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In 2015, the Northwell Health ACO chose to participate in the Medicare Shared Savings Program, with an effective start date of January 1, 2016. The Northwell Health ACO is governed by independent physicians, Northwell Health employed physicians, and a Medicare FFS beneficiary.

Northwell Health’s participation in the Medicare Shared Savings Program presents an opportunity to develop innovative approaches to health care delivery, streamline existing value-based programs, and promote wellness that will improve the health of our communities.

What is a Medicare Shared Savings Program ACO?

A Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) is a new, national approach to health care delivery for Medicare fee-for-service (FFS) beneficiaries. Created under the 2010 Patient Protection and Affordable Care Act, a MSSP ACO works to improve quality and reduce unnecessary costs.

MSSP ACOs are not managed care organizations, do not use closed networks of providers, and do not limit a Medicare beneficiary’s ability to seek care from participating Medicare providers outside an ACO.

There is no financial downside risk or disruption to underlying Medicare fee-for-service billing. When an MSSP ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

For general questions or additional information about Accountable Care Organizations, please visit www.medicare.gov/acos.html or call 1-800 MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048.

Our mission

The Northwell Health ACO’s mission is to improve the health and wellness of the community through the collaborative efforts of physicians and other healthcare providers who:
  • Share a commitment to the provision of excellent healthcare services; and
  • Seek to enhance delivery of quality, coordinated and efficient care.
The Northwell Health ACO provides an opportunity to collaboratively improve patient outcomes by:

 

Northwell Health ACO annual compliance training (for participants only)

MSSP public reporting ACO Name and Location:

North Shore-LIJ MSSP ACO, LLC d/b/a Northwell Health ACO
2000 Marcus Avenue
New Hyde Park, New York 11042

ACO Primary Contact:

Sandy Balwan, MD
Medical Director, Northwell Health ACO
(516) 600-1351
sbalwan@northwell.edu

Organizational Information: ACO Participants:

Advanced Internal Medicine Pc
All Care Family Medicine, PC
Anat Benjamin Md Pc
Anthony Panarelli
Arsenio Medical P.C.
Bay Family Medicine, PLLC
Bellerose Medical Care P.C.
Brian Campolatarro
Brookhaven Gastroenterology Associates PC
Bruce Lowell
Central Suffolk Hospital
Comprehensive Island Medical Care
David A Schlessinger, M.D., P.C.
Devicka Persaud Medical PC.
Doctors Medical Office Pllc
Draga Eye Care & Surgery Associates, LLP
East Side Primary Medical Care PC
Eyeguys LLP
Florante Melchor MD FACP PLLC
Frederick Wang
Gastrointestinal Care of Long Island, PC
George Tung MD, PC*
Glen Cove Hospital
Huntington Hospital Association
Huntington Hospital Dolan Family Health Center
Internal Medicine & Geriatrics PLLC
Ira J. Salzman, MD PLLC
Island Medicine, PLLC
Jeffrey Krupen MD
Kinwell Medical Services, PC
Lenox Hill Hospital
Lenox Hill Hospital Medical, PC
Lenox Hill Pathology, PC
Lenox Otolaryngology Head And Neck Surgery,P.C.
Long Island Eye Surgeons, PC*
Long Island Gastroenterology and Liver Disease P.C.
Long Island Jewish ESRD
Long Island Vitreo Retinal Consultants*
Luz del Carmen Cespedes MD, PLLC
Mark J Coronel MD PC
Medical Surgical Eye Care Services PC
Michael Oliverio, DO, PC
Neil J.Dash MD, P.C.
Noah Zinkin MD PC
North Shore – Lij Radiology Services, Pc
North Shore Digestive Medicine PC
North Shore Gastroenterology Associates
North Shore Lij Internal Medicine At New Hyde Park Pc
North Shore Lij Physicians Group Pc
North Shore University Hospital
North Shore-LIJ Cardiology at Deer Park, PC
North Shore-LIJ Cardiovascular Medicine PC
North Shore-LIJ Heart Surgery, PC
North Shore-LIJ Internal Medicine at Lynbrook, PC
North Shore-LIJ Medical Group at North Nassau, PC
North Shore-LIJ Medical Group at Syosset, PC
North Shore-LIJ Medical PC
North Shore-LIJ Ob/GYN at Garden City, PC
North Shore-LIJ Ob/GYN, PC
North Shore-LIJ OB-GYN at New Hyde Park, PC
North Shore-LIJ Pediatrics of Suffolk County, PC
North Shore-LIJ Urgent Care, PC*
Northern Westchester Hospital Association
Northwell Health Stern Family Center For Rehabilitation
Northwell Healthcare Inc
Ophthalmology Associates of Glen Cove PC
Palmadessa Brodsky Gastroenterology Associates PC
Parmeshwar Mahabir
Paulette Stewart, MD PC
Peconic Bay Primary Medical Care P.C.
Peter L. Menger M.D., P.C.
Phelps Medical Services, PC
Phelps Memorial Hospital Association
Physicians of University Hospitals PC
Plainview Hospital
Prime Care Medical Of Long Island, Pc
Rego Park Medical Associate PC
Richard P Boughal MD PC
Sajid Malik, MD PC
Skope Medical Care P.C.
South Island Gastroenterology Associates PC
South Shore Eye Care LLP*
Southside Hospital
Stewart A Levine MD PC
The Long Island Home
Twin Forks Gastroenterology & Hepatology, PC
United Medical Surgical, PC
Westchester Health Medical, PC

*Participants involved in a joint venture.

governing-body

ACO Governing Body:

Member Member’s Voting Power Membership Type ACO Participant TIN Legal Business Name/DBA, if Applicable
Last Name First Name Title/Position
Balwan, MD Sandy Voting Member 1 ACO Participant Representative North Shore-LIJ Medical, P.C.
Carney, MD Maria Voting Member 1 ACO Participant Representative North Shore-LIJ Medical, P.C.
Geier, MD Steven Voting Member 1 ACO Participant Representative North Shore-LIJ Medical, P.C.
Gottridge, MD JoAnne Voting Member 1 ACO Participant Representative North Shore-LIJ Medical, P.C.
Jonisch, MD John Voting Member 1 ACO Participant Representative Long Island Vitreo Retinal Consultants
Longjohn, MD Data Voting Member 1 ACO Participant Representative Skope Medical Care PC
Mahabir, MD Parmeshwar Voting Member 1 ACO Participant Representative Parmeshwar Mahabir
Raza, MD Yanira Voting Member 1 ACO Participant Representative Comprehensive Island Medical Care, LLC
Siegelheim, MD Mark Voting Member 1 ACO Participant Representative North Shore-LIJ Medical, P.C.
Stein, MD Mark Voting Member 1 ACO Participant Representative South Shore Eye Care LLP
Stenzler Leonard Voting Member 1 Medicare Beneficiary N/A

 

Key ACO Clinical and Administrative Leadership:

Executive Director

Matthew Jelavic

Medical Director

Sandy Balwan, MD

Compliance Officer

Louis DiGiovanni

Quality Assurance/Improvement Officer

Lisa Sokoloff, RN, MS

Associated Committees and Committee Leadership:

Performance and Distribution Committee

Chairperson:

Mark Siegelheim, MD

Members:

Sandy Balwan, MD
Steven Geier, MD
Mark Stein, MD

Clinical Performance and Quality Committee

Chairperson:

Sandy Balwan, MD

Members:

Sandy Balwan, MD
Maria Carney, MD
Parmeshwar Mahabir, MD

Network Composition and Credentialing Committee

Chairperson:

Mark Stein, MD

Members:

Steven Geier, MD
Mark Siegelheim, MD

Types of ACO Participants or Combinations of Participants that Formed the ACO:

  • ACO professionals in group practice arrangements
  • Networks of individual practices of ACO professionals
  • Hospitals employing ACO professionals
  • Partnerships or Joint Venture arrangements between hospitals and ACO professionals

Shared Savings and Losses:

Amount of Shared Savings/Losses

  • Second Agreement Period
    • Performance Year 2019, $0
  • First Agreement Period
    • Performance Year 2019, $0
    • Performance Year 2018, $0
    • Performance Year 2017, $0
    • Performance Year 2016, $0

Note: Our ACO participated in multiple performance years during Calendar Year 2019. Shared savings/losses amount reported for Performance Year 2019 therefore represents net shared savings or losses across all performance years in 2019 and is shown under all agreement periods in which the ACO operated during Calendar Year 2019.

Shared Savings Distribution

  • Second 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
  • 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 2018
      • 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 2017
      • 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 2016
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A

Note: Our ACO participated in multiple performance years during Calendar Year 2019. Distribution of shared savings reported for Performance Year 2019 therefore represents the distribution of the net shared savings across all performance years n 2019 and is shown under all agreement periods in which  the ACO operated during Calendar Year 2019.

2019 Quality Performance Results

ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 81.63 85.86
ACO-2 CAHPS: How Well Your Providers Communicate 94.35 94.11
ACO-3 CAHPS: Patients’ Rating of Provider 93.11 92.69
ACO-4 CAHPS: Access to Specialists 81.25 81.54
ACO-5 CAHPS: Health Promotion and Education 54.72 60.44
ACO-6 CAHPS: Shared Decision Making 60.27 62.78
ACO-7 CAHPS: Health Status/Functional Status 74.21 73.79
ACO-34 CAHPS: Stewardship of Patient Resources 18.55 26.17
ACO-45 CAHPS: Courteous and Helpful Office Staff 89.69 92.84
ACO-46 CAHPS: Care Coordination 86.10 86.89
ACO-14 Influenza Immunization 73.88 74.77
ACO-17 Tobacco Screening and Cessation Intervention 85.19 78.04
ACO-18 Depression Screening & Follow-up Plan 46.69 70.40
ACO-19 Colorectal Cancer Screening 60.23 70.76
ACO-20 Breast Cancer Screening 61.32 73.84
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 84.21 82.17
ACO-8 Risk Standardized, All Condition Readmission 15.90 14.86
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 67.24 58.15
ACO-43 Ambulatory Sensitive Condition Acute Composite 1.57 1.87
ACO-13 Screening for Future Fall Risk 91.03 84.04
ACO-40 Depression Remission at Twelve Months Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size.
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 10.96 13.88
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 72.82 75.04

For Previous Years’ Financial and Quality Performance Results, please visit data.cms.gov.

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