Pricare ACO, LLC

9510 Ormsby Station Rd
Louisville, KY 40223

ACO Primary Contact:

Gary Albers
9510 Ormsby Station Rd
Louisville, KY 40223
502-386-4944
garyalbers@imperiumhlth.com

Pricare ACO, LLC


1775 Alysheba Way
Ste 201
Lexington, Kentucky 40509

ACO Primary Contact

Primary Contact Name

Gary Albers

Primary Contact Phone Number

502-386-4944

Primary Contact Email Address

garyalbers@imperiumhlth.com

Organizational Information

ACO participants:

ACO Participants

ACO Participant in Joint Venture (Enter Y or N)

Benjamin P. Lyon, M.D., LLC

N

Matthew C Birdwhistell DO LLC

N

Family Practice Associates of Lexington, PSC

N

Capital Family Physicians, PSC

N

R. Craig Martin, M.D., P.S.C.

N

Family Medicine Clinic of Danville, P.S.C.

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

Gillispie

Craig

Voting Member

12.5%

ACO Participant Representative

Family Practice Associates of Lexington

Lyon

Benjamin

Voting Member

12.5%

ACO Participant Representative

Benjamin P. Lyon, MD, LLC

Hempel

Richard

Voting Member

12.5%

ACO Participant Representative

Family Medical Clinic of Danville, P.S.C.

Amick

Carol

Voting Member

12.5%

ACO Participant Representative

Capital Family Physicians, PSC

Crum

Steven

Voting Member

12.5%

ACO Participant Representative

Capital Family Physicians, PSC

Foxx

William

Voting Member

12.5%

ACO Participant Representative

Family Practice Associates of Lexington

Cooper

Vivian

Voting Member

12.5%

Medicare Beneficiary Representative

N/A

Albers

Gary

Voting Member

12.5%

Other: Management Representative

N/A

 

Key ACO clinical and administrative leadership:

Gary Albers

ACO Executive

John Reesor

Medical Director

Benjamin Levine

Compliance Officer

Richard Hempel

Quality Assurance/Improvement Officer

 

Associated committees and committee leadership:

Committee Name

Committee Leader Name and Position

Clinical Policy Committee

Richard Hempel, Chair

Quality Committee

Steven Crum, Chair

Performance Review, Finance Compliance Committee

William Foxx, Chair

 

 

 

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

  • Networks of individual practices of ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses

  • First Agreement Period
    • Performance Year 2016, $0
    • Performance Year 2015, $0

 

 

Shared Savings Distribution

  • 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

Quality Performance Results

2016 Quality Performance Results:

ACO#

Measure Name

Rate

ACO Mean

ACO-1

CAHPS: Getting Timely Care, Appointments, and Information

81.29

79.9

ACO-2

CAHPS: How Well Your Providers Communicate

94.57

92.63

ACO-3

CAHPS: Patients' Rating of Provider

94.77

91.93

ACO-4

CAHPS: Access to Specialists

81.93

83.52

ACO-5

CAHPS: Health Promotion and Education

58.23

60

ACO-6

CAHPS: Shared Decision Making

73.69

75.28

ACO-7

CAHPS: Health Status/Functional Status

73.04

71.82

ACO-34

CAHPS: Stewardship of Patient Resources

32.73

27.52

ACO-8

Risk-Standardized, All Condition Readmission

14.81

14.7

ACO-35

Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM)

17.77

18.17

ACO-36

All-Cause Unplanned Admissions for Patients with Diabetes

52.08

53.2

ACO-37

All-Cause Unplanned Admissions for Patients with Heart Failure

69.32

75.23

ACO-38

All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions

55.42

59.81

ACO-9

Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5)

4.37

9.27

ACO-10

Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8 )

15.59

14.53

ACO-11

Percent of PCPs who Successfully Meet Meaningful Use Requirements

100

82.72

ACO-39

Documentation of Current Medications in the Medical Record

92.93

87.54

ACO-13

Falls: Screening for Future Fall Risk

46.23

64.04

ACO-14

Preventive Care and Screening: Influenza Immunization

76.61

68.32

ACO-15

Pneumonia Vaccination Status for Older Adults

75.21

69.21

ACO-16

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up

92.58

74.45

ACO-17

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

97.22

90.98

ACO-18

Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan

45.29

53.63

ACO-19

Colorectal Cancer Screening

69.57

61.52

ACO-20

Breast Cancer Screening

69.88

67.61

ACO-21

Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented

80.8

76.84

ACO-42

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

79.36

77.72

ACO-27

Diabetes Mellitus: Hemoglobin A1c Poor Control

13.14

18.24

ACO-41

Diabetes: Eye Exam  

43.8

44.94

ACO-28

Hypertension (HTN): Controlling High Blood Pressure

67.31

70.52

ACO-30

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

90.06

85.05

ACO-31

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

91.94

88.67

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%)

77.51

79.67

 

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low samples.   

 

Note: In the Quality Performance Results file(s) above, search for “Pricare ACO, LLC” to view the quality performance results. This ACO can also be found by using the ACO ID A50281 in the public use files on data.cms.gov.

Payment Rule Waivers

·         No, our ACO does not use the SNF 3-Day Rule Waiver