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 ParticipantsACO Participant in Joint Venture
Cardiology Associates of Sumter LLCN
Carolina Allergy & Asthma ConsultantsN
Carolina Anesthesia IncN
Carolina Anesthesiology Associates, PAN
CAROLINA KIDNEY SPECIALISTS, LLCN
CARYN M WEST & ASSOC PCN
CENTA MEDICAL GROUP PAN
Donen Davis Plastic Surgery, LLCN
Elgin Podiatry Institute, LLCN
KRAEMER WOMENS CARE, LLCN
MCCAIN ORTHOPAEDIC CLINICN
Midland Ear Nose and ThroatN
Palmetto Retina Center LLCN
PIERRE JAFFEN
Plastic Surgery Consultants, LLCN
PRISMA HEALTH MEDICAL GROUP-MIDLANDSN
PRISMA HEALTH MIDLANDSN
PRISMA HEALTH TUOMEYN
Professional Pathology Services PCN
SANDHILLS OBGYN ASSOCIATES, P.A.N
South Carolina ENT Allergy & Sleep Medicine PAN
South Carolina Oncology Assoc PaN
TANDEM HEALTH SCN
The Dermatology Group LLCN
WELLSPRING FAMILY MEDICINE, PAN

ACO Governing Body

Board of Managers

Member Last NameMember First NameMember

Title/Position

Member’s Voting Power (Expressed as a percentage or number)Membership TypeACO Participant Legal Business Name and D/B/A, if applicable
Gerard, MDWilliam (Bill)Chair

Voting Member

1ACO Participant RepresentativePRISMA HEALTH MIDLANDS
Brannigan, MDJosephVice Chair

Voting Member

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

Voting Member

1ACO Participant RepresentativePRISMA HEALTH MIDLANDS
BundyMichael (Mike)Treasurer

Voting Member

1ACO Participant RepresentativePRISMA HEALTH MIDLANDS
Bell, MDGaryVoting Member1ACO Participant RepresentativePRISMA HEALTH MEDICAL GROUP-MIDLANDS
Brown, DrPHThomas (Tom)Voting Member1Medicare Beneficiary RepresentativeN/A
Davis, MDDonenVoting Member1ACO Participant RepresentativeDonen Davis Plastic Surgery, LLC
Ellis, MDJames (Jim)Voting Member1ACO Participant RepresentativePRISMA HEALTH MEDICAL GROUP-MIDLANDS
Giles, MDWilliamVoting Member1ACO Participant RepresentativeCENTA MEDICAL GROUP PA
Goode, MDKimberleeVoting Member1ACO Participant RepresentativePRISMA HEALTH MEDICAL GROUP-MIDLANDS
Haladay, MDJeffVoting Member1ACO Participant RepresentativeCarolina Anesthesiology Associates, PA
Kudrick, MDFredVoting Member1ACO Participant RepresentativeSouth Carolina Oncology Assoc Pa
Mitchiner, MDJ. MarkVoting Member1Other Entity Representative (Non-MSSP, but Clinically Integrated Network Participant)Sumter Pediatrics
Presnal, MDBradleyVoting Member1ACO Participant RepresentativePRISMA HEALTH MEDICAL GROUP-MIDLANDS
Steen, MDJameeVoting Member1ACO Participant RepresentativePRISMA HEALTH MEDICAL GROUP-MIDLANDS
Wessinger, MDKevinVoting Member1Other 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 NameCommittee Leader Name and Position
Finance CommitteeJeff Haladay, MD, Chair
Quality and Care Delivery CommitteeGreta Harper, MD, Chair
Network Participation Committee Participation CommitteeWilliam Giles, MD, Chair
Sumter Steering CommitteeJ. Mark Mitchiner, MD Chair
Compliance CommitteeScott 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 NameRateACO Mean
ACO-43Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91))0.720.95
ACO-13Falls: Screening for Future Fall Risk91.5884.97
ACO-14Preventive Care and Screening: Influenza Immunization80.8576.03
ACO-17Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention93.3381.67
ACO-18Preventive Care and Screening: Screening for Depression and Follow-up Plan80.4771.46
ACO-19Colorectal Cancer Screening81.0872.59
ACO-20Breast Cancer Screening73.6674.05
ACO-42Statin Therapy for the Prevention and Treatment of Cardiovascular Disease80.0883.37
ACO-27Diabetes Mellitus: Hemoglobin A1c Poor Control (>9%)8.9914.70
ACO-28Hypertension (HTN): Controlling High Blood Pressure68.3272.87

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