Medicare Accountable Care Organization (ACO)

Medicare Accountable Care Organization (ACO)

Have questions and want to learn more about Cleveland Clinic Medicare ACO? Watch this short video for the answers to many of your questions.

What's an ACO?

An ACO is a group of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. 

How ACOs Work

  • Local health care providers and hospitals volunteer to work together to provide you with coordinated care.
  • The doctors and other providers who are helping care for
    you will communicate with each other, and partner with you in making health care decisions. 
  • You may spend less time filling out medical history paper work because your doctors may already have this information in an electronic health record. 
  • You’ll likely have fewer repeated medical tests because your doctors and hospitals will share information and coordinate your care. 
  • You’ll be in the center of care, and your doctors will be better able to keep you informed, and to keep listening and honoring your choices. 
  • Unlike HMOs, managed care, or some insurance plans, an ACO can't tell you which health care providers to see and can't change your Medicare benefits. 

How ACOs Share Information

Cleveland Clinic Medicare ACO doctors will use data from Medicare to help improve how they provide care. For example, your doctors will get your medical information from Medicare to help them to know your medical history, including your medical conditions, prescriptions, and visits to the doctor, and give you the right care at the right time in the right setting. Doctors, hospitals, and other health care providers working together in an ACO are able to read your medical records, along with other office staff authorized to help coordinate your care.The privacy and security of your medical information is protected by federal law. You'll continue to get the same rights enjoyed by all people with Medicare. 

Declining to Share Your Health Information

Your privacy is very important to us, and you control how your personal information is used. 
To help you get the best possible care, Medicare shares information with Cleveland Clinic Medicare ACO about the care their patients get. To prevent Medicare from sharing your personal information with Cleveland Clinic Medicare ACO:

  • Call 1.800.MEDICARE (633.4227). 
  • TTY users should call 1.877.486.2048. 

Consent to Change Your Personal Health Information Preference

  • Call 1.800.MEDICARE (633.4227).
  • TTY users should call 1.877.486.2048.

Cleveland Clinic Medicare ACO Contact Information

  • Call Cleveland Clinic Medicare ACO at 216.986.4123
  • Business hours are Monday – Friday 10 a.m. - 3 p.m.

Where Can I Find More Information About ACOs?

Other Resources

*Cleveland Clinic Medicare ACO is only for fee-for-service (FFS) Medicare patients and not Medicare Advantage based beneficiaries. 

ACO Public Reporting Information

ACO Public Reporting Information

ACO Name and Location

Cleveland Clinic Medicare ACO, LLC
6000 West Creek Rd., #10
Independence, Ohio 44131

ACO Primary Contact

Ms. Monica Deadwiler
deadwim@ccf.org
216.445.0300

Organizational Information

ACO Participants

  • Clinic Regional Physicians, LLC
  • CCF Tennessee Medical Services, PC
  • Cleveland Clinic Children's Hospital for Rehabilitation
  • The Cleveland Clinic Foundation
  • Fairview Hospital
  • Cleveland Clinic Home Care Services
  • Wooster Clinic, LLC
  • Clinic Physician Services Company, LLC
  • Clinic Medical Services Company
  • Cleveland Clinic Support Services
  • Alla Kirsch
  • Broadview Heights Family Medicine, Inc
  • Brunswick Internal Medicine, Inc
  • Chesterland Internal Medicine Associates, Inc
  • Community Internists, Inc
  • Brown Medical Center, Inc
  • Edward S. Rosenthal, MD, LLC
  • Emmanuel O Tuffuor
  • Family Medicine & Occupational Health Center, Inc
  • Gary A Greenspan, MD
  • Hackett Medical, Ltd
  • Health First Primary Care LLC
  • Kishor Patel, MD
  • Med Consults, Inc
  • New Family Physicians Associates, Inc
  • Nitin Govani, MD, PC
  • Northern Ohio Internal Medicine Associates, Inc
  • Tessy Meridores, MD, Inc
  • Neighborhood Health Care, Inc

ACO Participants in Joint Ventures Between ACO Professionals and Hospitals

Note: No participants are involved in a joint venture between ACO professionals and hospitals. Practitioners are employed or part of a clinically integrated network.

ACO Governing Body

  • Brian G. Donley, MD - Executive Director and Chairman, ACO Participant, The Cleveland Clinic Foundation
  • John Bertsch, MD - ACO Participant, New Family Physicians Associates, Inc
  • Brian Donley, MD - ACO Participant, The Cleveland Clinic Foundation
  • Tarek Elsawy, MD - ACO Participant, The Cleveland Clinic Foundation
  • James Gutierrez, MD - Medical Director, ACO Participant, The Cleveland Clinic Foundation
  • Eiran Gorodeski, MD - ACO Participant, The Cleveland Clinic Foundation
  • Michael Harrington - ACO Participant, The Cleveland Clinic Foundation
  • Oliver Henkel - Medicare Beneficiary
  • Catherine Keating, MD - ACO Participant, The Cleveland Clinic Foundation
  • Michael Modic MD - ACO Participant, The Cleveland Clinic Foundation
  • Michael Rabovsky, MD - ACO Participant, The Cleveland Clinic Foundation
  • Edward Rosenthal, MD - ACO Participant, Edward S. Rosenthal, MD, LLC
  • Rebecca Stark, MD - ACO Participant, The Cleveland Clinic Foundation
  • Nirav Vakharia, MD - ACO Participant, The Cleveland Clinic Foundation
  • Rebecca Ware, MD - ACO Participant, The Cleveland Clinic Foundation

Key Clinical and Administrative Leadership

  • ACO Executive: Brian G. Donley, MD
  • Medical Director: James Gutierrez, MD
  • Compliance Official: Don Sinko, CPA

ACO Committees and Committee Leaderships

  • Quality Assurance and Improvement Committee: Nirav Vakharia, MD, Chair
  • Finance Committee: Michael Harrington, Chair
  • Compliance Official: Don Sinko, CPA

ACO Committees and Key Leadership Personnel

Quality Committee

  • John Bertsch, MD
  • Eric Boose, MD
  • Laura Churchill
  • Cory Fisher, MD
  • Dawn Gerz
  • James Gutierrez, MD
  • Robert Jones, MD
  • Diana Keron
  • Ahmad Kilani, MD
  • Jacqueline Matthews
  • Craig Martin
  • Jeannie Michaels
  • Kishor Patel, MD
  • Erica Roesch, MD
  • Elizabeth Salay, MD
  • James Seidel
  • Meghan Snow
  • Nancy Stall
  • Sandra Sykes
  • Nirav Vakharia, MD – Chair
  • Robert White, MD

Finance Committee

  • David M. Brill, DO
  • Arun Gupta, MD
  • Michael Harrington, Chair
  • Raymond Horwood, MD
  • Craig Nielsen, MD
  • Michael Rabovsky, MD
  • Edward Rosenthal, MD
  • Dhanashree Abhyankar

Types of ACO participants, or combinations of participants, that formed the ACO

  • The Cleveland Clinic Medicare ACO, LLC is a collaboration among Cleveland Clinic, its owned hospitals and employed physicians in a group practice arrangement, as well as a network of individual practices of ACO professionals and independent physicians in Northeast Ohio. In addition, it contains a federally qualified health center (FQHC).
  • Cleveland Clinic formed a separate legal entity for the Medicare ACO in order to allow more independent practices to join the ACO as participants over time.

Shared Savings and Losses

Amount of Shared Savings/Losses

ACO in first year of first agreement period

  • Agreement period beginning 2015, Performance Year 2015: $16,614,051

Shared Savings Distribution

ACO in first year of first agreement period

  • Agreement period beginning 2015, Performance Year 2015
    • Proportion invested in infrastructure: 10%
    • Proportion of distribution to ACO participants: 90%

Payment Rule Waivers

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

2015 Quality Performance Results

Measure
Number
Measure Name ACO 
Performance Rate
Mean Performance Rate 
(SSP - ACOs)
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 78.88 80.61
ACO-2 CAHPS: How Well Your Doctors Communicate 92.06 92.65
ACO-3 CAHPS: Patients’ Rating of Doctor 92.77 91.94
ACO-4 CAHPS: Access to Specialists 81.04 83.61
ACO-5 CAHPS: Health Promotion and Education 60.49 59.06
ACO-6 CAHPS: Shared Decision Making 70.83 75.17
ACO-7 CAHPS: Health Status/Functional Status 69.08 72.30
ACO-34  CAHPS: Stewardship of Patient Resources* 21.94 26.87
ACO-8 Risk Standardized, All Condition Readmissions 15.16 14.86
ACO-35  Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM)* Readmission 19.60 18.07
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes* 48.23 54.60
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure* 79.64 76.96
ACO-38  All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 63.88 62.92
ACO-9 Ambulatory Sensitive Condition Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5) 1.31 1.11
ACO-10 Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8) 1.13 1.04
ACO-11 Percent of Primary Care Physicians who Successfully Meet Meaningful Use Requirements 88.16% 76.22%
ACO-39  Documentation of Current Medications in the Medical Record* 95.67% 84.07%
ACO-13 Falls: Screening for Future Fall Risk 92.18% 56.46%
ACO-14 Preventive Care and Screening: Influenza Immunization 62.82% 62.03%
ACO-15 Pneumonia Vaccination Status for Older Adults 85.67% 63.73%
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up 69.66% 71.15%
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 94.93% 90.16%
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 12.46% 45.25%
ACO-19 Colorectal Cancer Screening 80.88% 60.06%
ACO-20 Breast Cancer Screening 81.91% 65.67%
ACO-21 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 47.79% 70.04%
ACO-40  Depression Remission at Twelve Months* 2.63% 6.11%
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 14.93% 20.38%
ACO-41  Diabetes: Eye Exam* 68.40% 41.05%
ACO-28 Hypertension: Controlling High Blood Pressure 74.30% 69.62%
ACO-30 Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic 94.96% 83.82%
ACO-31 Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 100% 87.22%
ACO-33 Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%) 88.01% 77.73%
CAHPS = Consumer Assessment of Healthcare Providers and Systems, PQI = Prevention Quality Indicator, LVSD = left ventricular systolic dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery disease. 
*= Measure required beginning Reporting Year 2015. 
N/A= Reporting on the depression remission measure is not required for 2015, as indicated by N/A

Quality Performance Results

Measure number Performance 
measure
2012 reporting period 2013 reporting period 2014 reporting period
ACO performance rate Mean performance rate for all ACOs ACO performance rate Mean performance rate for all ACOs ACO performance rate Mean performance rate for all ACOs
ACO #1 Getting Timely Care, Appointments, and Information Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #2 How Well Your Doctors Communicate Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #3 Patients’ Rating of Doctor Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #4 Access to Specialists Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #5 Health Promotion and Education Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #6 Shared Decision Making Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #7 Health Status/Functional Status Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #8 Risk Standardized, All Condition Readmissions Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #9 ASC Admissions: COPD or Asthma in Older Adults Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #10 ASC Admission: Heart Failure Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #11 Percent of PCPs who Qualified for EHR Incentive Payment Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #12 Medication Reconciliation Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #13 Falls: Screening for Fall Risk Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #14 Influenza Immunization Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #15 Pneumococcal Vaccination Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #16 Adult Weight Screening and Follow-up Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #17 Tobacco Use Assessment and Cessation Intervention Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #18 Depression Screening Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #19 Colorectal Cancer Screening Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #20 Mammography Screening Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #21 Proportion of Adults who had blood pressure screened in past 2 years Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #22 Hemoglobin A1c Control (HbA1c) (<8 percent) Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #23 Low Density Lipoprotein (LDL) (<100 mg/dL) Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #24 Blood Pressure (BP) <140/90 Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #25 Tobacco Non Use Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #26 Aspirin Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #27 Percent of beneficiaries with diabetes whose HbA1c in poor control (>9 percent) Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #28 Percent of beneficiaries with hypertension whose BP <140/90 Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #29 Percent of beneficiaries with IVD with complete lipid profile and LDL control <100mg/dl Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #30 Percent of beneficiaries with IVD who use Aspirin or other antithrombotic Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #31 Beta-Blocker Therapy for Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #32 Drug Therapy for Cholesterol Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations
ACO #33 ACE Inhibitor or ARB Therapy for Patients with CAD and Diabetes and/or LVSD Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations Not in Operations