ACO

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ACO Name and Location:

Illinois Health Partners ACO, LLC
1100 W. 31st Street, Suite 300
Downers Grove, IL 60302

ACO Primary Contact:

Gina Sharp
Vice President, Illinois Health Partners
gsharp@edward.org
630-305-5830

Organizational Information:

• ACO participants:

2014 Participants

1. EDWARD HEALTH VENTURES*
2. EDWARD HOSPITAL*
3. ELMHURST MEMORIAL HEALTHCARE*
4. ELMHURST MEMORIAL HOSPITAL*
5. DU PAGE MEDICAL GROUP LTD*

2015 Participants

1. EDWARD HEALTH VENTURES*
2. EDWARD HOSPITAL*
3. ELMHURST MEMORIAL HEALTHCARE*
4. ELMHURST MEMORIAL HOSPITAL*
5. DU PAGE MEDICAL GROUP LTD*
6. NORTHWEST COMMUNITY HEALTH SERVICES INC
7. ADDISON MEDICAL ASSOCIATES LTD
8. AFFILIATES IN PRIMARY CARE,S.C.
9. DR. ALVARO ENRIQUE PENA M.D.
10. DR. ANTONIOS PAPADOPOULOS MD
11. DR H KALSI & ASSOCIATES P C
12. GENERATIONS FAMILY MEDICINE, INC
13. KARIM S. YUNEZ, M.D.S.C.
14. MUHAMMAD A SHAHZAD MD
15. NAPERVILLE FAMILY PRACTICE INC
16. NARENDRA D DABHADE MD LTD
17. PETER GRANT, MD, LTD
18. PREMIER INTERNISTS OF NAPERVILLE INC
19. PRIME HEALTH ASSOCIATES INC
20. ROBERT A. WINIECKI, M.D.
21. ROBERT J. MILLAR MD
22. SEEMA GUPTA MD PC
23. WILLIAM Z LANGREDER & GARY YONG PTRS

2016 Participants

1. ADDISON MEDICAL ASSOCIATES LTD
2. ALVARO PENA, MD
3. ANTONIOS PAPADOPOULOS, MD
4. DR H KALSI & ASSOCIATES P C
5. DU PAGE MEDICAL GROUP LTD*
6. EDWARD HEALTH VENTURES*
7. EDWARD HOSPITAL*
8. ELMHURST MEMORIAL HEALTHCARE*
9. ELMHURST MEMORIAL HOSPITAL*
10. GENERATIONS FAMILY MEDICINE, INC
11. KARIM S. YUNEZ, M.D.S.C.
12. LOMBARD FAMILY HEALTH CENTER
13. MUHAMMAD A SHAHZAD MD
14. NAPERVILLE FAMILY PRACTICE INC
15. NAPERVILLE PSYCHIATRIC VENTURES*
16. NARENDRA D DABHADE MD LTD
17. NORTHWEST COMMUNITY HEALTH SERVICES INC
18. NORTHWEST COMMUNITY HOSPITAL
19. NORTHWEST SUBURBAN PHYSICIANS LLC
20. PETER GRANT, MD, LTD
21. PREMIER INTERNISTS OF NAPERVILLE INC
22. PRIME HEALTH ASSOCIATES INC
23. ROBERT A. WINIECKI, M.D.
24. ROBERT J. MILLAR MD
25. SEEMA GUPTA MD PC

2017 Participants

1. EDWARD HEALTH VENTURES*
2. EDWARD HOSPITAL*
3. ELMHURST MEMORIAL HEALTHCARE*
4. ELMHURST MEMORIAL HOSPITAL*
5. DU PAGE MEDICAL GROUP LTD*
6. NAPERVILLE PSYCHIATRIC VENTURES*
7. NORTHWEST COMMUNITY HEALTH SERVICES INC
8. NORTHWEST COMMUNITY HOSPITAL
9. NORTHWEST SUBURBAN PHYSICIANS LLC
10. ADDISON MEDICAL ASSOCIATES LTD
11. DR. ALVARO ENRIQUE PENA M.D.
12. DR. ANTONIOS PAPADOPOULOS MD
13. DR. CAROL R. WEINBERG
14. DR H KALSI & ASSOCIATES P C
15. GENERATIONS FAMILY MEDICINE, INC
16. HOBSON MEADOWS FAMILY MEDICINE S C
17. KARIM S. YUNEZ, M.D.S.C.
18. MUHAMMAD A SHAHZAD MD
19. NAPERVILLE FAMILY PRACTICE INC
20. NARENDRA D DABHADE MD LTD
21. PETER GRANT, MD, LTD
22. PREMIER INTERNISTS OF NAPERVILLE INC
23. ROBERT A. WINIECKI, M.D.
24. SEEMA GUPTA MD PC
25. WILLIAM Z LANGREDER & GARY YONG PTRS

ACO participants in joint ventures between ACO professionals and hospitals are annotated by an asterisk [*]

• ACO governing body:

1. Pamela Davis, Voting Member and Co-Chair, ACO Participant, Edward Hospital & Edward Health Ventures
2. Michael Kasper, Voting Member, Co-Chair and President, ACO Participant, Du Page Medical Group, Ltd.
3. Vince Pryor, Voting Member and Treasurer, ACO Participant, Edward Hospital & Edward Health Ventures
4. Michael Pacetti, Voting Member and Secretary, ACO Participant, Du Page Medical Group, Ltd.
5. Dr. Brent Smith, Voting Member, ACO Participant, Edward Hospital
6. Bill Kottmann, Voting Member, ACO Participant, Edward Health Ventures
7. Dr. Jean Houlihan, Voting Member, ACO Participant, Du Page Medical Group, Ltd.
8. Dr. Paul Merrick, Voting Member, ACO Participant, Du Page Medical Group, Ltd.
9. Michael Hartke, Voting Member, ACO Participant, Northwest Community Hospital
10. Steve Scogna, Voting Member, ACO Participant, Northwest Community Hospital
11. Robert Poland, Voting Member, Medicare Beneficiary Representative
12. Andy Lindsay, Voting Member, Medicare Beneficiary Representative

• Key ACO clinical and administrative leadership:

1. ACO Executive: Dr. Michael Kwiecinski
2. Medical Director: Dr. Michael Kwiecinski
3. Compliance Official: Mr. Krishna Ramachandran
4. CMS Liaison: Ms. Teri Kaneski

• Associated Committees and Committee Leadership:

1. Nominations Committee: Pamela Davis, Chair
2. ACO Physician Advisory Committee: Dr. Michael Kwiecinski, Chair
3. Clinical Integration Committee: Dr. Brent Smith, Dr. Susan Nelson, Dr. Michael Kwiecinski, Co-Chairs
4. Utilization Management Committee: Dr. Michael Kwiecinski, Chair
5. Finance and Contracting Committee: Vince Pryor, Michael Pacetti, Co-Chairs

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

1. ACO professionals in a group practice arrangement
2. Network of individual practices of ACO professionals
3. Partnership or joint venture arrangement between hospitals and ACO professionals
4. Hospital employing ACO professionals

Shared Savings and Losses:

Amount of Shared Savings/Losses
• Agreement period beginning 2014, Performance Year 2014: $0
• Agreement period beginning 2014, Performance Year 2015: $0

Shared Savings Distribution

Agreement period beginning 2014, Performance Year 1
• Proportion invested in infrastructure: 50%
• Proportion invested in redesigned care processes/resources: 0%
• Proportion of distribution to ACO participants: 50%

Agreement period beginning 2014, Performance Year 2015
• Proportion invested in infrastructure: 33%
• Proportion invested in redesigned care processes/resources: 33%
• Proportion of distribution to ACO participants: 33%

Agreement period beginning 2014, Performance Year 2016
• Proportion invested in infrastructure: 33%
• Proportion invested in redesigned care processes/resources: 33%
• Proportion of distribution to ACO participants: 33%

Payment Rule Waivers
• No, our ACO does not utilize the SNF 3-Day Rule Waiver.

Quality Performance Results
• See 2015 Quality Performance Results Table here. 2015-quality-performance-results-table
• See 2012 -2014 Quality Performance Results Table here. 2012-2014-quality-performance-results-table

ACO Initiatives:

The Illinois Health Partners ACO Board has approved the following arrangements for the waivers authorized by CMS and the OIG pursuant to the “Medicare Program; Final Waivers in Connection with the Shared Savings Program” published on November 2, 2011:

Illinois Health Partners ACO, LLC (ACO), DuPage Medical Group, Ltd. (a participant in the ACO) (“DMG”), and certain of its physicians (ACO health care professionals in the ACO) are parties to an arrangement whereby participating DMG physicians may receive payments from DMG for their activities relating to educating identified at-risk patients regarding DMG’s “patient-centric” care delivery model, which is designed to provide more personalized monitoring of patients who have, or are at-risk of having, one or more chronic medical condition, thus enhancing the patient experience and improving clinical outcomes.
Illinois Health Partners ACO, LLC (ACO), Edward Hospital and Elmhurst Memorial Hospital (each a participant in the ACO) (“Participating Hospitals”) and eligible group practices that are comprised of ACO health care professionals in the ACO (“Participating Group Practice(s)”) are parties to an arrangement whereby Participating Hospitals will provide Participating Group Practices with implementation services related to, access to, and ongoing upgrades and maintenance of, an electronic health record system (“EHR Items and Services”) and will contribute a portion of the costs related to such EHR Items and Services. This arrangement is designed to improve quality and manage care coordination through better integration and sharing of care plans, provide the data necessary for the ACO to determine trending of care patterns, identify best practices, and develop population health and disease management protocols and initiatives.

Illinois Health Partners ACO, LLC (ACO), Edward Health Ventures (a participant in the ACO) (“EHV”), and certain ACO health care professionals in the ACO are parties to an arrangement whereby participating physicians may receive payments from EHV for their activities relating to educating identified at-risk patients regarding EHV’s “patient-centric” care delivery model for patients with diabetes, which is designed to provide more personalized monitoring of such patients, thus enhancing the patient experience and improving clinical outcomes.

Illinois Health Partners ACO, LLC (ACO), Edward Hospital (a participant in the ACO) has engaged physicians participating in the ACO to administer a program to advance evidence-based medicine, increase patient satisfaction, and manage the cost of care for the orthopedic service line of Edward Hospital. The focus will be general ortho, total joint replacement, and spine; eligible physicians will be eligible for compensation based upon meeting quality and cost metrics.

Illinois Health Partners ACO, LLC (ACO), Elmhurst Memorial Hospital (a participant in the ACO), has engaged physicians participating in the ACO to administer a program to advance evidence-based medicine, increase patient satisfaction, and manage the cost of care for the orthopedic service line of Elmhurst Memorial Hospital. The focus will be general ortho, total joint replacement, and sports medicine; eligible physicians will be eligible for compensation based upon meeting quality and cost metrics.

Illinois Health Partners ACO, LLC (ACO), and certain of its eligible professionals (health care professionals in the ACO) are parties to an arrangement whereby physician and advance practice professional (APP) teams, rounding in Skilled Nursing Facilities (SNF), may be incentivized to improve quality while providing enhanced patient oversight and optimize efficiency to reduce sub-acute health care costs. Physicians and advance practice professionals will be eligible for compensation based upon meeting clinical quality and utilization outcomes.