Medicare Shared Savings Program ACO
If you have original Medicare, your provider may be part of a Medicare Shared Savings Program (MSSP) in an Accountable Care Organization (ACO). Doctors, hospitals and health professionals in an ACO work together to ensure Medicare fee-for-service patients get the best care.
The OHSU Health Clinically Integrated Network (OHSU Health CIN) is a clinician network with providers who team up to give you high-quality, coordinated care around Portland in the following locations.
- OHSU hospitals and clinics
- OHSU Health Hillsboro Medical Center
- Adventist Health Portland
- Independent clinics in the Portland area
Letters to Medicare members
If you are a Medicare member, you may get letters from OHSU Health CIN saying your provider is part of a Medicare Shared Savings Program in an ACO.
These letters are just required notices. Nothing is changing with your benefits. Medicare requires that we send these letters to keep you informed.
Why you may get a letter
- You are an original Medicare beneficiary living in Multnomah, Washington or Clackamas County.
- One or more of your providers chooses to take part in the OHSU Health Medicare Shared Savings Program.
- Medicare automatically assigned you to OHSU Health CIN based on where you receive primary care.
Frequently asked questions
What is a Medicare Shared Savings Program (MSSP)?
In Medicare Shared Savings Programs, or MSSPs, doctors, hospitals and health care providers team up to make sure you get the best care. This is not an insurance plan like Medicare Advantage. This is a network of health care providers who agree to work together.
Because original Medicare beneficiaries can choose their providers, they may pick several providers who don't usually share information. Medicare wants providers to communicate with each other to ensure you get the right tests, medications and treatments.
What is an Accountable Care Organization?
An Accountable Care Organization (ACO) is a group of hospitals and health care providers that work together to give you high-quality, coordinated health care. A Medicare Shared Savings Program is a program within an ACO.
ACOs make agreements with Medicare to ensure the care Medicare patients receive meets cost and quality standards. Medicare can reward or fine ACOs based on their results.
Watch the video to learn more about ACOs.
What is OHSU Health CIN?
OHSU Health Clinically Integrated Network (OHSU Health CIN) includes hospitals and providers at Oregon Health & Science University (OHSU), OHSU Doernbecher Children’s Hospital, Adventist Health Portland, OHSU Health Hillsboro Medical Center and independent clinics in the Portland metro area.
Watch the video to learn more about OHSU Health CIN.
Does my provider’s membership in an MSSP change the cost or quality of my care?
There is no change or added cost for your care. The purpose of the MSSP is to make sure you get the best care.
- You get patient-centered care focused on your needs.
- Your health care providers see the same test results, diagnoses and prescriptions. This coordination helps prevent medical errors and drug interactions.
- You may save time, money and frustration by avoiding repeated tests and appointments.
- Better communication can help protect you against Medicare fraud and waste.
Is my health information shared?
Medicare shares claims data through a secure process with providers in the Medicare Shared Savings Program. Data may show the date and location of an X-ray or lab test, but it will not show the results of those tests. Medicare includes claims data from providers, hospitals and clinics that provide your care. This helps ensure your providers can see your health information when they need it.
Medicare does not have access to your OHSU Health electronic health record.
What if I don’t want to share my health information?
If you don’t want Medicare to share your information to coordinate care, you must call 1-800-MEDICARE (1-800- 633-4227). Your decision not to share your data will not change which provider you can see. Only you can make this request with Medicare.
Medicare may share general information to measure provider quality. For more information on how Medicare may use and give out your information, read the Notice of Privacy Practices for Original Medicare.
Fraud, waste and abuse: See something wrong? Tell someone.
Fraud, waste and abuse in health care hurt everyone. When money is misused, it can't help those who need it.
- Fraud is when someone tricks others on purpose for their own benefit.
- Waste is spending money on health care that isn't needed or used well.
- Abuse is when someone accidentally gives wrong information causing unneeded cost.
Some examples of fraud, waste and abuse by a provider are:
- Faking reports of services that didn't happen or products that weren't provided.
- Reporting more services than were provided.
- Charging too much to people who don't have Medicaid or other insurance.
- Not giving the right services that are supposed to be given.
- Charging people more than they should pay.
- Doing things that cost too much, aren't needed or don't follow good healthcare practices.
Some examples of fraud, waste and abuse by a member are:
- Cheating in enrolling or disenrolling people.
- Going to multiple doctors for prescriptions for a drug already prescribed.
- Using another person’s ID to get benefits.
You can report fraud, waste or abuse if you think you've seen it. You don't have to give your name, and you're protected by law. OHSU Health CIN tells the authorities about any fraud they find.
Here is how you can report it:
- Call the OHSU Anonymous Compliance Hotline at 1-877-733-8313.
- Fill out a form online at www.ohsu.edu/hotline.
ACO public reporting information
ACO name and location
OHSU Health Clinically Integrated Network
P.O. Box 925
335 SE 8th Avenue
Hillsboro, OR 97123
ACO primary contact
Mary Ransome, LMT MMOL
971-254-5958
OHSUHealthCIN@ohsu.edu
Organizational information
Learn more
Medicare support
- Medicare, 1-800-MEDICARE (633-4227)
- Local State Health Insurance Assistance Program (SHIP)
Resources for seniors
Find a Medicare primary care provider
Visit Medicare.gov to log in or create an account and choose your doctor.
- Watch this how-to video for step-by-step instructions.
ACO Participant | ACO Participant in Joint Venture (Y or N) |
---|---|
Diagnostic Radiologists PC | N |
Marion Lee Gardner, Jr. M.D. | N |
Hillsboro Pediatric Clinic LLC | N |
Oregon Health & Science University | N |
Portland Adventist Medical Center | N |
Tuality Healthcare PC | N |
Tuality Medical Group LLC | N |
University Professional Services | N |
Member Name Title, Position | Voting Power % | Membership Type | ACO Participant Legal Business Name |
---|---|---|---|
Kathryn Schabel, Chair, Physician | 11.11% | ACO Participant Representative | Oregon Health & Science University |
Dean Thongkham, Vice Chair, Physician | 11.11% | ACO Participant Representative | Portland Adventist Medical Center |
Khalid Wahab, President & Secretary | 11.11% | ACO Participant Representative | Oregon Health & Science University |
Mike Olson, CPA, Treasurer | 11.11% | ACO Participant Representative | Oregon Health & Science University |
Kamaljit Atwal, Physician | 11.11% | ACO Participant Representative | Portland Adventist Medical Center |
Greg Brown, Physician | 11.11% | ACO Participant Representative | Hillsboro Pediatric Clinic |
Lori James-Nielsen, CEO, Hillsboro Medical Center | 11.11% | ACO Participant Representative | Tuality Healthcare |
Rasha Nakhleh, Physician | 11.11% | ACO Participant Representative | OHSU Health Hillsboro Medical Center |
George Pernsteiner, Medicare member | Not applicable | Medicare Beneficiary Representative | Not applicable |
Xiaofang Shen, Medicare member | Not applicable | Medicare Beneficiary Representative | Not applicable |
Randi White, Nonphysician | 11.11% | ACO Participant Representative | Portland Adventist Medical Center |
Key ACO clinical and administrative leadership
- ACO Executive: Khalid Wahab, J.D., M.P.H.
- Medical Director: Katrina McPherson, M.D.
- Compliance Officer: Anju Kumar
- Quality Assurance/Improvement Officer: Jorge Melendez, D.B.A, M.B.A.
Committee Name | Committee Leaders Name and Position |
---|---|
Finance & Plan Review Committee | Marc Lewis, M.D., Chair |
Clinical Value & Quality Committee | Greg Brown, M.D., Chair |
Credentialing Sub-committee | Katrina McPherson, M.D., Chair |
Types of ACO participants, or combinations of participants, that formed the ACO
- ACO professionals in a group practice arrangement
- Hospital employing ACO professionals
- Federally Qualified Health Center (FQHC)
- Rural Health Clinic (RHC)
Shared savings and losses
Fourth Agreement Period
-
N/A
Third Agreement Period
-
N/A
Second Agreement Period
-
N/A
First Agreement Period
- Performance Year 2020, $0.00
- Performance Year 2021, $0.00
- Performance Year 2022, $0.00
- Performance Year 2023, $0.00
Shared Savings Distribution
Fourth Agreement Period
-
N/A
Third Agreement Period
-
N/A
Second Agreement Period
-
N/A
First Agreement Period
-
N/A
Quality performance results are based on CMS web interface collection type.
Measure Number | Measure Name | Collection Type | Reported Performance Rate | Current Year Mean Performance Rate (SSP ACOs) |
---|---|---|---|---|
Quality ID #001 | Diabetes: Hemoglobin A1c (HbA1c) Poor Control [1] | CMS Web Interface | 16.40 | 9.84 |
Quality ID #134 | Preventive Care and Screening: Screening for Depression and Follow-up Plan | CMS Web Interface | 71.37 | 80.97 |
Quality ID #236 | Controlling High Blood Pressure | CMS Web Interface | 72.58 | 77.80 |
Quality ID #318 | Falls: Screening for Future Fall Risk | CMS Web Interface | 91.13 | 89.42 |
Quality ID #110 | Preventive Care and Screening: Influenza Immunization | CMS Web Interface | 70.56 | 70.76 |
Quality ID #226 | Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention | CMS Web Interface | 84.62 | 79.29 |
Quality ID #113 | Colorectal Cancer Screening | CMS Web Interface | 71.77 | 77.14 |
Quality ID #112 | Breast Cancer Screening | CMS Web Interface | 81.45 | 80.36 |
Quality ID# 438 | Statin Therapy for the Prevention and Treatment of Cardiovascular Disease [2] | CMS Web Interface | 87.31 | 87.05 |
Quality ID #370 | Depression Remission at 12 Months [2] | CMS Web Interface | 2.86 | 16.58 |
CAHPS-1 | Getting Timely Care, Appointments and Information | CAHPS for MIPS Survey | 73.06 | 83.68 |
CAHPS-2 | How Well Providers Communicate | CAHPS for MIPS Survey | 91.94 | 93.69 |
CAHPS-3 | Patient’s Rating of Provider | CAHPS for MIPS Survey | 89.84 | 92.14 |
CAHPS-4 | Access to Specialists | CAHPS for MIPS Survey | 62.19 | 75.97 |
CAHPS-5 | Health Promotion and Education | CAHPS for MIPS Survey | 63.00 | 63.93 |
CAHPS-6 | Shared Decision Making | CAHPS for MIPS Survey | 51.68 | 61.60 |
CAHPS-7 | Health Status and Functional Status | CAHPS for MIPS Survey | 69.90 | 74.12 |
CAHPS-8 | Care Coordination | CAHPS for MIPS Survey | 82.23 | 85.77 |
CAHPS-9 | Courteous and Helpful Office Staff | CAHPS for MIPS Survey | 91.43 | 92.31 |
CAHPS-11 | Stewardship of Patient Resources | CAHPS for MIPS Survey | 21.23 | 26.69 |
Measure #479 | Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups [1] | Administrative Claims | 0.1441 | 0.1553 |
Measure #484 | Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions (MCC) [1] | Administrative Claims | 34.44 | 35.39 |
1 A lower performance rate corresponds to a higher quality.
2 For PY 2022, the CMS Web Interface measures Quality ID #438 and Quality ID #370 do not have benchmarks and, therefore, were not scored.
For the previous years’ financial and quality performance results, please visit data.cms.gov.
Payment rule waivers
Payment for telehealth services waiver
Our ACO clinicians provide telehealth services using the flexibilities under 42 CFR § 425.612(f) and 42 CFR § 425.613.
Waivers for fraud and abuse
ACO pre-participation waiver
The following information describes each arrangement for which our ACO seeks protection under the ACO Pre-Participation Waiver, including any material amendment or modification to a disclosed arrangement.
-
Not applicable
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.
For each arrangement, provide the following information:
- Parties to the arrangement: THPS Board of Directors
- Date of arrangement: 03/18/2021
- Items, services, goods, or facility provided: Specifically, the board has determined that the:
- ACO arrangement contemplated in 2019 and implemented effective January 2020 meets CMS criteria for ACOs participating in the MSSP Program.
- The ACO will put the beneficiary and family at the center of all its activities. It will honor individual preferences, values, backgrounds, resources, and skills, and it will thoroughly engage people in shared decision-making about diagnostic and therapeutic options.
- The ACO will ensure coordination of care for beneficiaries regardless of its time or place.
- The ACO will attend carefully to care transitions, especially as Beneficiaries journey from one part of the care system to another.
- The ACO will manage resources carefully and respectfully. Because of its capabilities with respect to prevention and anticipation, especially for chronically ill people, an ACO will be able to continually reduce its dependence on in patient care, Instead, its patients will more likely be able to be home, where they often want to be, and, during a hospital admission, they receive assurance that their discharges will be well coordinate, and that they will not return due to avoidable complications.
- The ACO will be proactive by reaching out to patients with reminders and advice that can help them stay healthy and let them know when it is time for a checkup or test.
- The ACO will collect, evaluate, and use data on health care processes and outcomes sufficiently to measure what it achieves for beneficiaries and communities over time and use such data to improve care delivery and patient outcomes.
- The ACO will be innovative in the service of the quadruple aim. It will draw upon the best, most advanced models of care, using modern technologies, including telehealth and electronic health records, and other tools to continually reinvent care in the modern age. It will monitor and compare its performance to other ACOs, identify and examine new processes for care improvement, and adopt those approaches that are demonstrated to be effective.
- The ACO will continually invest in the development and pride of its own workforce, including affiliated clinicians. It will maintain and execute plans for helping build skill, knowledge, and teamwork.
- ACO arrangement contemplated in 2019 and implemented effective January 2020 meets CMS criteria for ACOs participating in the MSSP Program.
- Date and nature of any amendments to the arrangement, if applicable: N/A