Public Reporting

ACO Name and Location

Prisma Health Midlands Network, LLC

Previous Names: Palmetto Health Quality Collaborative, LLC

1301 Taylor Street
STE 9A
Columbia, South Carolina 29201

ACO Primary Contact

Robynn Butler

803-391-2877
Robynn.Butler2@prismahealth.org

Organizational Information

ACO Participants and Participation in ACO Joint Venture, Yes (Y) or No (N)

  • CAROLINA KIDNEY SPECIALISTS, LLC – N
  • CARYN M WEST & ASSOC PC – N
  • CENTA MEDICAL GROUP PA – N
  • Cardiology Associates of Sumter LLC – N
  • Carolina Allergy & Asthma Consultants – N
  • Carolina Anesthesia Inc – N
  • Carolina Anesthesiology Associates, PA – N
  • Columbia Heart Clinic
  • Donen Davis Plastic Surgery, LLC – N
  • Elgin Podiatry Institute, LLC – N
  • KRAEMER WOMENS CARE, LLC – N
  • MCCAIN ORTHOPAEDIC CLINIC – N
  • Midland Ear Nose and Throat – N
  • PIERRE JAFFE – N
  • PRISMA HEALTH MEDICAL GROUP-MIDLANDS – N
  • PRISMA HEALTH MIDLANDS – N
  • PRISMA HEALTH TUOMEY – N
  • Palmetto Family Practice, LLC – N
  • Palmetto Retina Center LLC – N
  • Plastic Surgery Consultants, LLC – N
  • Professional Pathology Services PC – N
  • SANDHILLS OBGYN ASSOCIATES, P.A. – N
  • South Carolina ENT Allergy & Sleep Medicine PA – N
  • South Carolina Neurological Clinic PA – N
  • South Carolina Oncology Assoc Pa – N
  • Sumter Family Medicine Associates, P.A. – N
  • TANDEM HEALTH SC – N
  • The Dermatology Group LLC – N
  • WELLSPRING FAMILY MEDICINE, PA – N

ACO Governing Body

Board of Managers

Member Name Member Title/Position Member’s Voting Power (Expressed as a percentage or number) Membership Type ACO Participant Legal Business Name and D/B/A, if applicable
William (Bill) Gerard, MD Chair

Voting Member

1 ACO Participant Representative Prisma Health
Joseph Brannigan, MD Vice Chair

Voting Member

1 Other Entity Representative (Non-MSSP, but Clinically Integrated Network Participant Columbia Nephrology Associates, PA
Joseph (Joey) Campbell, MD Secretary

Voting Member

1 ACO Participant Representative Prisma Health
Michael (Mike) Bundy Treasurer

Voting Member

1 ACO Participant Representative Prisma Health
Gary Bell, MD Voting Member 1 ACO Participant Representative Prisma Health
Thomas (Tom) Brown, DrPH Voting Member 1 Medicare Beneficiary Representative N/A
Donen Davis, MD Voting Member 1 ACO Participant Representative Donen Davis Plastic Surgery, LLC
James (Jim) Ellis, MD Voting Member 1 ACO Participant Representative Prisma Health Midlands Medical Group
William Giles, MD Voting Member 1 ACO Participant Representative CENTA MEDICAL GROUP PA
Kimberlee Goode, MD Voting Member 1 ACO Participant Representative Prisma Health Midlands Medical Group
Jeff Haladay, MD Voting Member 1 ACO Participant Representative Carolina Anesthesiology Associates, PA
Fred Kudrick, MD Voting Member 1 ACO Participant Representative South Carolina Oncology Assoc Pa
J. Mark Mitchiner, MD Voting Member 1 Other Entity Representative (Non-MSSP, but Clinically Integrated Network Participant Sumter Pediatrics
Bradley Presnal, MD Voting Member 1 ACO Participant Representative Prisma Health Midlands Medical Group
Jamee Steen, MD Voting Member 1 ACO Participant Representative Prisma Health Midlands Medical Group
Kevin Wessinger, MD Voting Member 1 Other Entity Representative (Non-MSSP, but Clinically Integrated Network Participant South Carolina Pediatric Alliance

Key ACO Clinical and Administrative Leadership

  • ACO Executive: Anna Kay
  • Medical Director: Bill Gerard, MD
  • Compliance Officer: Scott Pietras
  • Quality Assurance/Improvement Officer: Scott Hultstrand

Committees

  • Finance Committee: Jeff Haladay, MD Chair
  • Quality and Care Delivery Committee: Greta Harper, MD, Chair
  • Network Participation Committee: William Giles, MD, Chair
  • Sumter Steering Committee: J. Mark Mitchiner, MD Chair
  • Compliance Committee: Scott Pietras, Chair

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

  • ACO professionals in a group practice arrangement
  • Federally Qualified Health Centers (FQHCs)
  • Hospital Employing ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses

  • First Agreement Period
    • Performance Year 2016: $0
    • Performance Year 2017: $0
    • Performance Year 2018: $0
    • Performance Year 2019: $1,673,163.57

Shared Savings Distribution

  • First Agreement Period
    • Performance Year 2019
      • Portion invested in infrastructure: 10%
      • Portion invested in redesigned care processes/resources: 10%
      • Portion of distribution to ACO participants: 80%
    • Performance Year 2018
      • Portion invested in infrastructure: N/A
      • Portion invested in redesigned care processes/resources: N/A
      • Portion of distribution to ACO participants: N/A
    • Performance Year 2017
      • Portion invested in infrastructure: N/A
      • Portion invested in redesigned care processes/resources: N/A
      • Portion of distribution to ACO participants: N/A
    • Performance Year 2016
      • Portion invested in infrastructure: N/A
      • Portion invested in redesigned care processes/resources: N/A
      • Portion of distribution to ACO participants: N/A
    • 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

2019 Quality Performance Results

2

ACO # Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 85.59 85.86
ACO-2 CAHPS: How Well Your Providers Communicate 93.86 94.11
ACO-3 CAHPS: Patient’s Rating of Provider 93.80 92.69
ACO-4 CAHPS: Access to Specialists 83.55 81.54
ACO-5 CAHPS: Health Promotion and Education 58.21 60.44
ACO-6 CAHPS: Shared Decision Making 63.04 62.78
ACO-7  CAHPS: Health Status/Functional Status 74.48 73.39
ACO-34 CAHPS: Stewardship of Patient Resources 23.15 26.17
ACO-45 CAHPS: Courteous and Helpful Office Staff 92.38 92.84
ACO-46 CAHPS: Care Coordination 86.82 86.89
ACO-8 Risk Standardized, All Condition Readmission 14.13 14.86
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 54.13 58.15
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 1.80 1.87
ACO-13 Falls: Screening for Future Fall Risk 92.57 84.04
ACO-14 Preventive Care and Screening: Influenza Immunization 77.50 74.77
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 77.27 78.04
ACO-18 Preventive Care and Screening: Screening for Depression and Follow-up Plan 80.14 70.40
ACO-19 Colorectal Cancer Screening 81.05 70.76
ACO-20 Breast Cancer Screening 79.52 73.84
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 84.08 82.17
ACO-27 Diabetes: Hemoglobin A1c Poor Control (>9%) 11.07 13.88
ACO-28 Controlling High Blood Pressure 76.98 75.04

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size. In addition, the Centers for Medicare & Medicaid Services (CMS) waived the requirement for ACOs to field a CAHPS for ACOs survey data.

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

Payment Rule Waivers

  • Waiver for Payment for Telehealth Services:
    • Our ACO clinicians provide telehealth services using the flexibilities under 42 CFR 425.612(f) and 42 CFR 425.613.