Northwest Ohio Accountable Care Organization

ACO Name and Location:

Northwest Ohio ACO, LLC
4235 Secor Rd
Toledo, OH 43623

ACO Primary Contact:

Tim Poplawski
Executive Director
tpoplawski@toledoclinic.com
419-318-9447

Organizational Information:

ACO Participants:

ACO participants in joint ventures between ACO professionals and hospitals (annotated by asterisk [*]):

No participants are involved in a joint venture between ACO professionals and hospitals.

ACO Governing Body:

Key ACO clinical and administrative leadership:

Associated committees and committee leadership:

1. Quality Assurance and Improvement Committee: Dr. Moshir Jacob, Chair

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

Shared Savings and Losses:

Amount of Shared Savings/Losses

Agreement period beginning 2013, Performance Year 1: $0
Agreement period beginning 2013, Performance Year 2014: $0
Agreement period beginning 2013, Performance Year 2015: $0

Shared Savings Distribution

Agreement period beginning 2013, Performance Year 1

Proportion invested in redesigned care processes/resources: 20%
Proportion of distribution to ACO participants: 80%

Agreement period beginning 2013, Performance Year 2014

Proportion invested in redesigned care processes/resources: 20%
Proportion of distribution to ACO participants: 80%

Agreement period beginning 2013, Performance Year 2015

Proportion invested in redesigned care processes/resources: 20%
Proportion of distribution to ACO participants: 80%

Payment Rule Waivers

No, our ACO does not use the SNF 3-Day Rule Waiver
Participation Waiver

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, the governing body of Northwest Ohio ACO, LLC (“Northwest Ohio ACO”) has made a bona fide, detailed determination that the following arrangement is reasonably related to the purposes of the MSSP.
Northwest Ohio ACO has authorized a waiver of certain federal fraud and abuse laws for the development of an ambulatory surgery center (“ASC”) among certain physicians, some of whom are participating providers in Northwest Ohio ACO and/or affiliated with The Toledo Clinic, Inc., a participant in Northwest Ohio ACO, which provides dialysis vascular and peripheral arterial disease services to patients within the community, including Medicare beneficiaries attributed to Northwest Ohio ACO (the “Arrangement”). As part of the Arrangement, the ASC will create a plan of clinical integration with Northwest Ohio ACO, which may include, without limitation, the ASC sharing quality and claims data for purposes of enhancing the triple aim.
The governing body of Northwest Ohio ACO authorized the application of the waiver to the Arrangement on April 11, 2017, following a determination that the Arrangement supports the goals of Northwest Ohio ACO and is reasonably related to the purposes of the MSSP, in each case because the Arrangement: (i) increases the quality of vascular/PAD services and reduces the costs of healthcare for the community, which include Medicare beneficiaries attributed to Northwest Ohio ACO; (ii) allows for greater access to vascular/PAD services in the community, including for Medicare beneficiaries attributed to Northwest Ohio ACO; (iii) encourages investment in infrastructure for high quality and efficient service delivery for patients, including Medicare beneficiaries attributed to Northwest Ohio ACO; and (iv) enhances physician engagement for driving true performance and clinical integration, including for physicians affiliated with Northwest Ohio ACO participants.

Quality Performance Results

2015 Quality Performance Results Table

Measure number	Measure Name	2015 reporting period
Measure number	Measure Name	ACO performance rate	Mean performance rate (SSP- ACOs)
ACO-1	CAHPS: Getting Timely Care, Appointments, and Information	80.22	80.61
ACO-2	CAHPS: How Well Your Providers Communicate	93.64	92.65
ACO-3	CAHPS: Patients’ Rating of Provider	92.88	91.94
ACO-4	CAHPS: Access to Specialists	82.60	83.61
ACO-5	CAHPS: Health Promotion and Education	56.54	59.06
ACO-6	CAHPS: Shared Decision Making	79.45	75.17
ACO-7	CAHPS: Health Status/Functional Status	71.59	72.3
ACO-34	CAHPS: Stewardship of Patient Resources*	29.06	26.87
ACO-8	Risk Standardized, All Condition Readmission	14.41	14.86
ACO-35	Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM)* Readmission	17.83	18.07
ACO-36	All-Cause Unplanned Admissions for Patients with Diabetes*	55.61	54.60
ACO-37	All-Cause Unplanned Admissions for Patients with Heart Failure*	75.93	76.96
ACO-38	All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions	62.21	62.92
ACO-9	Ambulatory Sensitive Condition Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5)	1.35	1.11
ACO-10	Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8)	1.08	1.04
ACO-11	Percent of Primary Care Physicians who Successfully Meet Meaningful Use Requirements	100.00%	80.14%
ACO-39	Documentation of Current Medications in the Medical Record*	95.59	84.07
ACO-13	Falls: Screening for Future Fall Risk	39.45	56.46
ACO-14	Preventive Care and Screening: Influenza Immunization	66.41	62.03
ACO-15	Pneumonia Vaccination Status for Older Adults	49.63	63.73
ACO-16	Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up	63.12	71.15
ACO-17	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	72.42	90.16
ACO-18	Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan	10.67	45.25
ACO-19	Colorectal Cancer Screening	42.14	60.06
ACO-20	Breast Cancer Screening	46.56	65.67
ACO-21	Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented	45.60	70.04
ACO-40	Depression Remission at Twelve Months*	N/A	N/A
ACO-27	Diabetes Mellitus: Hemoglobin A1c Poor Control	35.08	20.38
ACO-41	Diabetes: Eye Exam*	57.26	41.05
ACO-28	Hypertension: Controlling High Blood Pressure	60.94	69.62
ACO-30	Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic	87.80	83.82
ACO-31	Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)	90.57	87.22
ACO-33	Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%)	82.76	77.73
CAHPS = Consumer Assessment of Healthcare Providers and Systems, PQI = Prevention Quality Indicator, LVSD = left ventricular systolic dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery disease. *= Measure required beginning Reporting Year 2015. N/A= Reporting on the depression remission measure is not required for 2015, as indicated by N/A

2012 -2014 Quality Performance Results Table

Measure number	Performance measure	2012 reporting period		2013 reporting period		2014 reporting period
Measure number	Performance measure	ACO performance rate	Mean performance rate for all ACOs	ACO performance rate	Mean performance rate for all ACOs	ACO performance rate	Mean performance rate for all ACOs
ACO-1	Getting Timely Care, Appointments, and Information	Not in operations	Not in operations	77.04	81.48	79.98	80.13
ACO-2	How Well Your Doctors Communicate	Not in operations	Not in operations	92.11	92.96	92.67	92.39
ACO-3	Patients’ Rating of Doctor	Not in operations	Not in operations	91.69	92.06	91.18	91.58
ACO-4	Access to Specialists	Not in operations	Not in operations	84.19	85.12	84.84	83.97
ACO-5	Health Promotion and Education	Not in operations	Not in operations	57.08	58.38	57.85	58.29
ACO-6	Shared Decision Making	Not in operations	Not in operations	74.50	74.53	77.21	74.6
ACO-7	Health Status/Functional Status	Not in operations	Not in operations	69.30	71.12	70.80	71.1
ACO-8	Risk Standardized, All Condition Readmissions	Not in operations	Not in operations	15.97	14.90	14.74	15.15
ACO-9	ASC Admissions: COPD or Asthma in Older Adults	Not in operations	Not in operations	1.65	1.17	1.37	1.08
ACO-10	ASC Admission: Heart Failure	Not in operations	Not in operations	1.42	1.20	1.25	1.19
ACO-11	Percent of PCPs who Qualified for EHR Incentive Payment	Not in operations	Not in operations	79.52	66.21	92.50	76.71
ACO-12	Medication Reconciliation	Not in operations	Not in operations	87.12	73.56	98.88	82.61
ACO-13	Falls: Screening for Fall Risk	Not in operations	Not in operations	3.40	39.57	26.10	45.6
ACO-14	Influenza Immunization	Not in operations	Not in operations	69.68	56.93	64.62	57.51
ACO-15	Pneumococcal Vaccination	Not in operations	Not in operations	43.75	54.76	45.26	55.03
ACO-16	Adult Weight Screening and Follow-up	Not in operations	Not in operations	64.23	61.61	57.56	66.75
ACO-17	Tobacco Use Assessment and Cessation Intervention	Not in operations	Not in operations	91.06	84.01	95.62	86.79
ACO-18	Depression Screening	Not in operations	Not in operations	2.20	31.19	19.34	39.27
ACO-19	Colorectal Cancer Screening	Not in operations	Not in operations	55.11	59.30	54.01	56.14
ACO-20	Mammography Screening	Not in operations	Not in operations	57.84	62.05	70.07	61.41
ACO-21	Proportion of Adults who had blood pressure screened in past 2 years	Not in operations	Not in operations	92.52	74.25	60.95	60.24
ACO-22	Hemoglobin A1c Control (HbA1c) (<8 percent)	Not in operations	N/A	64.79	N/A	64.96	N/A
ACO-23	Low Density Lipoprotein (LDL) (<100 mg/dL)	Not in operations	N/A	44.02	N/A	56.45	N/A
ACO-24	Blood Pressure (BP) <140/90	Not in operations	N/A	65.91	N/A	62.77	N/A
ACO-25	Tobacco Non Use	Not in operations	N/A	71.11	N/A	83.45	N/A
ACO-26	Aspirin Use	Not in operations	N/A	72.73	N/A	86.08	N/A
ACO-27	Percent of beneficiaries with diabetes whose HbA1c in poor control (>9 percent)	Not in operations	Not in operations	29.35	22.11	23.36	20.35
ACO-28	Percent of beneficiaries with hypertension whose BP <140/90	Not in operations	Not in operations	67.52	67.79	66.18	68.02
ACO-29	Percent of beneficiaries with IVD with complete lipid profile and LDL control <100mg/dl	Not in operations	Not in operations	43.53	55.44	N/A	N/A
ACO-30	Percent of beneficiaries with IVD who use Aspirin or other antithrombotic	Not in operations	Not in operations	67.15	76.35	92.46	80.79
ACO-31	Beta-Blocker Therapy for LVSD	Not in operations	Not in operations	87.60	79.82	97.92	82.71
ACO-32	Drug Therapy for Lowering LDL Cholesterol	Not in operations	N/A	67.45	71.60	N/A	N/A
ACO-33	ACE Inhibitor or ARB Therapy for Patients with CAD and Diabetes and/or LVSD	Not in operations	N/A	64.53	69.13	88.05	N/A
Note: ASC = ambulatory sensitive conditions, COPD = chronic obstructive pulmonary disease,, EHR = electronic health record, IVD = ischemic vascular disease, LVSD = left ventricular systolic dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery disease.

Contact Info

Northwest Ohio ACO
4235 Secor Rd.
Toledo, OH 43623

P: 419-318-9447

E: tpoplawski@toledoclinic.com

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