CMS Reporting

ACO Name and Location

Caravan Health ACO 22 LLC
dba Caravan Collaborative Pathways
7509 NW Tiffany Springs Parkway
Ste. 310
Kansas City, Missouri 64153

ACO Primary Contact

Primary Contact Name	Kristine Miller
Primary Contact Phone Number	916-542-4568
Primary Contact Email Address	kmiller@signifyhealth.com

Organizational Information

ACO participants:

 

ACO governing body:

Member			Member's Voting Power (Expressed as a percentage or number)	Membership Type	ACO Participant TIN Legal Business Name/DBA, if Applicable
Last Name	First Name	Title/Position
Desmond	Heather	Board Member	1.176%	ACO Participant Representative	The Bibb County Healthcare Authority
Robeson, Jr., M.D.	James	Board Member	1.176%	ACO Participant Representative	Fairview Clinic, P.C.
Whiteman	Lenny	Board Member	1.176%	ACO Participant Representative	Washington Regional Medical System
Wilson	Jason	Board Member	1.176%	ACO Participant Representative	Medical Associates of Northwest Arkansas, PA
Pankey	Andrea	Board Member	1.176%	ACO Participant Representative	White County Medical Center
Miller	Rick	Board Member	1.176%	ACO Participant Representative	Gila Health Resources
Morrow	Shawn	Board Member	1.176%	ACO Participant Representative	Summit Healthcare Association
Mills	Celia	Vice Chair	1.176%	ACO Participant Representative	Ridgecrest Regional Hospital
Russell, M.D.	Anthony	Board Member	1.176%	ACO Participant Representative	Community Memorial Health System
Lockwood	EJay	Board Member	1.176%	ACO Participant Representative	Prospect Health Services CT, Inc.
Aggen	Dale	Board Member	1.176%	ACO Participant Representative	Florida Health Sciences Center, Inc.
Wynn	Paige	Board Member	1.176%	ACO Participant Representative	Hospital Authority of Ben Hill
Blevins	Jeanne	Board Member	1.176%	ACO Participant Representative	Irwin County Hospital
Bonk	Daniel	Board Member	1.176%	ACO Participant Representative	Midcoast Medical Center - Bellville (FKA Bellville Medical Center)
Hoffman	Clint	Board Member	1.176%	ACO Participant Representative	Tanner Health System
Skaggs	Jonathan	Board Member	1.176%	ACO Participant Representative	Phoebe Physician Group, Inc.
Kimura, M.D.	Bradon	Board Member	1.176%	ACO Participant Representative	Bradon Kimura M.D. Inc.
Neitzel	Monte	Board Member	1.176%	ACO Participant Representative	Greater Regional Medical Center
Moore	Jennifer	Board Member	1.176%	ACO Participant Representative	Family Medicine Clinic, P.C.
Russell	Brittany	Board Member	1.176%	ACO Participant Representative	Mountain View Hospital LLC
Muntz	Tim	Board Member	1.176%	ACO Participant Representative	St. Margaret's Hospital
Durkin	Patrick	Board Member	1.176%	ACO Participant Representative	Morris Hospital
Macgregor	Adrian	Board Member	1.176%	ACO Participant Representative	McDonough County Hospital District
Kahn	Maureen	Board Member	1.176%	ACO Participant Representative	Blessing Hospital
Brown	Zigrida	Board Member	1.176%	Medicare Beneficiary	N/A
Keene	Julie	Board Member	1.176%	ACO Participant Representative	Margaret Mary Community Hospital, Inc.
Franklin	Michelle	Board Member	1.176%	ACO Participant Representative	Sullivan County Community Hospital
Muckerheide	Brian	Board Member	1.176%	ACO Participant Representative	Hancock Regional Hospital
Speer	Kevin	Board Member	1.176%	ACO Participant Representative	Hendricks County Hospital
Klayer	Geni	Board Member	1.176%	ACO Participant Representative	Witham Memorial Hospital
Handley	Michael	Board Member	1.176%	ACO Participant Representative	Ohio County Hospital
Fones	John Mark	Board Member	1.176%	ACO Participant Representative	Bowling Green Warren County Community Hospital
Meese	Larry	Board Member	1.176%	ACO Participant Representative	Hospital Service District 1 of East Baton Rouge Parish
Reviel	Jackie	Board Member	1.176%	ACO Participant Representative	Allen Parish Hospital District No. 3
Spencer	Nancy	Board Member	1.176%	ACO Participant Representative	Alcona Citizens for Health, Inc.
Hodshire	Jeremiah	Board Member	1.176%	ACO Participant Representative	Hillsdale Community Health Center
Garrett	Barbara	Board Member	1.176%	ACO Participant Representative	Three Rivers Health System, Inc
Kalchik	Kevin	Board Member	1.176%	ACO Participant Representative	War Memorial Hospital
Schultz	Rachelle	Board Member	1.176%	ACO Participant Representative	Winona Health Services
Jacobson	Kristin	Board Member	1.176%	ACO Participant Representative	Johnson Memorial Health Services
Westman	Ken	Board Member	1.176%	ACO Participant Representative	Aitkin Community Hospital Inc.
Weir	Tim	Board Member	1.176%	ACO Participant Representative	Olmsted Medical Center
Henderson	Patty	Board Member	1.176%	ACO Participant Representative	Glencoe Regional Health Services
Lohn	Eric	Board Member	1.176%	ACO Participant Representative	St. Luke's Hospital of Duluth
Underdahl	Steve	Board Member	1.176%	ACO Participant Representative	Northfield Hospital
Breuer	Rick	Board Member	1.176%	ACO Participant Representative	Community Memorial Hospital Association
Ulseth	Randy	Board Member	1.176%	ACO Participant Representative	Welia Health
Ash	Rick	Board Member	1.176%	ACO Participant Representative	United Hospital District
Jones	Julie	Board Member	1.176%	ACO Participant Representative	Community Hospital Association, Inc.
Weber	Meagan	Board Member	1.176%	ACO Participant Representative	Scotland County Memorial Hospital
Langbehn	Cody	Board Member	1.176%	ACO Participant Representative	Central Montana Medical Facilities, Inc
Doty	Jen	Board Member	1.176%	ACO Participant Representative	Sidney Health Center
Hanson	Troy	Chair	1.176%	ACO Participant Representative	Marcus Daly Memorial Hospital Corporation
Hanson	Greg	Board Member	1.176%	ACO Participant Representative	Plains Hospital Corporation
Villa	Jo Ellen	Board Member	1.176%	ACO Participant Representative	Community Hospital of Anaconda
Books	Dr. Clyde	Board Member	1.176%	ACO Participant Representative	Carteret Medical Group LLC
Brink	Shon	Board Member	1.176%	ACO Participant Representative	WakeMed
Kornele	Alyson	Board Member	1.176%	ACO Participant Representative	West River Health Services
Banner	Manuela	Board Member	1.176%	ACO Participant Representative	Memorial Community Hospital Corporation
Owen	Summer	Board Member	1.176%	ACO Participant Representative	North Platte Nebraska Hospital Corporation
Venable	April	Board Member	1.176%	ACO Participant Representative	Inspira Medical Centers, Inc.
Tartacoff	Dr. Randy	Board Member	1.176%	ACO Participant Representative	Holy Name Medical Center
Salgado	Joe	Board Member	1.176%	ACO Participant Representative	Artesia General Hospital
Hamilton	Dan	Board Member	1.176%	ACO Participant Representative	Nor Lea Hospital District
Whitaker	Robert	Board Member	1.176%	ACO Participant Representative	Rehoboth McKinley Christian Healthcare Services
Kronenberg	Seth	Board Member	1.176%	ACO Participant Representative	Crouse Health Hospital Inc
Ruane	Shannon	Board Member	1.176%	ACO Participant Representative	Community Memorial Hospital
Sherry	Jim	Board Member	1.176%	ACO Participant Representative	The Chautauqua Center, Inc.
Looomis	Joanna	Board Member	1.176%	ACO Participant Representative	HealthCare Partners of the North Country, LLC
Peck	Geoff	Board Member	1.176%	ACO Participant Representative	Nathan Littauer Hospital Association
Huntley	Heather	Board Member	1.176%	ACO Participant Representative	Bay Clinic
Rico	Richard	Board Member	1.176%	ACO Participant Representative	Sky Lakes Medical Center Inc
Williams	Virginia	Board Member	1.176%	ACO Participant Representative	Curry Health District
Pandolph	Philip	Board Member	1.176%	ACO Participant Representative	Meadville Medical Center
Tarap	Paul	Board Member	1.176%	ACO Participant Representative	Southern Hills Family Medicine
Pascasio	Bob	Board Member	1.176%	ACO Participant Representative	Chambers County Public Hospital District No 1
Byrom	David	Board Member	1.176%	ACO Participant Representative	Coryell County Memorial Hospital
Edmondson	Cory	Board Member	1.176%	ACO Participant Representative	Sid Peterson Memorial Hospital
Boles	Lee	Board Member	1.176%	ACO Participant Representative	Hunt Memorial Hospital District
Carper	Joleen	Board Member	1.176%	ACO Participant Representative	Tri-State Memorial Hospital
Kibby	Rosalinda	Board Member	1.176%	ACO Participant Representative	Grant County Public Hospital District No 3
Kwate	Theresa	Board Member	1.176%	ACO Participant Representative	Public Hospital District #1-A Of Whitman County
Town	Alex	Board Member	1.176%	ACO Participant Representative	Samaritan Hospital
Johnson	Catherine	Board Member	1.176%	ACO Participant Representative	Fort HealthCare, Inc.
Dial	Dr. Larry	Board Member	1.176%	ACO Participant Representative	MHC Accountable Care Organization, LLC
Slater	Kerry	Board Member	1.176%	ACO Participant Representative	Cheyenne Regional Physicians Group, LLC

Key ACO clinical and administrative leadership:

Jerome Gronniger	ACO Executive
Frederick Wallisch	Medical Director
T. Gregory	Compliance Officer
Rayna Caplan	Quality Assurance/Improvement Officer

Associated committees and committee leadership:

Committee Name	Committee Leader Name and Position
Executive Committee	Michelle Franklin - Chairman
Steering Committee	Dr. Seth Kronenberg - Vice-Chairman

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

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

Shared Savings and Losses

Amount of Shared Savings/Losses

• First Agreement Period
  • Performance Year 2019, $1,092,848.54
  • Performance Year 2020, $15,432,521.48
  • Performance Year 2021, $14,379,795.53
  • Performance Year 2022, $30,812,483.60

Shared Savings Distribution

• First Agreement Period
  • 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: 10%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 90%
  • Performance Year 2021
    • Proportion invested in infrastructure: 10%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 90%
  • Performance Year 2022
    • Proportion invested in infrastructure: 31.93%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 68.07%

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	6.25	10.71
134	Preventative Care and Screening: Screening for Depression and Follow-up Plan	CMS Web Interface	91.07	76.97
236	Controlling High Blood Pressure	CMS Web Interface	82.00	76.16
318	Falls: Screening for Future Fall Risk	CMS Web Interface	94.10	87.83
110	Preventative Care and Screening: Influenza Immunization	CMS Web Interface	83.49	77.34
226	Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention	CMS Web Interface	84.00	79.27
113	Colorectal Cancer Screening	CMS Web Interface	83.72	75.32
112	Breast Cancer Screening	CMS Web Interface	85.41	78.07
438	Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	CMS Web Interface	85.42	86.37
370	Depression Remission at Twelve Months	CMS Web Interface	14.67	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	0.1547	0.1510
MCC1	Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions [1]	CMS Web Interface	33.94	30.97

 

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

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Payment Rule Waivers

• Skilled Nursing Facility (SNF) 3-Day Rule Waiver:

• Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.612.

 

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 arrangements: Caravan Health ACO 22 LLC and ACO Participants
• Date of arrangements: Effective January 1, 2023
• Items, services, goods, or facility provided: See description below.
• Date and nature of any amendments to the arrangements, if applicable: N/A

Caravan Health ACO 22 LLC (“Company”) maintains and operates an accountable care organization (“ACO”) that participates in the Medicare Shared Savings Program (“MSSP”). Pursuant to Section 1899(f) of the Social Security Act (42 U.S.C. § 1395jjj), the Secretary of the Department of Health and Human Services (“HHS”) made available certain waivers of federal fraud and abuse laws in connection with the operation of ACOs that have entered into a participation agreement, as defined under 42 C.F.R. § 425.20, under the MSSP with the Centers for Medicare & Medicaid Services (“CMS”).

The Company Board of Managers (the “Board”) has approved two arrangements for protection under ACO Participation Waivers. Use of the ACO Participation Waiver requires public disclosure of certain elements of the arrangement. This document establishes the public disclosure requirements set forth in the MSSP waivers. This document will be supplemented as additional arrangements arise consistent with the timing requirements set forth in the waivers.

Annual Wellness Visit Patients Initiative

The Board made a bona fide determination effective January 1, 2023, that the Annual Wellness Visit Patients Initiative (“AWV Patients Initiative”) is reasonably related to the purposes of the MSSP to manage and coordinate care for Medicare fee-for-service beneficiaries through the ACO. The AWV Patients Initiative is intended to increase the likelihood that patients whom CMS has identified as assigned or assignable to the ACO under the MSSP and whom CMS has recognized would benefit from an AWV will receive an AWV. The AWV Patients Initiative includes the provision of a single, in- kind, non-cash equivalent gift card of nominal value to patients whom CMS has identified as assigned or assignable to the ACO under the MSSP, and who complete an AWV during the current MSSP year with an ACO Participant participating in the AWV Patients Initiative while budgeted funds remain. The AWV Patients Initiative will be offered to all ACO Participants and ACO Participants must choose to participate on or before March 31, 2023.

Annual Wellness Visit Participants Initiative

The Board made a bona fide determination effective January 1, 2023, that the Annual Wellness Visit Participants Initiative (“AWV Participants Initiative”) is reasonably related to the purposes of the MSSP to manage and coordinate care for Medicare fee-for-service beneficiaries through the ACO. The AWV Participants Initiative is intended to expand the number of medically necessary and appropriate AWVs that ACO Participants will complete on patients assigned to the ACO under the MSSP whom CMS has recognized would benefit from an AWV. The AWV Participants Initiative will be offered to all ACO Participants eligible to perform AWVs, so long as all such ACO Participants in the community choose to participate by March 31, 2023. The ACO Participants’ communities that demonstrates the largest improvements in AWV performance rates by size as calculated between January 1, 2023 and June 30, 2023 will receive an award to support their ACO program administration.

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