ACO Model

Next Generation ACO Model Information

 
Next Generation ACO Model Public Reporting Guidance
 
ACO Name and Location

Southwestern Health Resources Accountable Care Network
8150 Brookriver Dr.
Dallas, Texas 75247

Mailing address: 

5323 Harry Hines Blvd., MC 9257
LB6S.200
Dallas, Texas 75390-9257

Hours of Operation:

Monday: 8 a.m. – 5 p.m.
Tuesday: 8 a.m. – 5 p.m.
Wednesday:  8 a.m. – 5 p.m.
Thursday: 8 a.m. – 5 p.m.
Friday: 8 a.m. – 5 p.m.

 

ACO Primary Contacts

Danny Irland, Executive Officer Network Services
Email
Phone: 214-645-0303

 

Accountable Care Organization Information

Southwestern Health Resources Accountable Care Network (SWHRACN) represents a model of health care delivery based on a strategy to better align physicians, hospitals, and payers in order to provide better access to care, better clinical quality, and control costs. In January 2017, SWHRACN was selected to participate in Next Generation Accountable Care Organization (Next Generation ACO) Model through the Centers for Medicare and Medicaid Services (CMS) as an ACO. SWHRACN works with CMS through the Next Generation ACO Model to provide high-quality care in a cost-efficient manner with a patient-centered approach. SWHRACN shares the following information regarding its participation as a Next Generation ACO Model:

Southwestern Health Resources Next Generation Model ACO Participants (names listed under each letter below):

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Southwestern Health Resources Next Generation Model ACO Preferred Providers (names listed under each letter below):

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Southwestern Health Resources Next Generation Model ACO Cost Sharing Specialists Eligible (names listed under each letter below):

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Southwestern Health Resources Next Generation Model ACO Participants in Joint Ventures Between ACO Professionals and Hospitals

There are currently no ACO participants in joint ventures between ACO professionals and hospitals.

 

Southwestern Health Resources Accountable Care Network Governing Body

Dr. Herbert Zeh, Voting Member and Chairman, UT Southwestern Medical Center, ACO participant representative

Dr. Donna Casey, Voting Member, Franklin Leroy Casey, P.A., ACO participant representative

Dr. Donald Fowler, Voting Member, Texas Health Physicians Group, ACO participant representative

Dr. David Johnson, Voting Member, UT Southwestern Medical Center, ACO participant representative

Dr. Mack Mitchell, Voting Member, UT Southwestern Medical Center, ACO participant representative

Dr. Shawn Parsley, Voting Member, Texas Health Physicians Group, ACO participant representative

Dr. Randall Todd Richwine, Voting Member, Texas Health Physicians Group, ACO participant representative

Dr. Neil Rofsky, Voting Member, UT Southwestern Medical Center, ACO participant representative

Dr. George Shires, Voting Member, Texas Health Physicians Group, ACO participant representative

Dr. Walton Taylor, Voting Member, Texas Health Physicians Group, ACO participant representative

Donald Zale, Voting Member, Medicare beneficiary representative and Consumer Advocate

 

Key Clinical and Administrative Leadership

Senior Executive Officer: Andy Ziskind, M.D., SWHR Clinically Integrated Network

Interim Chief Medical Officer: Mack Mitchell, M.D., UT Southwestern Medical Center

Interim Chief Financial Officer: Gary Goldberg, Texas Health Resources

Chief Compliance Officer: Gail Howard, Texas Health Resources

 

Southwestern Health Resources Accountable Care Network Committees and Committee Leaderships

Network Quality and Performance Committee: John Warner, M.D., Chair

Academic Affiliation Committee: Dwain Thiele, M.D., Chair

Finance Committee: Rick McWhorter, Chair

Utilization Management Committee: Lynne Kirk, M.D., Chair

Credentialing Committee: Michael Chiu, M.D., Chair

Quality Assurance Committee: Lynn Myers, M.D., Chair

 

ACO Composition

Physician-led partnership between UT Southwestern Medical Center, Texas Health Physicians Group, community physicians, and other health care providers organized to improve health care in communities we serve.

 

Shared Savings and Losses

SWHRACN is obligated under its Next Generation ACO Model participation agreement with CMS to secure potential shared losses and other monies owed under the Next Generation ACO Model with a financial guarantee.

Amount of Savings and Losses

  • Medicare Shared Savings Program (SSP) Performance Year 2014: $2,945,035 (Amount of Shared Savings)
  • Medicare Shared Savings Program (SSP) Performance Year 2015: $14,188,861 (Amount of Shared Savings)
  • Medicare Shared Savings Program (SSP) Performance Year 2016: $17,464, 034 (Amount of Shared Savings)
  • Next Generation ACO Model (NGACO) Performance Year 2017: $29,271,300 (Amount of Shared Savings)

Savings Distribution

Medicare Share Savings Program (SSP) Agreement period beginning 2014, Performance Year 2014, 2015, 2016:

  • Proportion invested in infrastructure: 19 percent
  • Invested in redesigned care processes/resources: 22 percent
  • Proportion of distribution to ACO participants: 59 percent

Next Generation ACO Model (NGACO) Agreement period beginning 2017:

  • Proportion invested in infrastructure: 19 percent
  • Invested in redesigned care processes/resources: 22 percent
  • Proportion of distribution to ACO participants: 59 percent
 
Southwestern Health Resources Next Generation Model Skilled Nursing Facility (SNF) 3-Day Waiver

Yes, our ACO utilizes the SNF 3-Day Rule Waiver.

  • Azle Manor Healthcare, LLP
  • Beltline SCC, LCC dba Senior Care Beltline
  • Bryant Irvin Medical Investors, LLC
  • C.C. Young Memorial Home
  • CHG Senior Living Preston Hollow, LLC dba Crystal Creek
  • Dallas County Hospital District
  • Dallas County Hospital District dba Prairie Estates
  • Dallas County Hospital District dba Town East Rehabilitation
  • Dallas County Hospital District dba The Homestead of Sherman
  • Decatur Hospital Authority dba Hollymead
  • Decatur Hospital Authority dba The Belmont at Twin Creeks
  • Eastland Memorial Hospital District dba Legend Healthcare and Rehab - Euless
  • Fort Austin Limited Partnership dba Brookdale Broadway Cityview
  • FS Tenant Pool Trust
  • Green Oaks SCC, LLC
  • Haltom Operations, LLC dba Life Care Center of Haltom
  • HEB SNF OE, LP
  • Holland SCC, LLC dba Senior Care at Holland Lake
  • JSC Lake Highlands Operations, LP dba Villages of Lake Highlands
  • LCS-WP, LLC
  • Nexion Health of Garland, Inc. dba Pleasant Valley Healthcare
  • Northwest Senior Housing Corporation
  • Oakpointe Healthcare, Inc.
  • OP OPS ARL TX, LLC
  • Presbyterian Village North dba Presbyterian Village North Spec
  • Prestonwood Rehabilitation and Nursing Center (Dallas County Hospital District in Plano, TX)
  • Regency HIS of Richardson LLC
  • Rowlett SCC, LLC dba Rowlett Health & Rehab Ctr
  • South Limestone Hospital District dba Baybrooke Village Care
  • Stonegate SCC, LLC
  • Tarrant County Senior Living Center, Inc.
  • United Investors, LP

 

The SWHRACN Board has approved the following arrangement(s) for the waivers authorized by CMS and the Department of Health and Human Services Office of Inspector General pursuant to the Notice of Waiver of Certain Fraud and Abuse Laws in Connection with the Next Generation ACO Model (December 9, 2015), the Notice of Amended Waivers of Certain Fraud and Abuse Laws in Connection with the Next Generation ACO Model (December 29, 2016), and the Notice of Amended Waivers of Certain Fraud and Abuse Laws in Connection with the Next Generation ACO Model (December 12, 2018): 

The SWHRACN Board has approved an arrangement under which specialist physicians who are Preferred Providers of SWHRACN may receive an annual incentive payment from SWHRACN upon implementing certain care coordination and quality of care activities.  The payment is intended to incentivize eligible physicians to deliver high quality and cost effective care and enhance access to specialty services for SWHRACN aligned patients.  To be eligible, a physician must (i) maintain a certified electronic medical records (EMR) system connected to SWHRACN’s EMR system, (ii) utilize the services of the Population Health Services Company to coordinate care of SWHRACN’s patients, and (iii) participate in the care of at least twelve SWHRACN patient encounters per year.  The amount of payment under the arrangement will be based on meeting the following collected metrics: (i) quality of care (determined by scores in patient satisfaction, control of diabetes, control of hypertension, annual vaccination against influenza, and tobacco use cessation), (ii) access to care (determined by time to set up an appointment and the utilization of continued care treatment guidelines), (iii) use of electronic health records in continued treatment process, (iv) patient satisfaction score, and (v) adherence to the care models approved by SWHRACN.  The arrangement was approved by the SWHRACN Board for Performance Year. 

The SWHRACN Board has approved an arrangement under which physicians who are Preferred Providers of SWHRACN and agree to be subject to a population based fee reduction for covered services provided to beneficiaries aligned with SWHRACN receive from SWHRACN (i) resources and information to help identify patient readmissions into acute care facilities, and (ii) an opportunity to receive cost reduction incentive payments for meeting or exceeding SWHRACN's cost benchmark targets for covered services provided to aligned beneficiaries.

The SWHR ACN Board has approved an arrangement under which physicians who are UTSCAP physicians and participants in SWHR ACN’s Next Generation Accountable Care Organization Program may receive quarterly incentive payments from SWHR ACN upon demonstrating a certain level of quality, cost-effectiveness, and efficiency in their provision of services to ACO beneficiaries (“QPP”).  The QPP is intended to incentivize eligible physicians to deliver high quality, efficient, and cost-effective care for SHWR ACN aligned patients.  Incentive payments paid under the QPP will be based on meeting the following metrics: (i) quality of care (determined by completing targeted measures of care delivery), (ii) coding practices (determined by recapture rates for Hierarchical Condition Category codes), and (iii) network effectiveness procedures.

The SWHR ACN Board has approved an arrangement under which SWHR ACN will provide to physicians who are participants and/or preferred providers in SWHR ACN’s Next Generation Accountable Care Organization an electronic referral management tool called the Southwest Health Resources Referral Platform (“SRP”) designed to avoid disrupting physician workflow by incorporating into physician’s electronic medical records.  The goal of the SRP is to streamline referral workflows to improve the efficiency of referral management within a physician’s preferred network of consulting providers, increase continuity of care for patients, and decrease lost or dropped referrals.  Additionally, utilizing the SRP will assist physicians in compliance with Meaningful Use Stage III requirements for electronic transmission of clinical documentation.  The provision of SRP to physicians does not prevent such physicians from making referrals to specialists outside of the SWHR ACN network.

As permitted by SWHRACN’s Participation Agreement, SWHRACN has elected to participate in the Cost Sharing Support Benefit Enhancement for the Next Generation ACO Model Performance Year 2019. Under the Cost Sharing Support Benefit Enhancement, SWHRACN has entered into Cost Sharing Arrangements with certain Next Generation ACO Participants to reduce or eliminate eligible ACO beneficiaries’ cost sharing obligation for certain categories of Part B services.  Eligible services consist of Medicare Part B professional services, excluding durable medical equipment and prescription drugs. Eligible beneficiaries include Next Generation ACO Beneficiaries who are (i) without Medicare supplemental insurance, (ii) experiencing high health care costs, and (iii) in need of certain Part B services, the receipt of which could reduce the Next Generation ACO Beneficiaries’ health care costs.

 

Medicare Shared Savings Quality Performance Results

 

Talk to your doctor

ACO Beneficiary Fact Sheet: Accountable Care Organizations and You: Frequently Asked Questions (FAQ) for People with Medicare (PDF)

Visit www.cms.gov/aco

Call 1-800-MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY users should call 1-877-486-2048

For Next Generation Model ACO Participants ONLY – Reporting Violations and Concerns

To report suspected violations or compliance related concerns, please contact the ACO Compliance Officer and/or to the Compliance Hotline at the following:

Gail Howard                                                               

Chief Compliance Officer                                          

SWHR Network Entities                                           

c/o Texas Health Resources                               

8150 Brookriver Dr.                                            

Dallas, Texas 75247                                                       

Phone: 469-291-3202                  

Email:  GailHoward@texashealth.org


Compliance Hotline: 1-877-507-7319
www.utsouthwestern.edu/hotline