CMS Reporting

ACO Name and Location

Collaborative ACO 30 LLC
dba Avera Prairie View ACO
7509 NW Tiffany Springs Parkway
Ste. 310
Kansas City, Missouri 64153

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

 

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

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

Key ACO clinical and administrative leadership:

David Flicek	ACO Executive
Dr. David Basel	Medical Director
T. Gregory	Compliance Officer
Eric Boyce	Quality Assurance/Improvement Officer

Associated committees and committee leadership:

Committee Name	Committee Leader Name and Position
Executive Committee	David Flicek-Chairman
Steering Committee	David Basel, MD- 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, $0
  • Performance Year 2020, $0
  • Performance Year 2021, $0
  • Performance Year 2022, $0

Shared Savings Distribution

• First Agreement Period
  • Performance Year 2019
    • 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 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

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

 

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.

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