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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:

Mr. Terry Lynam
Chief Public Relations Officer, Northwell Health
(516) 321-6702
tlynam@northwell.edu

Organizational Information: ACO Participants:

Advanced Internal Medicine Pc
All Care Family Medicine, PC
Anat Benjamin Md Pc
Andrew Zaager MD
Arsenio Medical P.C.
Bay Family Medicine, PLLC
Bellerose Medical Care P.C.
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
Family Medical Care of Bayshore, PC
Floral Park Medical PC
Florante Melchor MD FACP PLLC
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 Jewish ESRD
Long Island Vitreo Retinal Consultants*
Luz del Carmen Cespedes MD, PLLC
Mark J Coronel MD 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 Medical Group Urgent Medical Care, P.C
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
Peconic Bay Primary Medical Care P.C.
Peter L. Menger M.D., P.C.
Phelps Medical Services, PC
Phelps Memorial Hospital Association
Plainview Hospital
Prime Care Medical Of Long Island, Pc
Raber Medical PC
Rego Park Medical Associate PC
Richard P Boughal MD PC
Richmond Hill Medical Services,P.C.
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
Burns, MD Patrick Voting Member 1 ACO Participant Representative Island Medicine, PLLC
Carney, MD Maria Voting Member 1 ACO Participant Representative North Shore-LIJ Medical, P.C.
Balwan, MD Sandy 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.
Raza, MD Yanira Voting Member 1 ACO Participant Representative Comprehensive Island Medical Care, LLC
Jonisch, MD John Voting Member 1 ACO Participant Representative Vitreoretinal Consultants
Longjohn, MD Data Voting Member 1 ACO Participant Representative Skope Medical Care PC
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, FACP

Compliance Officer

Maria Joseph

Quality Assurance/Improvement Officer

Lisa Sokoloff, RN, MS

Associated Committees and Committee Leadership:

Performance and Distribution Committee

Chairperson:

Mark Siegelheim, MD

Members:

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

Clinical Performance and Quality Committee

Chairperson:

Sandy Balwan, MD

Members:

Patrick Burns, MD
Sandy Balwan, MD
Maria Carney, 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

  • First Agreement Period
    • Performance Year 2017, $0
    • Performance Year 2016, $0

Shared Savings Distribution

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

2017 Quality Performance Results

ACO# Measure Name Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 78.96 80.60
ACO-2 CAHPS: How Well Your Providers Communicate 94.09 93.13
ACO-3 CAHPS: Patients’ Rating of Provider 93.25 92.31
ACO-4 CAHPS: Access to Specialists 83.08 83.32
ACO-5 CAHPS: Health Promotion and Education 63.01 62.30
ACO-6 CAHPS: Shared Decision Making 76.90 75.85
ACO-7 CAHPS: Health Status/Functional Status 73.81 73.05
ACO-34 CAHPS: Stewardship of Patient Resources 22.08 25.68
ACO-8 Risk-Standardized, All Condition Readmission 15.46 15.01
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) 18.10 18.46
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure 81.64 79.16
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 63.46 61.74
ACO-43 Ambulatory Sensitive Conditions Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 1.57 1.93
ACO-11 Use of Certified EHR Technology 100.00 98.48
ACO-12 Medication Reconciliation 57.68 75.32
ACO-13 Falls: Screening for Future Fall Risk 82.01 74.38
ACO-44 Imaging Studies for Low Back Pain 60.00 67.32
ACO-14 Preventive Care and Screening: Influenza Immunization 77.22 72.52
ACO-15 Pneumonia Vaccination Status for Older Adults 59.90 72.92
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up 79.44 70.69
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 95.89 90.48
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 36.41 61.98
ACO-19 Colorectal Cancer Screening 58.17 64.58
ACO-20 Breast Cancer Screening 60.49 70.05
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 86.17 79.89
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 13.80 16.74
ACO-41 Diabetes: Eye Exam 29.34 50.37
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 60.10 71.47
ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 87.92 86.86

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low samples and the ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes quality measure is not included in public reporting due to a non-material technical error.

Note: In the Quality Performance Results file(s) above, search for “North Shore-LIJ MSSP ACO, LLC” or “Northwell Health ACO” to view the quality performance results. This ACO can also be found by using the ACO ID A22038 in the public use files on data.cms.gov.

Participation waiver disclosure

No, our ACO does not use the SNF 3-Day Rule Waiver.

The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain federal fraud and abuse laws that may otherwise limited innovation by ACOs participating in the Medicare Shared Savings Program (“MSSP”). See Final Waivers in Connection With the Shared Savings Program, 79 Fed. Reg. 62356 (Oct. 17, 2014) (“Interim Final Rule”). Pursuant to the Interim Final Rule, North Shore-LIJ MSSP ACO, Inc. (the “ACO”) seeks waiver protection for the arrangement described below:

The ACO has entered into an agreement with Northwell Health to provide a broad range of necessary management services and operational personnel to support the ACO’s operations as an ACO in the MSSP. Under the arrangement, the ACO shall compensate Northwell Health from any shared savings payments for its provision of management services, including but not limited general day-to-day operational personnel and services, financial management and accounting services, and credentialing.

The ACO’s governing body, consistent with its obligations under 42 C.F.R. § 425.106(b)(3), has made and duly authorized a bona fide determination on August 23, 2016 that the arrangement is reasonably related to the purposes of the Medicare Shared Savings Program, including, specifically, promoting accountability for the quality, cost, and overall care for a Medicare population and aiding the ACO in managing and coordinating care for Medicare fee-for-service beneficiaries.

Posted: August 23, 2016

Resources

Quality Payment Program
Webinars and Events
Provider Information for New Medicare Cards
Beneficiary Video for New Medicare Cards
Northwell Health ACO Poster Template (must be publicly displayed in ACO participant offices)
Beneficiary Information Notice (must be distributed to beneficiaries at or before their first primary care visit of the Performance Year)
Spanish Beneficiary Information Notice
Voluntary Alignment Fact Sheet for Providers
Voluntary Alignment Fact Sheet for Beneficiaries

 

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