SIMED Online

ICA ACO Name and Location Integrated Care Alliance, LLC
4343 W. Newberry Road, Suite 18
Gainesville, FL  32607

ICA ACO Primary Contact
Connie Pegram, Population Health Management Director
cpegram@simedhealth.com
(352) 224-2234

Organizational Information: ICA ACO Participants

Southeastern Integrated Medical, PL (SIMED)
James McCauley, MD, PA
No participants are involved in a joint venture between ACO professionals and hospitals.

ICA ACO Governing Body
Voting members

Larissa Lim, MD, Chair (SIMED Board of Managers-ACO Participant)
Greg Geiger, MD, ICA Medical Director (SIMED-ACO Participant)
Daniel Duncanson, MD (CEO of ICA and SIMED, Vice Chair of SIMED Board of Managers- ACO Participant)
James McCauley, MD, (James McCauley, MD, PA, CEO, Partner-ACO Participant)
Russell Deegan (Medicare Beneficiary Representative)
Ex officio participants
Farrukh Ambareen, MD (James McCauley, MD, PA-ACO Participant)
Cristoforo Cama, MD (SIMED-ACO Participant)
Jenny Chen, MD (SIMED-ACO Participant) 
Mary Hurd, MD (SIMED Board of Managers-ACO Participant)
Wilda Murphy, MD (SIMED-ACO Participant)
Yogi Patel, MD (SIMED-ACO Participant)
Meera Nair, MD (SIMED-ACO Participant)
Seth Perkins, MD (SIMED-ACO Participant)
Eric Svetska, MD (SIMED-ACO Participant)

Connie Pegram (ICA Director-Staff)
Angela Kuhn, (COO of SIMED-Staff)
Key ICA ACO Clinical and Administrative Leadership
ACO Executive:                                            Daniel M. Duncanson, MD, CPE, CEO
Medical Directors:                                          Gregory Geiger, MD and James McCauley, MD
Compliance Official                                        Connie Pegram
Quality Assurance/Improvement Officer:       Connie Pegram
 
ICA ACO Committees and ACO Committee Leadership

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

Network of individual practices of ACO professionals. 

Integrated Care Alliance, LLC (ICA) Committee Members  

ICA Quality Committee

Mary Hurd, MD, Chairman (SIMED, Participant Representative)

Raul Diaz, MD (SIMED, Participant Representative)

Greg Geiger, MD (SIMED, Participant Representative)

David Lefkowitz, MD (SIMED, Participant Representative)

James McCauley, MD, (James McCauley, MD, PA, Participant Representative)

Wilda Murphy, MD (SIMED, Participant Representative)

Shelley Roque-Lichtig, MD (SIMED, Participant Representative)

Prethi Vaddadi, MD (SIMED, Participant Representative)

Diane Watson, Executive Director, Primary Care and Pulmonology (SIMED)

Connie Pegram, Director, Population Health Management (SIMED)

ICA Utilization Management Committee

Greg Geiger, MD, Chairman, (SIMED Participant Representative)

Cristoforo Cama, MD (SIMED Participant Representative)

Oscar DePaz, MD (SIMED, Participant Representative)

James McCauley, MD, ICA Medical Director (James McCauley, MD, PA, Participant Representative)

Meera Nair, MD (SIMED, Participant Representative)

Yogi Patel, MD (SIMED, Participant Representative)

Seth Perkins, MD (SIMED, Participant Representative)

Connie Pegram, Director, Population Health Management (SIMED)

ICA Compliance Committee

Oscar DePaz, MD, Chairman (SIMED, Participant Representative)

Elizabeth Durgee, ARNP (SIMED, Participant Representative)

Stephanie Ingram, MD, (SIMED, Participant Representative)

David Lefkowitz, MD (SIMED, Participant Representative)

Michael MacMillan, MD (SIMED, Participant Representative)

James McCauley, MD, ICA Medical Director (James McCauley, MD, PA, Participant Representative)

Ozzie Rodriguez, MD (SIMED, Participant Representative)

Belen Tan, MD (SIMED, Participant Representative)

Scott Wilson, MD (SIMED, Participant Representative)

Polina Rivera, Director, A/R (SIMED)

Kristin Roberts, VP, Support Services (SIMED)

Connie Pegram, Director, Population Health Management (SIMED)

Amount of Shared Saving/Losses and How Shared Savings are Distributed

Agreement period beginning 2012, Performance Year 1: $0
Agreement period beginning 2012, Performance Year 2014 – $0
Agreement period beginning 2012, Performance Year 2015 – $0

 

Shared Savings Distribution 
The ICA goal is to maintain a 20% expense ratio to savings.  The ICA will retain a portion of the CMS Shared Savings Program (SSP) funds to cover the administrative and development costs listed below as “Y” and “Z”.

ICA Shared Savings = X
ICA Administrative costs = Y
ICA Retention = Z
X – Y – Z = A (Distribution funds)

Administrative costs support additional resources, personnel and associated capital, and other start-up expenses:

  • Medical Directors
  • ACO Director
  • Case Managers
  • Data Analyst
  • Administrative Support

Retention will support:

  • Improved infrastructure
  • Resources and tools to redesign care processes
  • Interoperability between care providers (EHR)
  • Resources to educate care providers (Dashboards, data analytics capabilities)
  • Beneficiaries access to medical information (i.e., patient portal)
  • Reserves to offset potential expenses related to assuming future financial risk

The remainder (“A”) of ICA’s portion of the SSP funds will be distributed to ACO participating care providers (participants/partners).  The ICA will base the ACO participant’s payment on the number of physicians participating with each ACO partner in each category (Primary Care Physician and Specialist).  The distribution percentage is then applied to the number of employed physicians.  The ACO partner will then distribute funds to their participating ACO physicians.

The formula that has been established for distribution of the SSP funds is:

A x 65% = Primary Care Physicians’ pool
A x 35% = Specialty Care Physicians’ pool

The distribution percentages are based on a formula that rewards primary care physicians in greater proportion than specialists.  This is to reward primary care physicians for their contributions in reducing fragmentation of care by managing care across the continuum, and in providing and documenting care and services in accordance with SSP quality metrics.

Payment Rule Waivers 
No, our ACO does not utilize the SNF 3-Day Rule Waiver.

Quality Performance Results

Measure number Measure Name 2015 reporting period
ACO
performance rate
Mean performance rate (SSP-  ACOs)
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 75.74 80.61
ACO-2 CAHPS: How Well Your Providers Communicate 91.77 92.65
ACO-3 CAHPS: Patients’ Rating of Provider 89.95 91.94
ACO-4 CAHPS: Access to Specialists 86.61 83.61
ACO-5 CAHPS: Health Promotion and Education 66.77 59.06
ACO-6 CAHPS: Shared Decision Making 74.54 75.17
ACO-7 CAHPS: Health Status/Functional Status 72.06 72.30
ACO-34 CAHPS: Stewardship of Patient Resources* 37.34 26.87
ACO-8 Risk Standardized, All Condition Readmission 15.62 14.86
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM)* Readmission 20.05 18.07
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes* 69.46 54.60
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure* 91.57 76.96
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 75.08 62.92
ACO-9 Ambulatory Sensitive Condition Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5) 1.11 1.11
ACO-10 Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8) 1.31 1.04
ACO-11  Percent of Primary Care Physicians who Successfully Meet Meaningful Use Requirements 96.43 80.14
ACO-39 Documentation of Current Medications in the Medical Record* 14.09 84.07
ACO-13 Falls: Screening for Future Fall Risk 72.66 56.46
ACO-14 Preventive Care and Screening: Influenza Immunization 59.50 62.03
ACO-15 Pneumonia Vaccination Status for Older Adults 73.05 63.73
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up 91.89 71.15
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 97.21 90.16
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 53.52 45.25
ACO-19 Colorectal Cancer Screening 61.18 60.06
ACO-20 Breast Cancer Screening 63.24 65.67
ACO-21 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 82.82 70.04
ACO-40 Depression Remission at Twelve Months* 2.94 6.11
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 18.95 20.38
ACO-41 Diabetes: Eye Exam* 46.37 41.05
ACO-28 Hypertension: Controlling High Blood Pressure 76.49 69.62
ACO-30 Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic 83.33 83.82
ACO-31 Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 98.25 87.22
ACO-33 Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%)  82.33 77.73
CAHPS = Consumer Assessment of Healthcare Providers and Systems, PQI = Prevention Quality Indicator, LVSD = left ventricular systolic dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery disease.
*= Measure required beginning Reporting Year 2015.
N/A= Reporting on the depression remission measure is not required for 2015, as indicated by N/A

 

Quality Performance Results Table
Measure
number
Performance measure 2012 reporting period 2013 reporting period 2014 reporting period
ACO
performance rate
Mean performance
rate for all ACOs
ACO
performance rate
Mean performance
rate for all ACOs
ACO
performance rate
Mean performance
rate for all ACOs
ACO #1 Getting Timely Care, Appointments, and Information N/A N/A N/A N/A 74.39 80.13
ACO #2 How Well Your Doctors Communicate N/A N/A N/A N/A 90.73 92.39
ACO #3 Patients’ Rating of Doctor N/A N/A N/A N/A 89.68 91.58
ACO #4 Access to Specialists N/A N/A N/A N/A 85.32 83.97
ACO #5 Health Promotion and Education N/A N/A N/A N/A 59.58 58.29
ACO #6 Shared Decision Making N/A N/A N/A N/A 75.04 74.60
ACO #7 Health Status/Functional Status N/A N/A N/A N/A 69.57 71.10
ACO #8 Risk Standardized, All Condition Readmissions 16.09 15.42 16.34 14.9 16.34 15.15
ACO #9 ASC Admissions: COPD or Asthma in Older Adults 1.12 1.13 1.03 1.17 1.16 1.08
ACO #10 ASC Admission: Heart Failure 1.52 1.09 1.58 1.2 1.51 1.19
ACO #11 Percent of PCPs who Qualified for EHR Incentive Payment 12.5 59.87 76.92 66.21 80.00 76.71
ACO #12 Medication Reconciliation N/A N/A N/A N/A 74.68 82.61
ACO #13 Falls: Screening for Fall Risk N/A N/A N/A N/A 60.24 45.60
ACO #14 Influenza Immunization N/A N/A N/A N/A 46.15 57.15
ACO #15 Pneumococcal Vaccination N/A N/A N/A N/A 53.75 55.03
ACO #16 Adult Weight Screening and Follow-up N/A N/A N/A N/A 87.59 66.75
ACO #17 Tobacco Use Assessment and Cessation Intervention N/A N/A N/A N/A 95.26 86.79
ACO #18 Depression Screening N/A N/A N/A N/A 46.03 39.27
ACO #19 Colorectal Cancer Screening  N/A N/A N/A N/A 56.42 56.14
ACO #20 Mammography Screening N/A N/A N/A N/A 59.76 61.41
ACO #21      Proportion of Adults who had blood pressure screened in past 2 years N/A N/A N/A N/A 58.13 60.24
ACO #22  Hemoglobin A1c Control (HbA1c) (<8 percent)  N/A N/A N/A N/A 74.76 N/A
 ACO #23  Low Density Lipoprotein (LDL) (<100 mg/dL) N/A N/A N/A N/A N/A N/A
 ACO #24  Blood Pressure (BP) <140/90  N/A N/A N/A N/A 70.05 N/A
ACO #25   Tobacco Non Use ACO N/A N/A N/A N/A 73.35 N/A
ACO #26  Aspirin Use ACO N/A N/A N/A N/A 82.39 N/A
ACO #27   Percent of beneficiaries with diabetes whose HbA1c in poor control (>9 percent) N/A N/A N/A N/A 16.75 20.35
ACO #28 #28 Percent of beneficiaries with hypertension whose BP <140/90   N/A N/A N/A N/A 68.61 68.02
ACO #29  Percent of beneficiaries with IVD with complete lipid profile and LDL control <100mg/dl  N/A N/A N/A N/A N/A N/A
ACO #30   Percent of beneficiaries with IVD who use Aspirin or other antithrombotic  N/A N/A N/A N/A 82.89 80.79
ACO  #31  Beta-Blocker Therapy for LVSD  N/A N/A N/A N/A 94.34 82.71
ACO #32  Drug Therapy for Lowering LDL Cholesterol   N/A N/A N/A N/A N/A N/A
ACO #33  ACE Inhibitor or ARB Therapy for Patients with CAD and Diabetes and/or LVSD N/A N/A N/A N/A 56.37 N/A

Note: ASC = ambulatory sensitive conditions, COPD = chronic obstructive pulmonary disease,, EHR = electronic health record, IVD = ischemic vascular disease, LVSD = left ventricular systolic dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery disease.
Please visit www.medicare.gov/acos.html or call 1-800-MEDICARE (1-800-633-4227 (TTY users should call 1-877-486-2048)) for questions or additional information about Accountable Care Organizations.