CMS Reporting

Caravan Health ACO 15 LLC

ACO Name and Location

Caravan Health ACO 15 LLC
dba Prairie Vista Care Organization

4055 Valley View Ln, Suite 700

Dallas, TX 75244

ACO Primary Contact

Primary Contact Name	Teri Bergeleen
Primary Contact Phone Number	605-322-4576
Primary Contact Email Address	Teri.Bergeleen@avera.org

Organizational Information

ACO participants:

ACO Participants	ACO Participant in Joint Venture
SIOUX CENTER HEALTH	Y
CITY OF REDFIELD	Y
REGIONAL HEALTH SERVICES OF HOWARD COUNTY	Y
AVERA GRANITE FALLS	Y
AVERA GETTYSBURG	Y
ST BENEDICT HEALTH CENTER	Y
PLATTE COMMUNITY MEMORIAL HOSPITAL INC	Y
LANDMANN JUNGMAN MEMORIAL HOSPITAL CORPORATION	Y
MARSHALL COUNTY MEMORIAL HOSPITAL	Y
Hendricks Community Hospital Assn & Retirement Home	Y
AVERA ST ANTHONYS HOSPITAL	Y
AVERA HOLY FAMILY	Y
Freeman Regional Health Services	Y
Hegg Memorial Hospital	Y
Pipestone County Medical Center	Y
Avera Tyler	Y

ACO governing body:

Member First Name	Member Last Name	Member Title/Position	Member’s Voting Power (Expressed as a percentage)	Membership Type	ACO Participant Legal Business Name, if applicable
Lavonne	Koenen	Board Member	5.882%	Medicare Beneficiary Representative	N/A
Gale	Melissa	Vice-Chairman	5.882%	ACO Participant Representative	Landmann Jungman Memorial Hospital Corporation
Zevenbergen	Glenn	Board Member	5.882%	ACO Participant Representative	Hegg Memorial Hospital
Burris	Brad	Board Member	5.882%	ACO Participant Representative	Pipestone County Medical Center
Unruh	Courtney	Board Member	5.882%	ACO Participant Representative	Freeman Regional Health Services
Kooiman	Tom	Board Member	5.882%	ACO Participant Representative	Avera Granite Falls
Gollaher	Jeff	Board Member	5.882%	ACO Participant Representative	Hendricks Community Hospital Assn & Retirement Home
Weber	Lindsay	Board Member	5.882%	ACO Participant Representative	St. Benedict Health Center
Bergeleen	Teri	Board Member	0	Other	N/A
Burket	Mark	Board Member	5.882%	ACO Participant Representative	Platte Community Memorial Hospital Inc
Herzberg	Deb	Chairman	5.882%	ACO Participant Representative	Avera Holy Family
Nelson	Cory	Board Member	5.882%	ACO Participant Representative	Sioux Center Health
Sanger	Larissa	Board Member	5.882%	Other	N/A
Kozyra	John	Board Member	5.882%	ACO Participant Representative	Avera St Anthony’s Hospital
Basel	David	ACO Medical Director	5.882%	Other	N/A
Fosness	Nick	Board Member	5.882%	ACO Participant Representative	Marshall County Memorial Hospital
Sjurseth	Karen	Board Member	5.882%	ACO Participant Representative	City of Redfield

Due to rounding, ‘Member’s Voting Power’ may not equal 100 percent.

Key ACO clinical and administrative leadership:

David Flicek	ACO Executive
David Basel, MD	Medical Director
T. Gregory	Compliance Officer
Rayna Caplan	Quality Assurance/Improvement Officer

Associated committees and committee leadership:

Committee Name	Committee Leader Name and Position
Information Technology Committee	Eric Boyce, Chairman
Care Coordination & Patient Engagement Committee	Michael Webber, Chairman
Evidence-Based Medicine Committee	David Basel, Chairman
Finance Committee	Teri Bergeleen, Chairman
Quality & Performance Improvement Committee	Michael Webber, Chairman

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

Critical Access Hospital (CAH) billing under Method II
Hospital employing ACO professionals
Partnerships or joint venture arrangements between hospitals and ACO professionals
Rural Health Clinic (RHC)

Shared Savings and Losses

Amount of Shared Savings/Losses

First Agreement Period
- Performance Year 2018, $0
- Performance Year 2019, $1,755,090.00
- Performance Year 2020, $0
- Performance Year 2021, $0
- Performance Year 2022, $0

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

First Agreement Period
- Performance Year 2018
  - Proportion invested in infrastructure: N/A
  - Proportion invested in redesigned care processes/resources: N/A
  - Proportion of distribution to ACO participants: N/A

- Performance Year 2019
  - Proportion invested in infrastructure: 10%
  - Proportion invested in redesigned care processes/resources: 0%
  - Proportion of distribution to ACO participants: 90%

- Performance Year 2020
  - Proportion invested in infrastructure: N/A
  - Proportion invested in redesigned care processes/resources: N/A
  - Proportion of distribution to ACO participants: N/A
- Performance Year 2021
  - Proportion invested in infrastructure: N/A
  - Proportion invested in redesigned care processes/resources: N/A
  - Proportion of distribution to ACO participants: N/A
- Performance Year 2022
  - 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

2022 Quality Performance Results:

*Quality performance results are based on CMS Web Interface

Measure#	Measure Name	Collection Type	Rate	ACO Mean
001	Diabetes: Hemoglobin A1c (HbA1c) Poor Control2	CMS Web Interface	7.36	10.71
134	Preventative Care and Screening: Screening for Depression and Follow-up Plan	CMS Web Interface	90.73	76.97
236	Controlling High Blood Pressure	CMS Web Interface	69.20	76.16
318	Falls: Screening for Future Fall Risk	CMS Web Interface	99.02	87.83
110	Preventative Care and Screening: Influenza Immunization	CMS Web Interface	82.21	77.34
226	Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention	CMS Web Interface	88.89	79.27
113	Colorectal Cancer Screening	CMS Web Interface	84.72	75.32
112	Breast Cancer Screening	CMS Web Interface	81.10	78.07
438	Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	CMS Web Interface	87.50	86.37
370	Depression Remission at Twelve Months	CMS Web Interface	14.29	16.03
321	CAHPS for MIPS3	CMS Web Interface	N/A	N/A
479	Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups2	CMS Web Interface	0.1276	0.1510
484	Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions [1]	CMS Web Interface	36.18	30.97

For Previous Years’ Financial and Quality Performance Results, Please Visit data.cms.gov