Integrated Care Alliance, LLC

ICA ACO Name and Location
Integrated Care Alliance, LLC
4343 W. Newberry Road, Suite 18
Gainesville, FL  32607

ICA ACO Primary Contact
Connie Pegram, Population Health Management Director
cpegram@simedhealth.com
(352) 224-2234

ICA Composition of ACO
Partnership arrangement between physician groups

ICA ACO Participants
Southeastern Integrated Medical, PL (SIMED)
James McCauley, MD, PA

ICA ACO Governing Body – Executive Committee
Voting members

Larissa Lim, MD, Chair (SIMED Board of Managers-ACO Participant)
Greg Geiger, MD, ICA Medical Director (SIMED-ACO Participant)
Russell Deegan (Medicare Fee-For-Service beneficiary that utilizes ICA providers)
Oscar DePaz, MD (SIMED Chairman of the Board of Managers-ACO Participant)
Daniel Duncanson, MD (CEO of ICA and SIMED, Vice Chair of SIMED Board of Managers- ACO Participant)
James McCauley, MD, (James McCauley, MD, PA, CEO, & Advanced Hospitalists Group, PA, Partner-ACO Participant)

Ex officio participants
Cristoforo Cama, MD (SIMED-ACO Participant)
Mary Hurd, MD (SIMED-ACO Participant)
Wilda Murphy, MD (SIMED Board of Managers-ACO Participant)
Meera Nair, MD (SIMED-ACO Participant)
Seth Perkins, MD (SIMED-ACO Participant)
Connie Pegram (ICA Director-Staff)
Yogi Patel, MD (SIMED-ACO Participant)

ICA ACO Committees and Key Leadership Personnel
ICA Quality Committee:         Wilda Murphy, MD and Mary Hurd, MD, Co-Chairs
ICA Utilization Committee:     Gregory Geiger, MD and James McCauley, MD, Co-Chairs
ICA Compliance Committee:  Oscar DePaz, MD, Chair
ICA CEO:                             Daniel M. Duncanson, MD, CPE
ICA Medical Directors:           Gregory Geiger, MD and James McCauley, MD
ICA Director:                         Connie Pegram

Aggregate Amount of Shared Savings/Losses
Performance Year 1 – None
Performance Year 2 – None
Performance Year 3 – TBD

How Shared Savings Are Distributed
The ICA goal is to maintain a 20% expense ratio to savings.  The ICA will retain a portion of the CMS Shared Savings Program (SSP) funds to cover the administrative and development costs listed below as “Y” and “Z”.

ICA Shared Savings = X
ICA Administrative costs = Y
ICA Retention = Z
X – Y – Z = A (Distribution funds)

Administrative costs support additional resources, personnel and associated capital, and other start-up expenses:

  • Medical Directors
  • ACO Director
  • Case Managers
  • Administrative Support

Retention will support:

  • Improved infrastructure
  • Resources and tools to redesign care processes
  • Interoperability between care providers (EHR)
  • Resources to educate care providers (Dashboards, data analytics capabilities)
  • Beneficiaries access to medical information (i.e., patient portal)
  • Reserves to offset potential expenses related to assuming future financial risk

The remainder (“A”) of ICA’s portion of the SSP funds will be distributed to ACO participating care providers (participants/partners).  The ICA will base the ACO participant’s payment on the number of physicians participating with each ACO partner in each category (Primary Care Physician and Specialist).  The distribution percentage is then applied to the number of employed physicians.  The ACO partner will then distribute funds to their participating ACO physicians.

The formula that has been established for distribution of the SSP funds is:

A x 65% = Primary Care Physicians’ pool
A x 35% = Specialty Care Physicians’ pool

The distribution percentages are based on a formula that rewards primary care physicians in greater proportion than specialists.  This is to reward primary care physicians for their contributions in reducing fragmentation of care by managing care across the continuum, and in providing and documenting care and services in accordance with SSP quality metrics.

Quality Performance Results

2012 Performance Summary Statistics
 
ACO Performance Rate
Mean Performance Rate for All ACOs
Risk Standardized, All Condition Readmissions
16.09
15.42
ASC Admissions: COPD or Asthma in Older Adults
1.12
1.13
ASC Admissions: Heart Failure
1.52
1.09
% of PCPs Who Qualified for EHR Incentive Payment
12.50
59.87
2013 Performance Summary Statistics
ACO Performance Rate
Mean Performance for All ACOs
Risk Standardized, All Condition Readmissions
16.34
14.90
ASC Admissions: COPD or Asthma in Older Adults
1.03
1.17
ASC Admissions: Heart Failure
1.58
1.20
% of PCPs Who Qualified for EHR Incentive Payment
76.92
66.21
2014 Performance Summary Statistics
ACO Performance
Rate
Mean Performance for All ACOs
Risk Standardized, All Condition Readmissions
16.34
15.15
ASC Admissions: COPD or Asthma in Older Adults
1.16
1.08
ASC Admissions: Heart Failure
1.51
1.19
% of PCPs Who Qualified for EHR Incentive Payment
80.00
76.71
2015 Performance Summary Statistics
 
ACO Performance
Rate
Mean Performance for All ACOs
Risk Standardized, All Condition Readmissions
TBD
TBD
ASC Admissions: COPD or Asthma in Older Adults
TBD
TBD
ASC Admissions: Heart Failure
TBD
TBD
% of PCPs Who Qualified for EHR Incentive Payment
TBD
TBD


Please visit www.medicare.gov/acos.html or call 1-800-MEDICARE (1-800-633-4227 (TTY users should call 1-877-486-2048)) for questions or additional information about Accountable Care Organizations.


© 2012 Southeastern Integrated Medical, PL