Accountable Care Organization

ACO Name and Location

ProMedica Health Network, Inc.
MSC-S29903
100 Madison Ave.
Toledo, OH 43604

ACO Primary Contact

Primary Contact Name: Deno Monnett

Primary Contact Phone Number: 567-585-7429

Primary Contact Email Address: Deno.Monnett@promedica.org

Organizational Information

ACO Participants


ACO Participants

ACO Participant in Joint Venture (Yes or No)

Arun Gupta Md PC

No

John Kalenkiewicz

No

Maywood Medical and Industrial Clinic, Inc

No

Memorial Professional Services, Ltd.

No

Nephrology Consultants Of Northwest Ohio, Inc

No

Promedica Central Corporation Of Michigan

No

PROMEDICA CENTRAL PHYSICIANS

No

ProMedica Genito-Urinary Surgeons, LLC

No

ProMedica Monroe Physicians PLLC

No

ProMedica Northwest Ohio Cardiology Consultants, LLC

No

Soudabeh Ahadi Md Pc

No

ACO Governing Body


First Name Last Name Title/Position Member's Voting Power Expressed as a % or number Membership Type ACO Participant Legal Business Name/DBA, if Applicable
Anthony Chung Voting Member 7.69% ACO Participant Representative ProMedica Central Physicians
Brooke Treloar Voting Member 7.69% ACO Participant Representative ProMedica Central Physicians
Danielle Pietrazak Voting Member 7.69% ACO Participant Representative ProMedica Central Physicians
Jeffery Bair Voting Member 7.69% ACO Participant Representative ProMedica Central Physicians
Joanna Shaw Voting Member 7.69% ACO Participant Representative ProMedica Central Physicians
Joanne Sickles Voting Member 7.69% Medicare Beneficiary Representative N/A
Julie Yaroch Voting Member 7.70% Other N/A
Lalaine Mattison Voting Member 7.69% ACO Participant Representative ProMedica Central Physicians
Matt Roth Voting Member 7.69% ACO Participant Representative ProMedica Central Physicians
Mohammad El Sayyad Voting Member 7.69% ACO Participant Representative Promedica Central Corporation Of Michigan
Patricia Modrowski Voting Member 7.70% Community Stakeholder Representative N/A
Sanjiv Josh Chair 7.70% ACO Participant Representative ProMedica Central Physicians
Vidhit Puri Voting Member 7.69% ACO Participant Representative Nephrology Consultants Of Northwest Ohio, Inc

Members' voting power may have been rounded to reflect a total voting power of 100 percent.

Key ACO Clinical and Administrative Leadership


ACO Executive: Deno Monnett
Medical Director: Dr. Kent Bishop
Compliance Officer: Ryan Dolan
Quality Assurance/Improvement Officer: Amanda Beck, Jo Hines

Associated Committees and Committee Leadership


Committee Name
Committee Leader Name and Position
Business and Network Development
Deno Monnett, Chair
Quality Committee
Jo Hines, Chair

Types of ACO Participants, or Combinations of Participants, That Formed the ACO:


  • ACO professionals in a group practice arrangement

  • Hospital employing ACO professionals

  • Networks of individual practices of ACO professionals

  • Rural Health Clinic (RHC)

Shared Savings and Losses


Amount of Shared Savings/Losses:

Third Agreement Period

  • Performance Year 2026, N/A
  • Performance Year 2025, N/A

Second Agreement Period

  • Performance Year 2024, $4,886,038.24
  • Performance Year 2023, $5,664,522.97
  • Performance Year 2022, $0
  • Performance Year 2021, $0
  • Performance Year 2020, $2,990,637.77
  • Performance Year 2019, $0

First Agreement Period

  • Performance Year 2019, $0
  • Performance Year 2018, $0
  • Performance Year 2017, N/A
  • Performance Year 2016, N/A

Note: Our ACO participated in multiple performance years during Calendar Year 2019. The 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:

Third Agreement Period

Performance Year 2026

  • 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 2025

  • Proportion invested in infrastructure: N/A
  • Proportion invested in redesigned care processes/resources: N/A
  • Proportion of distribution to ACO participants: N/A

Second Agreement Period

Performance Year 2024

  • Proportion invested in infrastructure: 40%
  • Proportion invested in redesigned care processes/resources: 0%
  • Proportion of distribution to ACO participants: 60%

Performance Year 2023

  • Proportion invested in infrastructure: 40%
  • Proportion invested in redesigned care processes/resources: 0%
  • Proportion of distribution to ACO participants: 60%

Performance Year 2022

  • 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 2021

  • 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 2020

  • Proportion invested in infrastructure: 40%
  • Proportion invested in redesigned care processes/resources: 0%
  • Proportion of distribution to ACO participants: 60%

Performance Year 2019

  • Proportion invested in infrastructure: N/A
  • Proportion invested in redesigned care processes/resources: N/A
  • Proportion of distribution to ACO participants: N/A

First Agreement Period

Performance Year 2019

  • 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 2018

  • 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 2017

  • 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 2016

  • Proportion invested in infrastructure: N/A
  • Proportion invested in redesigned care processes/resources: N/A
  • Proportion of distribution to ACO participants: N/A

Note: Our ACO participated in multiple performance years during Calendar Year 2019. The 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.

Waiver Arrangements Reasonably Related to MSSP Purposes

Electronic Health Record Access


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 accountable care organizations (“ ACOs”) that have entered into a participation agreement under the Medicare Shared Savings Program (“ MSSP”).

In order to receive the benefit of such waivers, on March 2, 2017, the governing body of ProMedica Health Network, Inc. (the “ Company”) made a bona fide, detailed determination that the following arrangement is reasonably related to the purposes of the MSSP and supports the goals of the Company:

The Company will subsidize, provide access to and the right to use certain electronic health records software and related services to the ACO participants listed below, in accordance with an end user agreement to be entered into by the Company and each ACO participant, pursuant to a written policy or policies as the governing body of the Company may adopt and amend from time to time.

  • 1. Soudabeh Ahadi, MD, PC
  • 2. Maywood Medical And Industrial Clinic, Inc.
  • 3. Associates in Womens Health, PLLC
  • 4. John J. Kalenkiewicz, M.D.
  • 5. Adrian Orthopedics, PC

Provision of Assistance to Achieve NCQA Recognition


The Centers for Medicare and Medicaid Services (“ CMS”)) and the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) have made available waivers of certain federal fraud and abuse laws in connection with the operation of accountable care organizations (“ ACOs”) that have entered into a participation agreement under the Medicare Shared Savings Program (“ MSSP”). In order to receive the benefit of such waivers, on August 11, 2016, the governing body of ProMedica Health Network, Inc. (the “ Company”) made a bona fide, detailed determination that the following arrangement is reasonably related to the purposes of the MSSP and supports the goals of the Company.

The Company will provide financial and administrative/operational assistance to eligible ACO participants who/that desire to seek recognition from the National Committee for Quality Assurance as a Patient Centered Medical Home or Patient Centered Specialty Practice, pursuant to a written policy or policies as the governing body of the Company may adopt and amend from time to time

Quality Performance Incentive – Primary Care Quality and Efficiency Fund


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

In order to receive the benefit of such waivers, on August 11, 2016, the governing body of ProMedica Health Network, Inc. (the “ Company” ) made a bona fide, detailed determination that the following arrangement is reasonably related to the purposes of the MSSP and supports the goals of the Company.

The Company will establish a quality performance incentive compensation fund and distribute incentive dollars within such fund to eligible ACO participants that employ or are otherwise affiliated with primary care providers who satisfy certain quality metrics, pursuant to a written policy or policies as the governing body of the Company may adopt and amend from time to time.

SNF 3-Day Rule Waiver


Yes, our ACO does utilize the SNF 3-Day Rule Wavier. Please contact us at PHN@promedica.org for the most current SNF Affiliate listing.

Quality Performance Results

2024 Quality Performance Results


Quality performance results are based on the CMS Web Interface collection type.

Measure
#
Measure
Title
Collection Type Performance Rate Current Year Mean Performance Rate (SSP ACOs)
321 CAHPS for MIPS CAHPS for MIPS Survey 8.55 6.67
479* Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups Administrative Claims 0.1474 0.1517
484* Clinician and Clinician Group Riskstandardized Hospital Admission Rates for Patients with Multiple Chronic Conditions (MCC) Administrative Claims - 37
318 Falls: Screening for Future Fall Risk CMS Web Interface 94.59 88.99
110 Preventative Care and Screening: Influenza Immunization CMS Web Interface 62.18 68.6
226 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention CMS Web Interface 80 79.98
113 Colorectal Cancer Screening CMS Web Interface 77.95 77.81
112 Breast Cancer Screening CMS Web Interface 88.8 80.93
438 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease CMS Web Interface 83.52 86.5
370 Depression Remission at Twelve Months CMS Web Interface 17.65 17.35
001* Diabetes: Hemoglobin A1c (HbA1c) Poor Control CMS Web Interface 9.09 9.44
134 Preventative Care and Screening: Screening for Depression and Follow-up Plan CMS Web Interface 86.33 81.46
236 Controlling High Blood Pressure CMS Web Interface 69.29 79.49
CAHPS-1 Getting Timely Care, Appointments, and Information CAHPS for MIPS Survey 87.07 83.7
CAHPS-2 How Well Providers Communicate CAHPS for MIPS Survey 94.91 93.96
CAHPS-3 Patient’s Rating of Provider CAHPS for MIPS Survey 92.96 92.43
CAHPS-4 Access to Specialists CAHPS for MIPS Survey 73.63 75.76
CAHPS-5 Health Promotion and Education CAHPS for MIPS Survey 69.61 65.48
CAHPS-6 Shared Decision Making CAHPS for MIPS Survey 70.15 62.31
CAHPS-7 Health Status and Functional Status CAHPS for MIPS Survey 75.9 74.14
CAHPS-8 Care Coordination CAHPS for MIPS Survey 87.48 85.89
CAHPS-9 Courteous and Helpful Office Staff CAHPS for MIPS Survey 95.28 92.89
CAHPS-11 Stewardship of Patient Resources CAHPS for MIPS Survey 28.86 26.98

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

*For Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) [Quality ID #001], Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups [Measure #479], and Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions (MCC) [Measure #484], a lower performance rate indicates better measure performance.

*For Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions (MCC) [Measure #484], patients are excluded if they were attributed to Qualifying Alternative Payment Model (APM) Participants (QPs). Most providers participating in Track E and ENHANCED track ACOs are QPs, and so performance rates for Track E and ENHANCED track ACOs may not be representative of the care provided by these ACOs' providers overall. Additionally, many of these ACOs do not have a performance rate calculated due to not meeting the minimum of 18 beneficiaries attributed to non-QP providers.

Payment Rule Waivers

  • Skilled Nursing Facility (SNF) 3-day Rule Waiver: Waiver
    • Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.612.