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

803-296-2407
Robynn.Butler2@prismahealth.org

Organizational Information

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

ACO Participants ACO Participant in Joint Venture
Cardiology Associates of Sumter LLC N
Carolina Allergy & Asthma Consultants N
Carolina Anesthesia Inc N
Carolina Anesthesiology Associates, PA N
CAROLINA KIDNEY SPECIALISTS, LLC N
CARYN M WEST & ASSOC PC N
CENTA MEDICAL GROUP PA N
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
Palmetto Retina Center LLC N
PIERRE JAFFE N
Plastic Surgery Consultants, LLC N
PRISMA HEALTH MEDICAL GROUP-MIDLANDS N
PRISMA HEALTH MIDLANDS N
PRISMA HEALTH TUOMEY N
Professional Pathology Services PC N
SANDHILLS OBGYN ASSOCIATES, P.A. N
South Carolina ENT Allergy & Sleep Medicine PA N
South Carolina Oncology Assoc Pa N
TANDEM HEALTH SC N
The Dermatology Group LLC N
WELLSPRING FAMILY MEDICINE, PA N

ACO Governing Body

Board of Managers

Member Last Name Member First 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
Gerard, MD William (Bill) Chair

Voting Member

1 ACO Participant Representative PRISMA HEALTH MIDLANDS
Brannigan, MD Joseph Vice Chair

Voting Member

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

Voting Member

1 ACO Participant Representative PRISMA HEALTH MIDLANDS
Bundy Michael (Mike) Treasurer

Voting Member

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

Associated Committees and Committee Leadership

Committee Name Committee Leader Name and Position
Finance Committee Jeff Haladay, MD, Chair
Quality and Care Delivery Committee Greta Harper, MD, Chair
Network Participation Committee 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

  • Second Agreement Period
    • Performance Year 2019: $1,673,163.57
    • Performance Year 2020: $1,756,523.86
  • First Agreement Period
    • Performance Year 2016: $0
    • Performance Year 2017: $0
    • Performance Year 2018: $0
    • Performance Year 2019: $1,673,163.57

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 2020
      • Portion invested in infrastructure: 10%
      • Portion invested in redesigned care processes/resources: 10%
      • Portion of distribution to ACO participants: 80%
    • Performance Year 2019
      • Portion invested in infrastructure: 10%
      • Portion invested in redesigned care processes/resources: 10%
      • Portion of distribution to ACO participants: 80%
  • 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

2020 Quality Performance Results

ACO # Measure Name Rate ACO Mean
ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 0.72 0.95
ACO-13 Falls: Screening for Future Fall Risk 91.58 84.97
ACO-14 Preventive Care and Screening: Influenza Immunization 80.85 76.03
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 93.33 81.67
ACO-18 Preventive Care and Screening: Screening for Depression and Follow-up Plan 80.47 71.46
ACO-19 Colorectal Cancer Screening 81.08 72.59
ACO-20 Breast Cancer Screening 73.66 74.05
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 80.08 83.37
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control (>9%) 8.99 14.70
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 68.32 72.87

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size. The Centers for Medicare & Medicaid Services (CMS) also waived the requirement for ACOs to field a CAHPS for ACOs survey for PY 2020 through the Physician Fee Schedule Final Rule for Calendar Year 2021. Additionally, CMS reverted ACO-8 Risk-Standardized, All Condition Readmission and ACO-38 Risk-Standardized Acute Admission Rates for Patients with Multiple Chronic Conditions to pay-for-reporting, given the impact of the coronavirus disease 2019 (COVID-19) public health emergency (PHE) on these measures.

 

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.

Fraud and Abuse Waivers

  • ACO Participation Waiver:

The following information describes each arrangement for which our ACO seeks protection under the ACO Participation Waiver, including any material amendment or modification to a disclosed arrangement.

    • Parties to the arrangement: Prisma Health Midlands Network, LLC and Prisma Health Midlands
    • Date of the arrangement: September 29, 2020
    • Items, services, goods, or facility provided: Education and Training Programs
    • Date and nature of any amendments to the arrangement, if applicable: Not applicable at this time

 

    • Parties to the arrangement: Prisma Health Midlands Network, LLC and Prisma Health Midlands
    • Date of the arrangement: September 29, 2020
    • Items, services, goods, or facility provided: Contact Center Services and Solutions
    • Date and nature of any amendments to the arrangement, if applicable: Not applicable at this time

 

    • Parties to the arrangement: Prisma Health Midlands Network, LLC and Prisma Health Midlands
    • Date of the arrangement: September 29, 2020
    • Items, services, goods, or facility provided: Information Technology Solutions
    • Date and nature of any amendments to the arrangement, if applicable: Not applicable at this time

 

    • Parties to the arrangement: Prisma Health Midlands Network, LLC and Prisma Health Midlands
    • Date of the arrangement: February 24, 2021
    • Items, services, goods, or facility provided: Physician Recruitment Services
    • Date and nature of any amendments to the arrangement, if applicable: Not applicable at this time

 

    • Parties to the arrangement: Prisma Health Midlands Network, LLC and Prisma Health Midlands
    • Date of the arrangement: May 26, 2021
    • Items, services, goods, or facility provided: Supply Chain Management Services
    • Date and nature of any amendments to the arrangement, if applicable: Not applicable at this time

 

    • Parties to the arrangement: Prisma Health Midlands Network, LLC and Prisma Health Midlands
    • Date of the arrangement: August 25, 2021
    • Items, services, goods, or facility provided: Community Connect User Access Value-Based Agreement
    • Date and nature of any amendments to the arrangement, if applicable: Not applicable at this time