Public Reporting

ACO Name and Location:
MHC Accountable Care Organization, LLC
5183 U.S. Route 60 East
Huntington, WV 25705

ACO Primary Contact:
David Campbell, Executive Director
Phone: (304) 399-4691
Email: [email protected]

Organizational Information:

ACO Participants:	ACO Participant in Joint Venture (Y-Yes; N-No)
UNIVERSITY PHYSICIANS & SURGEONS, INC.  DBA MARSHALL HEALTH	N
ST. MARY'S HIMG, LLC, DBA HUNTINGTON INTERNAL MEDICINE GROUP	N
CABELL HUNTINGTON HOSPITAL INC	N
ST. MARY’S MEDICAL CENTER, INC.	N
ST. MARY’S MEDICAL MANAGEMENT, LLC	N

Members of the MHC ACO governing body:

Member			Member's Voting Power	Membership Type	ACO Participant TIN Legal Business Name/DBA, if Applicable
Last Name	First Name	Title/Position
Rellan	Dev	Board Member, Secretary/Treasurer	Voting Member (1)	Medicare Beneficiary Representative	N/A
Campbell	Todd	Board Member	Voting Member (1)	ACO Participant Representative	St. Mary’s Medical Center, Inc. and St. Mary’s Medical Management, LLC
Dial	Dr. Larry	Board Member, Chairperson	Voting Member (1)	ACO Participant Representative	Cabell Huntington Hospital, Inc. and St. Mary's Medical Center, Inc. (Mountain Health Network, Inc.)
Martin	Tim	Board Member	Voting Member (1)	ACO Participant Representative	Cabell Huntington Hospital, Inc.
Morgan	Mark	Board Member, Vice-Chairperson	Voting Member (1)	ACO Participant Representative	St. Mary's HIMG, LLC, dba Huntington Internal Medicine Group
Shapiro	Dr. Joseph	Board Member	Voting Member (1)	ACO Participant Representative	University Physicians and Surgeons, Inc. dba Marshall Health
Snavely	Dr. Daniel	Board Member	Voting Member (1)	ACO Participant Representative	St. Mary's HIMG, LLC, dba Huntington Internal Medicine Group
Ward	Monte	Board Member	Voting Member (1)	ACO Participant Representative	Cabell Huntington Hospital, Inc.

Key clinical and administrative leadership:

ACO Executive: David Campbell, JD, Executive Director
Medical Director: Larry Dial, MD
Compliance Official: Jennifer Rice, JD
Quality Assurance/Improvement Officer: Daniel Snavely, MD

ACO committees and committee leadership:
Quality Improvement and Clinical Integration Committee: Daniel Snavely, MD, Chairperson
Finance, Risk and Compliance Management Committee: Mark Morgan and Monte Ward, Co-Chairpersons
Data and Technology Committee: Dennis Lee, Chairperson
Operations Committee: Beth Hammers, Chairperson.

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

ACO professionals in a group practice arrangement
Hospital employing ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses

• First Agreement Period
  • Performance Year 2018, $0
  • Performance Year 2019, $0
  • Performance Year 2020, $0

Shared Savings Distribution

• First Agreement Period
  • Performance Year 2018, 2019 and 2020:
    • Proportion invested in infrastructure: N/A
    • Proportion invested in redesigned care processes/resources: N/A
    • Proportion of distribution to ACO participants: N/A

Quality Performance Results

2020 Quality Performance Results:

ACO#	Measure Name	Rate	ACO Mean
ACO-8	Risk Standardized, All Condition Readmission	15.08	14.86
ACO-38	All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions	59.18	58.15
ACO-43	Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91)	1.62	1.87
ACO-13	Falls: Screening for Future Fall Risk	82.52	84.04
ACO-14	Preventive Care and Screening: Influenza Immunization	71.84	74.77
ACO-17	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	62.96	78.04
ACO-18	Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan	56.87	70.40
ACO-19	Colorectal Cancer Screening	70.07	70.76
ACO-20	Breast Cancer Screening	77.10	73.84
ACO-42	Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	81.17	82.17
ACO-27	Diabetes Mellitus: Hemoglobin A1c Poor Control	19.02	13.88
ACO-28	Hypertension (HTN): Controlling High Blood Pressure	65.68	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. 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.

Use of payment rule waivers: No, MHC Accountable Care Organization, LLC does not utilize the SNF 3-Day Rule Waiver or the Waiver for Payment for Telehealth Services.

MSSP Pre-Participation Waiver: The Centers for Medicare and Medicaid Services and the U.S. Department of Health and Human Services’ Office of Inspector General have provided certain waivers of federal fraud and abuse laws in connection with the operation of accountable care organizations under the Medicare Shared Savings Program (“MSSP”).

The Board of Managers of MHC Accountable Care Organization, LLC (“MHC ACO”) has duly authorized the arrangement described below and made a bona fide determination that this arrangement is reasonably related to the purposes of the MSSP because the arrangement will promote accountability for the quality, cost and overall care for Medicare beneficiaries assigned to ACO and/or encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery for patients, including Medicare beneficiaries. By undertaking this arrangement, MHC ACO and its Participants have acted with the good faith intent to apply for participation in the MSSP starting in Performance Year (calendar year) 2018.

Initial Organizational Investments: Cabell Huntington Hospital, Inc., as one of three Participants and Members of MHC ACO, has allocated staff time and incurred consulting and website development fees relating to MHC ACO’s formation, preparation and submission of the MSSP application and initial operations since April 1, 2017 (the “Initial Organizational Investments”) and these Initial Organizational Investment costs have been incurred consistent with the purposes of the MSSP as they were necessary to form the legal entity, comply with regulatory requirements, complete the MSSP application, and engage providers in anticipation of MSSP participation.

MHC ACO will publicly disclose additional arrangements that qualify for MSSP waivers as they are authorized by its governing board on this website, in compliance with CMS’s public disclosure requirements.