.14 60.97
CAHPS-7 Health Status and Functional Status 72.30 73.06
CAHPS-8 Care Coordination 87.60 85.46
CAHPS-9 Courteous and Helpful Office Staff 94.01 91.97
CAHPS-11 Stewardship of Patient Resources 25.99 25.62

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 1-877-486-2048.