Shared savings program
ACO name and location
ProHealth Solutions, LLC
N17W24100 Riverwood Drive
Waukesha, WI 53188
ACO primary contact
Peter Bacon
262-696-0475
peter.bacon@phci.org
Organizational information
ACO participants:
|
ACO participant name
|
ACO participant in joint venture
|
|
Allergy Research & Care, SC
|
N
|
|
Anex, SC
|
N
|
|
Anthony Hoang, MD, SC
|
N
|
|
Apogee Medical Group Waukesha, SC
|
N
|
| Central Otologic, LTD |
N
|
|
CJ Hussussian, MD, SC
|
N
|
|
D Strong, Inc
|
N
|
|
Doenier Family Medicine, SC
|
N
|
|
Emergency Medical Associates, LLP
|
N
|
|
Foot and Ankle Associates of WI, LTD
|
N
|
|
Gastroenterology Specialists, SC
|
N
|
|
Infectious Disease Specialists of SE WI, SC
|
N
|
|
Jane Neumann
|
N
|
|
Lake Country Emergency Physicians
|
N
|
|
Lake Country Pediatrics, SC
|
N
|
|
Lake Country Plastic and Hand Surgery, SC
|
N
|
|
Maple Medical, SC
|
N
|
|
Mary M Milbrath, MD, SC
|
N
|
|
Medical Eye Associates, SC
|
N
|
|
Milwaukee GI Specialists, SC
|
N
|
|
Moreland Ear Nose & Throat Group, LTD
|
N
|
|
Moreland OB-GYN Associates, SC
|
N
|
|
Nephrology Associates, SC
|
N
|
|
Nezih Z. Hasanoglu, DO, SC
|
N
|
|
Orthopaedic Associates of Wisconsin, SC
|
N
|
|
Paul B. Doenier, MD, SC
|
N
|
|
ProHealth Medical Group, Inc.
|
N
|
|
Radiology Waukesha, SC
|
N
|
|
Richard Neils
|
N
|
|
Thomas G Korkos, MD, SC
|
N
|
|
Timothy G McAvoy, MD, SC
|
N
|
|
Urology Associates, LTD, SC
|
N
|
|
Waukesha Surgical Specialists, SC
|
N
|
|
West Suburban Ctr For Arthritis
|
N
|
|
Womens Health Care, SC
|
N
|
ACO governing body:
| Member first name |
Member last name
|
Member title or position
|
Member's voting power (expressed as a percentage) |
Membership type
|
ACO participant legal business name, if applicable
|
|
Chris
|
Davies |
Chairperson
|
8.333%
|
ACO participant representative
|
Waukesha Surgical Specialists, SC
|
|
Vicki
|
Dallmann-Papke
|
Vice chairperson
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Susan
|
Edwards
|
President
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Rick
|
Papandrea
|
Vice president
|
8.333%
|
ACO participant representative
|
Orthopaedic Associates of Wisconsin, SC
|
|
Allison
|
Nelson
|
Secretary
|
8.333%
|
ACO participant representative
|
Moreland OB-GYN Associates, SC
|
|
Peter
|
Bacon
|
Board member
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Mary
|
Baer
|
Medicare beneficiary representative and consumer advocate
|
0%
|
Medicare beneficiary representative
|
N/A
|
|
Matt
|
Biebel
|
Board member
|
8.333%
|
Other
|
N/A
|
|
Arthur
|
Coffey
|
Board member
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Andy
|
Gutierrez
|
Treasurer
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Ken
|
Price
|
Board member
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Brad
|
Treichel
|
Board member
|
8.333%
|
ACO participant representative
|
ProHealth Medical Group, Inc. |
|
Tim
|
Westlake
|
Board member
|
8.333%
|
ACO participant representative
|
Lake Country Emergency Physicians
|
Key ACO clinical and administrative leadership:
ACO executive: Peter Bacon
Medical director: Arthur Coffey
Compliance officer: Lynn Wojnowski
Quality assurance and improvement officer: Vicki Dallmann-Papke
Associated committees and committee leadership:
|
Committee name
|
Committee leader name and position
|
|
ProHealth Solutions Board of Managers
|
Chris Davies, chairperson
|
|
ProHealth Solutions Credentialing and Peer Review Committee
|
Matt Biebel, chairperson
|
|
ProHealth Solutions Finance
|
Andy Gutierrez, chairperson
|
Types of ACO participants, or combinations of participants, that formed the ACO:
ACO professionals in group practice arrangements
Shared savings and losses:
Second agreement period
Performance year 2023: N/A
First agreement period
Performance year 2022: $0
Shared savings distribution:
Second agreement period
Performance year 2023: N/A
Proportion invested in infrastructure: N/A
Proportion invested in redesigned care processes and resources: N/A
Proportion of distribution to ACO participants: N/A
First agreement period
Performance year 2022: $0
Proportion invested in infrastructure: $0
Proportion invested in redesigned care processes and resources: $0
Proportion of distribution to ACO participants: $0
Quality performance results:
2022 quality performance results:
| Measure number |
Measure name |
Collection type |
Rate |
ACO mean |
| Quality 001 |
Diabetes: Hemoglobin A1c (HBA1c) poor control |
CMS web interface |
4.78 |
10.71 |
| Quality 134 |
Preventive care and screening: Depression and follow-up plan |
CMS web interface |
76.17 |
76.97 |
|
Quality 236
|
Controlling high blood pressure |
CMS web interface |
88.00 |
76.16 |
|
Quality 318
|
Falls: Screening for future fall risk |
CMS web interface |
88.26 |
87.83 |
|
Quality 110
|
Preventive care and screening: Influenza immunization |
CMS web interface |
77.49 |
77.34 |
|
Quality 226
|
Preventive care and screening: Tobacco use screening and cessation intervention |
CMS web interface |
51.28 |
79.27 |
|
Quality 113
|
Colorectal cancer screening |
CMS web interface |
82.75 |
75.32 |
|
Quality 112
|
Breast cancer screening |
CMS web interface |
90.51 |
78.07 |
|
Quality 438
|
Statin therapy for the prevention and treatment of cardiovascular disease |
CMS web interface |
88.19 |
86.37 |
|
Quality 370
|
Depression remission at twelve months |
CMS web interface |
4.48 |
16.03 |
|
Quality 479
|
Hospital-wide, 30-day, all-cause unplanned readmission (HWR) rate for MIPS groups |
Administrative claims |
0.1554 |
0.1510 |
|
Quality 484
|
Clinician and clinician group risk-standardized hospital admission rates for patients with multiple chronic conditions |
Administrative claims |
32.56 |
30.97 |
|
CAHPS 1
|
Getting timely care, appointments and information |
CAHPS for MIPS |
83.72 |
83.96 |
|
CAHPS 2
|
How well providers communicate |
CAHPS for MIPS |
94.77 |
93.47 |
|
CAHPS 3
|
Patient's rating of provider |
CAHPS for MIPS |
93.31 |
92.06 |
|
CAHPS 4
|
Access to specialists |
CAHPS for MIPS |
76.14 |
77.00 |
|
CAHPS 5
|
Health promotion and education |
CAHPS for MIPS |
63.88 |
62.68 |
|
CAHPS 6
|
Sharing decision making |
CAHPS for MIPS |
62.41 |
60.97 |
|
CAHPS 7
|
Health status and functional status |
CAHPS for MIPS |
76.04 |
73.06 |
|
CAHPS 8
|
Care coordination |
CAHPS for MIPS |
87.98 |
85.46 |
|
CAHPS 9
|
Courteous and helpful office staff |
CAHPS for MIPS |
94.36 |
91.97 |
|
CAHPS 11
|
Stewardship of patient resources |
CAHPS for MIPS |
19.33
|
25.62 |
2021 quality performance results:
ProHealth Solutions did not participate in the Shared Savings Program in 2021. This section is not applicable.
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
