Medicare Accountable Care Organization (ACO)

Medicare Accountable Care Organization (ACO)

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 216.445.3666
  • 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
Previous Names: N/A
9500 Euclid Avenue
Mail Code: JJ-19
Cleveland, Ohio 44195

ACO Primary Contact

ACO Participants ACO Participant in Joint Venture (Enter Y or N)
Michael Kalus, MD N
Cleveland Ear Nose Throat, Inc. N
Richard Koletsky N
Visiting Nurse Service, Inc. N
Oscar Nicholson, Jr., MD, Inc. N
Joel D. Weisblat, MD, Inc. N
OBGYN of Westlake, LLC N
VIJAY G. MISTRY, MD, INC. N
Partners Physician Group N
Jeffrey A. Chaitoff, MD, LLC N
THOMAS SLAWINSKI N
Dinkar V. Rao, MD, Inc. N
Randal March N
DR MIODRAG ZIVIC, LLC N
Cleveland Clinic Children's Hospital For Rehabilitation N
Med Consults, Inc. N
MARK A. LANG, MD, LLC N
Associates in Orthopaedics, Inc. N
Retina Specialists of Ohio N
Cleveland Clinic Avon Hospital N
Tim Nice, MD, Inc. N
HUDSON FAMILY PRACTICE, INC. N
Union Physician Services, Llc N
SIGNATURE MEDS, LLC N
System Optics, Inc. N
Emmanuel Tuffuor N
Lutheran Hospital N
Western Reserve Ophthalmology, Inc. N
Asaf Dar N
Cleveland Clinic Rehabilitation Hospitals, Llc N
Harold Mars, MD, Inc. N
Mahlies Internal Medicine Specialist, Inc. N
BROWN MEDICAL CENTER, INC. N
ID Consultants, Inc. N
Abrams Eye Center, Inc. N
TED PETERSON, DPM N
ATRIUM MEDICAL GROUP, INC. N
Akron General Medical Center N
Kishor Patel, MD N
Medina Hospital N
MEDINA EYE ASSOCIATES, INC. N
Signature Psychiatry Associates, Inc. N
Mohan J. Durve, MD, Inc. N
Jeffrey A. Halpert, Dpm, Llc N
SUSHIL K. JAIN, MD, INC. N
ELITE MEDICAL PRACTICE, LLC N
Gary Greenspan N
Yatish Goyal, MD, Inc. N
John Aron N
Fairview Hospital N
Ara E. Kallibjian N
Key Clinics, LLC N
Community Internists, Inc. N
Northcoast Dermatology Associates, Inc. N
Richard R. Watkins, MD, Llc N
Benhaven Counseling 2, Llc N
Henry Bloom N
Broadview Heights Family Medicine, Inc. N
CCF Tennessee Medical Services, PC N
COMPREHENSIVE PRIMARY CARE N
Marymount Hospital, Inc. N
Ronald A Freireich, DPM N
Cleveland Clinic Support Services N
Ashtabula County Medical Center N
Advanced Dermatology, Inc. N
Nitin Govani, MD, PC N
Cosmopolitan Dermatology, Inc. N
Creighton G Heyl, DO, Inc. N
Wooster Clinic, LLC N
Northern Ohio Internal Medicine Associates, Inc. N
LAKE POINT MEDICAL GROUP, LLC N
Stephen Musser DPM, Inc. N
Vyacheslav Isakov N
Cleveland Clinic Health System - East Region N
Mila Davidovic N
Timothy Levar N
NEIGHBORHOOD HEALTH CARE INCORPORATED N
FOOT AND ANKLE PHYSICIANS OF GEAUGA, INC. N
Advanced Neurology & EMG, LLC N
Yael Dinar Kushnir, MD N
Cleveland Clinic Foundation Cleveland Clinic Home Care N
Tessy Meridores, MD, Inc. N
FAMILY MEDICAL CARE PLUS, INC. N
Northcoast Foot And Ankle Associates, Inc. N
Prestige Foot & Ankle Center, Llc N
Lodi Community Hospital N
Cleveland Clinic Home Care Services N
Montrose Sleep Center, Llc N
Andrew Liu N
Hillcrest Mayfield Eye Associates, Inc. N
FAIRLAWN FAMILY PRACTICE, INC. N
Dayem Health Services, LLC N
RONALD GOLOVAN, MD, INC. N
Ori Kushnir, MD, OBGYN, LLC N
DR. KHALAFI, MD, LLC N
The Cleveland Clinic Foundation N
Great Lakes Hypertension & Kidney Care, Inc. N
Cardiovascular Consultants of Cleveland, Inc. N
Cynthia Weinstein N
N. Presswala N
Katrina Rakowsky N
Retina Associates of Cleveland, Inc. N
Clinic Medical Services Company N
Hassan Alzoubi N

ACO Governing Body

Member

Member's Voting Power-Expressed as a percentage or number

Membership Type

ACO Participant Legal Business Name/DBA, if Applicable

Last Name

First Name

Title/Position

Babiuch Christopher Physician 1 Voting Member The Cleveland Clinic Foundation
Bertsch John Physician 1 Voting Member New Family Physicians Associates, Inc.
Braman Kenneth Physician 1 Voting Member Partners Physician Group
Edwards Scott Finance Committee Chair 0 Non-Voting Member The Cleveland Clinic Foundation
Gormsen David Physician 1 Voting Member Mercy Medical Center
Henkel Oliver Medicare Beneficiary Representative and Community Stakeholder Representative 1 Voting Member N/A
Hutchison Lew Administration 1 Voting Member Ashtabula County Medical Center
Johnston Douglas Physician 1 Voting Member The Cleveland Clinic Foundation
Jones Robert Chair of Quality 1 Voting Member The Cleveland Clinic Foundation
McMenemy John Physician 1 Voting Member Union Physician Services
Myers Adam Chair, Board of Managers 1 Voting Member The Cleveland Clinic Foundation
Payton Joe Physician 1 Voting Member Fairlawn Family Practice
Rabovsky Michael Physician 1 Voting Member The Cleveland Clinic Foundation
Rogen Bruce Physician 1 Voting Member The Cleveland Clinic Foundation
Starck Rebecca Physician 1 Voting Member The Cleveland Clinic Foundation
Vakharia Nirav President of ACO
1 Voting Member The Cleveland Clinic Foundation
Wolfe Wesley ED, MNS 1 Voting Member The Cleveland Clinic Foundation

Key ACO clinical and administrative leadership

Adam Myers, MD ACO Executive
Nirav Vakharia, MD President
Jessica Hohman, MD Medical Director
Donald Sinko, CPA Compliance Officer
Robert Jones, MD Quality Assurance/Improvement Officer

Associated committees and committee leadership

Committee Name Committee Leader Name and Position
Performance Optimization Committee Robert Jones, MD, Chair
Finance Committee Scott Edwards, Chair
Compliance Committee Nirav Vakharia, MD, Chair

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

  • Federally Qualified Health Center (FQHC)
  • ACO professionals in a group practice arrangement
  • Networks of individual practices of ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses

  • Second Agreement Period
    • Performance Year 2019, $0
    • Performance Year 2018, $0
  • First Agreement Period
    • Performance Year 2017, $0
    • Performance Year 2016: $19,914,592
    • Performance Year 2015: $16,614,051

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
      • 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
    • 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: 5%
        • Proportion invested in redesigned care processes/resources: 5%
        • Proportion of distribution to ACO participants: 90%
      • Performance Year 2015
        • Proportion invested in infrastructure: 5%
        • Proportion invested in redesigned care processes/resources: 5%
        • Proportion of distribution to ACO participants: 90%

    2019 Quality Performance Results

    ACO# Measure Name Rate ACO Mean
    ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 79.97 85.86
    ACO-2 CAHPS: How Well Your Providers Communicate 93.04 94.11
    ACO-3 CAHPS: Patients’ Rating of Provider 91.11 92.69
    ACO-4 CAHPS: Access to Specialists 78.24 81.54
    ACO-5 CAHPS: Health Promotion and Education 61.26 60.44
    ACO-6 CAHPS: Shared Decision Making 55.77 62.78
    ACO-7 CAHPS: Health Status/Functional Status 74.98 73.79
    ACO-34 CAHPS: Stewardship of Patient Resources 26.15 26.17
    ACO-8 Risk Standardized, All Condition Readmission 15.50 14.86
    ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 61.95 58.15
    ACO-43 Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator (PQI #91)) 1.92 1.87
    ACO-13 Falls: Screening for Future Fall Risk 98.21 84.04
    ACO-14 Preventive Care and Screening: Influenza Immunization 86.37 74.77
    ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 82.98 78.04
    ACO-18 Preventive Care and Screening: Screening for Depression and Follow-up Plan 64.98 70.40
    ACO-19 Colorectal Cancer Screening 83.47 70.76
    ACO-20 Breast Cancer Screening 84.16 73.84
    ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 83.94 82.17
    ACO-27 Diabetes: Hemoglobin A1c Poor Control (>9%) 11.87 13.88
    ACO-28 Controlling High Blood Pressure 74.71 75.04

    Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size. In addition, the Centers for Medicare & Medicaid Services (CMS) waived the requirement for ACOs to field a CAHPS for ACOs survey data.

    Note: In the Quality Performance Results file(s) above, search for “Cleveland Clinic Medicare ACO, LLC” to view the quality performance results. This ACO can also be found by using the ACO ID A2729 in the public use files on data.cms.gov.

    Payment Rule Waivers

    • Yes, our ACO does use the SNF 3-Day Rule Waiver.
    • Yes, our ACO does use the Telehealth Waiver.

    Eligible SNF affiliates for the SNF 3-Day Rule Waiver include:

    • 3G Operating Company, LLC
    • Altercare of Cuyahoga Falls Center for Rehabilitation & Nursing Care I
    • Altercare of Hartville Center for Rehabilitation & Nursing Care, Inc.
    • Altercare of Mayfield Village, Inc.
    • Altercare of Mentor Center for Rehabilitation and Nursing Care, Inc.
    • Altercare of Wadsworth Center for Rehabilitation & Nursing Care, Inc.
    • Altercare Post-Acute Rehabilitation Center, Inc.
    • Altercare Transitional Care of the Western Reserve
    • Altercare, Inc.
    • Anchor Lodge Nursing Home, Inc.
    • Anna Maria of Aurora, Inc.
    • ARC Westlake Village SNF, LLC
    • Atrium Retirement Centers, LLC
    • Aurora Manor Limited Partnership
    • Autumn Aegis, Inc.
    • Avon Healthcare Center, Inc.
    • Bath Creek Healthcare Group, Inc.
    • Bath Manor Limited Partnership
    • Bradley Road Nursing Home, Inc.
    • Brecksville Healthcare Group, Inc.
    • Broadview Nursing Home, Inc.
    • Brunswick Health & Rehabilitation Center, Inc.
    • C A S Health Investors, Inc.
    • Center Ridge Nursing Home, Inc.
    • Cleveland Clinic Health System - East Region
    • Concordia of Ohio
    • Eliza Jennings Home
    • Eliza Jennings, Inc.
    • Falls Village Retirement Community
    • Franklin Boulevard Nursing Home, Inc.
    • Garnett Health Campus, LLC
    • Green Village Skilled Nursing & Rehabilitation, LTD
    • Heather Knoll Retirement Village, Inc.
    • Heritage (Ohio) Leasing Co., LLC
    • Jarvis Leasing Co., LLC
    • Jennings Operating, LLC
    • Kingston of Vermilion, LLC
    • Lakewood Senior Campus, LLC
    • Lodi Community Hospital
    • Lorain Medical Investors Limited Partnership
    • Lutheran Home
    • Main Street Care Center, LTD
    • Manor Care of Parma OH, LLC
    • Manor Care of Willoughby OH, LLC
    • Manorcare Health Services, LLC
    • Medina Operations, LLC
    • Menorah Park Center for Senior Living
    • Mentor Health and Rehabilitation Center, Inc.
    • Middleburg-Legacy Place, LLC
    • Montefiore Home
    • Munson Healthcare, Inc.
    • Normandy II Limited Partnership
    • Ohio Living Communities
    • Pleasant Lake Nursing Home, Inc.
    • Progressive Medina, LLC
    • Progressive Rolling Hills, LLC
    • R&G Nursing Care, Inc.
    • R & J Investment Co., Inc.
    • Rae-Ann Suburban, Inc.
    • Ridge-Pleasant Valley, Inc.
    • SHCP Medina, Inc.
    • St. Augustine Manor
    • The Montefiore Housing Corporation
    • The Ohio Masonic Home
    • Village at Marymount
    • Wadsworth Pointe Healthcare Group, Inc.
    • Wellington Place, LLC
    • West Side Deutscher Frauen Verein
    • Willowood Care Center of Brunswick, Inc.
    • Women's Welsh Clubs of America

    Website Disclosure Statement

    Public Disclosure of Arrangement Conducted Under the MSSP ACO Participation Waiver

    The Centers for Medicare and Medicaid Services (“CMS”) and the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) have made available a waiver of certain federal fraud and abuse laws in connection with the operation of accountable care organizations (“ACOs”) that have entered into a participation agreement under the Medicare Shared Savings Program (“MSSP”).

    In order to receive the benefit of such waiver, the governing body of the Cleveland Clinic Medicare ACO, LLC (“CCF ACO”) has made a bona fide, detailed determination that the following arrangement is reasonably related to the purposes of the MSSP.

    The CCF ACO proposes to provide, at no cost, an annual license to the Epic Systems electronic health records platform (the “Epic Platform”) to enable use of the Epic Platform (the “Proposed Epic License Program”), to certain physicians (“Eligible Physicians”), some of whom already have a license to use the Epic Platform and some of whom do not. For those Eligible Physicians who do not already have a license to use the Epic Platform, CCF ACO will also pay a one-time activation fee. Eligible Physicians will include primary care physicians participating in CCF ACO, and other physicians who: (i) serve a population that includes Medicare beneficiaries; (ii) demonstrate alignment with “the triple aim” by serving on a sub-committee of the CCF ACO or working toward the achievement of identified metrics that are complimentary to those of CCF ACO; (iii) have privileges at any CCF hospital; and (iv) satisfy any other eligibility requirements to be established by the CCF ACO.

    The governing body of CCF ACO approved the Proposed Epic License Program following a determination that the Proposed Epic License Program would support the purposes of the MSSP by managing and coordinating care for beneficiaries through the CCF ACO, encouraging investment in infrastructure for high quality and efficient service delivery for patients, providing enabling technology to monitor patients and access patient medical records, evaluating health needs of CCF ACO’s assigned population, and allowing for the potential for more efficient decision-making.

    The Centers for Medicare and Medicaid Services (“CMS”) and the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) have made available waivers of certain federal fraud and abuse laws in connection with the operation of accountable care organizations (“ACOs”) that have entered into a participation agreement under the Medicare Shared Savings Program (“MSSP”).

    In order to receive the benefit of such waivers, the governing body of Cleveland Clinic Medicare ACO, LLC, an Ohio nonprofit limited liability company (the “Company”) has made a bona fide, detailed determination that the following arrangement is reasonably related to the purposes of the MSSP.

    The Company has authorized a waiver of certain federal fraud and abuse laws for an arrangement whereby The Cleveland Clinic Foundation bears the full costs associated with the implementation of the Clinovations health information technology product for independent primary care providers, most of whom are participants in the Company but all of whom treat Medicare beneficiaries attributed to the Company (the “Arrangement”).

    The governing body of the Company authorized the application of the waiver to the Arrangement on December 14, 2017, following a determination that the Arrangement supports the goals of the Company and is reasonably related to the purposes of the MSSP, in each case because the Arrangement: (i) provides enabling technology to gain greater and more comprehensive access to patient information, which allows for the delivery of higher quality healthcare services to Medicare beneficiaries attributed to the Company; (ii) is targeted toward use for the Medicare-eligible patient population; (iii) encourages investment in infrastructure for high quality and efficient service delivery for Medicare beneficiaries attributed to the Company and maximizes the efficiency of the EpicCare Ambulatory platform; (iv) assists in managing and coordinating care for Medicare beneficiaries attributed to the Company; and (v) assists in evaluating the health needs of the Company’s assigned population.