MSSP


ACO Name and Location

Banner Health Network
2901 N Central
Suite 160
Phoenix, AZ 85012

 

ACO Primary Contact

Kynda Wolfrum, Sr. Director, Government Operations
Phone: 970-810-8706
Email: Kynda.Wolfrum@bannerhealth.com

 

Organizational Information

ACO ParticipantsACO Participant in Joint Venture
(Enter Y or N)
Accredited Family Healthcare PC N
ADAM S. NALLY, D.O., P.C. N
Advent Internal Medicine PLLC N
AFFILIATED INTERNAL MEDICINE ASSOCIATES LLC N
ALLIED MEDICAL ASSOCIATES PLC N
AMARDEEP S MAJHAIL MD PC N
ANTONIO T UVAS PLLC N
ANTONIO V YU JR MD PC N
Apex Internal Medicine, P.C. N
ARIZONA INTERNAL MEDICINE & PEDIATRICS CORP. N
Arizona Internal Medicine Associates LLC N
ARIZONA PREFERRED PRIMARY CARE,PLC N
Banner - - University Primary Care Physicians LLC N
Banner Health N
Banner Primary Care Physicians Arizona Llc N
BENDEL CLINIC PLLC N
Bestcare Internal Medicine PLLC N
Blair T Butterfield PC N
Brown Road Family Medicine PLLC N
CENTRAL ARIZONA MEDICAL ASSOCIATES N
Community Hospital Association Inc N
Consultants In Internal Medicine PC N
DESERET FAMILY MEDICINE AT GREENFIELD PLC N
DESERET MEDICAL ASSOCIATES PLC N
Desert View Family Medicine Pllc N
Dipti Patel PLLC N
Drew Durbin DO PLLC N
ESTRELLA INTERNAL MEDICINE & GERIATRICS CLINIC, PLC N
ESTRELLA SPECIALTY MEDICAL CARE P C N
FALA MEDICAL CLINIC PLLC N
FAMILY FIRST PHYSICIANS PLLC N
FAMILY HEALTH CENTER OF EAST VALLEY PLLC N
GOLD CANYON INTERNAL MEDICINE N
GOOD HEALTH MEDICAL, PLLC N
Good Years Family Medicine LLC N
GRAND CANYON FAMILY MEDICINE PC N
Greenfield Family Medicine LLC N
HEALTHFIRST PRIMARY CARE, PLLC N
Healthy Life Family Medicine Plc N
Innovative Family Health Practices LLC N
ISHA GUPTA MD PLLC N
JAMES G LIEBER MD PLC N
Karen Leber N
Kyrene Internal Medicine Pllc N
LEADING HEALTHCARE CLINIC OF GOODYEAR, LLC N
M ZUHDI JASSER MD PC N
MADHURI DHUPATI M.D. & ASSOCIATES PC N
MAXWELL GROUP N
Medcubed PLLC N
MESA FAMILY PHYSICIANS, PLC N
Monaliza Setudehnia MD PLLC N
NEENA K UPPAL MD PC N
NESTOR N. NAZARENO MD PC N
NORTERRA FAMILY MEDICINE, PLLC N
Ofelia Popluca N
Paul S. Charnetsky, M.D. P.C. N
Pete S Coury Md Pllc N
Phoenix West Internal Medicine Llc N
Pinakin G Bhakta MD PC N
Pinnacle Family Medicine, Plc N
Pradip Patel MD PC N
S P GILL MD PC N
SARITA S. SHARMA, M.D., INTERNAL MEDICINE P.L.L.C. N
Southwest Internal Medicine Llc N
Sun City Internal Medicine N
Sunrise Internal Medicine PC N
SUNRISE MEDICAL ASSOCIATES LLC N
SURPRISE MEDICAL CONSULTANTS LLC N
TESAI,PLC N
THOMPSON MEDICAL GROUP N
Valley Internal Medicine and Pediatrics PC N
VERSATILE MEDICINE PLLC N
Wabash Medical Associates P C N
WESTSIDE INTERNAL MEDICINE PC N
WESTSIDE PRIMARY CARE ASSOCIATES PLLC N

 

ACO Governing Body

 

Last NameFirst NameTitle/PositionMember's Voting Power -Expressed as a percentage or numberMembership TypeACO Participant Legal Business Name/DBA, if Applicable
Engstrom David Physician 1 ACO Participant Representative Pinnacle Family Medicine
Bader Karen Physician 1 ACO Participant Representative Desert View Family Medicine LLC
Bessel Marjorie Banner CMO 1 ACO Participant Representative Banner Health
Birdi Shiva Physician 1 ACO Participant Representative Banner Primary Care Physicians Arizona Llc
Butterfield Blair Physician 1 ACO Participant Representative Blair T Butterfield PC
Caplan Joseph Physician 1 Other: Specialty Network Joseph A Caplan MD PC DBA Cardiac Solutions
TBD TBD TBD 1 ACO Participant Representative Banner Health
Perry Amy Banner COO 1 ACO Participant Representative Banner Health
Piette Randy Physician 1 ACO Participant Representative Maxwell Group
Ritchie Thomas Physician 1 Other: Specialty Network Tri-City Cardiology
Sodhi Amandeep Physician 1 ACO Participant Representative Westside Internal Medicine
Valenzuela David Physician 1 ACO Participant Representative Banner Primary Care Physicians Arizona Llc
Weissman Jerry Beneficiary 1 Medicare Beneficiary Beneficiary
Werner Todd Banner, President AZ Community Delivery 1 ACO Participant Representative Banner Health
Zismann Nancy BMG Chief Clinical Services Officer 1 ACO Participant Representative Banner Primary Care Physicians Arizona Llc
Key ACO Clinical and Administrative Leadership 

ACO Executive: Chuck Lehn

Medical Director: Ed Clarke, M.D.

Compliance Officer: Sean Reneau

Quality Assurance/Improvement Officer: Sandra Robles-Caraveo

Associated Committees and Committee Leadership

Compliance Committee - Sean Reneau, Compliance Officer

Medical Executive Committee - Dr. Ed Clarke, VP, CMO Insurance Division

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
  • Second Agreement Period

    • Performance Year 2022, $22,965,884

    • Performance Year 2021, $25,580,704

    • Performance Year 2020, $12,893,795.33

    • Performance Year 2019, $3,908,104

  • First Agreement Period

    • Performance Year 2019, $3,908,104

    • Performance Year 2018, $4,471,259

    • Performance Year 2017, $0

Note: Our ACO participated in multiple performance years during Calendar Year 2019. Shared savings/losses amount reported for Performance Year 2019 therefore represents net shared savings or losses across all performance years in 2019 and is shown under all agreement periods in which the ACO operated during Calendar Year 2019.

Shared Savings Distribution:
  • Second Agreement Period

    • Performance Year 2022

      • Proportion invested in infrastructure: 25%

      • Proportion invested in redesigned care processes/resources: 25%

      • Proportion of distribution to ACO participants: 50%

    • Performance Year 2021

      • Proportion invested in infrastructure: 25%

      • Proportion invested in redesigned care processes/resources: 25%

      • Proportion of distribution to ACO participants: 50%

    • Performance Year 2020

      • Proportion invested in infrastructure: 25%

      • Proportion invested in redesigned care processes/resources: 25%

      • Proportion of distribution to ACO participants: 50%

    • Performance Year 2019

      • Proportion invested in infrastructure: 25%

      • Proportion invested in redesigned care processes/resources: 25%

      • Proportion of distribution to ACO participants: 50%

  • First Agreement Period

    • Performance Year 2019

      • Proportion invested in infrastructure: 25%

      • Proportion invested in redesigned care processes/resources: 25%

      • Proportion of distribution to ACO participants: 50%

Note: Our ACO participated in multiple performance years during Calendar Year 2019. Distribution of shared savings reported for Performance Year 2019 therefore represents the distribution of the net shared savings across all performance years in 2019 and is shown under all agreement periods in which the ACO operated during Calendar Year 2019.

 

Quality Performance Results

2022 Quality Performance Results

Quality Performance results are based on CMS Web Interface

Measure #Measure NameRateACO Mean
Measure #001 Diabetes: Hemoglobic A1c (BHA1c) Poor Control 6.0 10.71
Measure #134 Preventative Care and Screening: Screening for Depression and Follow-up Plan 87.00 76.97
Measure #236 Controlling High Blood Pressure 76.65 76.16
Measure #318 Falls: Screening for Future Fall Risk 94.19 87.83
Measure #110 Preventative Care and Screening: Influenza Immunization 80.42 77.34
Measure #226 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention 93.75 79.27
Measure #113 Colorectal Cancer Screening 80.88 75.32
Measure #112 Breast Cancer Screening 81.25 78.07
Measure #438 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 86.02 86.37
Measure #370 Depression Remission at Twelve Months 22.22 16.03
Measure #479 Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups [1]. 0.01418 0.151
Measure #484 Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions [1] 25.47 30.97

[1] A lower performance rate corresponds to higher quality.

Please note the Quality ID#: 370 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size.

For Previous Years’ Financial and Quality Performance Results, please visit data.cms.gov.

Payment Rule Waivers

Skilled Nursing Facility (SNF) 3-day Rule Waiver:

Yes, our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR 425.612

 

Banner Health Network ACO Participation Waiver

 

Background:

The Centers for Medicare and Medicaid Services and the U.S. Department of Health and Human Services’ Office of Inspector General have made available waivers of certain federal fraud and abuse laws in connection with the operation of the accountable care organizations (“ACOs”) that have entered into a participation agreement under the Medicare Shared Savings Program (“MSSP”).

 

Program Name:

Banner Health Network MSSP 2021 Incentive Program for Wet AMD

 

All Parties Involved:

Banner Health Network, Inc. (BHN)

Advanced Retina & Eye Cancer Center

Associated Retina Consultants

Arizona Retina and Vitreous Consultants

Phoenix Retina Associates

Arizona Macular Degeneration

Carrott Eye Center

Arizona Retina Associates

 

Date Program Will Begin:

July 1, 2021

 

Description of Arrangement:

BHN developed an incentive plan to reward ophthalmology practices that tend to see a significant volume of MSSP beneficiaries. Under the incentive plan, the participating practices agree to consider using lower cost, but equally efficacious, vascular endothelial growth factor modulating medications (VEGF) to treat AMD and other similar conditions when clinically appropriate. The program is intended to assist BHN in meeting the MSSP objectives of providing quality care and lowering costs to both CMS and to the beneficiary.  BHN will track individual performance as well as relative performance to determine if objectives are being met by participants. When goals are met, BHN will provide financial incentives to the participants.

 

Items, Services, Facilities or Goods Covered by the Arrangement:

Financial incentives paid to ophthalmology practices.

 

Date and Manner of Governing Body’s Authorization:

Approved by the BHN Board of Directors on November 19, 2020.  The BHN Board of Directors made a bona fide determination that the Banner Health Network MSSP 2021 Incentive Program for Wet AMD is reasonably related to the purposes of MSSP and will improve the care delivered to BHN’s Medicare beneficiaries.