Shared Savings Program ACO Public Reporting

ACO Name and Location

RGV ACO Health Providers, LLC
303 North D Salinas Blvd
Donna, Texas 78537

ACO Primary Contact

Primary Contact Name

Jose F. Peña, MD, FACP, FACHE, CRC

Primary Contact Phone Number

956-969-0120

Primary Contact Email Address

jpena@rgvacollc.com

Organizational Information

ACO participants:


ACO Participants

ACO Participant in Joint Venture

Passaic Primary Care Physicians, LLC

N

Providence Medical and Geriatric Associates, PA

N

Guillermo I. Rocha, MD, PA

N

Melva Palacios, MD and Chris Casso, MD, PA

N

Internal Medicine And Geriatrics Practice, Inc.

N

Centro Medico Iberoamericano, Inc.

N

Donna Medical Clinic, PA

N

Center For Adult Medicine And Preventive Care, Inc.

N

Hector G. Amaya, MD, PA

N

Pedro J. Peñalo, MD, PA

N

A & S General Physician, LLC

N

Alejandro Arizmendi, MD, PLLC

N

Center for Med Care, PC

N

Rio Grande Valley Adult & Internal Medicine Specialists, PA

N

Samuel Landero, MD, PA

N

Family Health Center of Mission, PLLC

N

Nelson R. Kalaf, MD, PA

N

Gamil Makar, MD, LLC

N

Melecia Fuentes, MD, PA

N

Rio Grande Medicine, Inc.

N

Johnson & Havener Medical Service, PA

N

Michael WM Mann, MD, PA

N

Dario Arango, MD, PA

N

Abreu Adult Clinic, PA

N

Alfonso Ochoa MD, PA

N

Mid Valley Adult Specialists, PA

N

Benjamin A. Salinas, MD, PA

N

Jose T, Sandoval, MD, PA

N

Yolanda Marcos, MD, PA

N

Solo Doc, MD, PA

N

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

Peña

Jose

President; Voting Member

1

ACO Participant Representative

Donna Medical Clinic, PA

McDougal

Pedro

Voting Member

1

ACO Participant Representative

Rio Grande Valley Adult & Internal Medicine Specialists, PA

Peñalo

Pedro

Voting Member

1

ACO Participant Representative

Pedro J. Penalo, MD, PA

Soto

Jose

Voting Member

1

Medicare Beneficiary Representative

N/A

Johnson

Jere

Voting Member

1

ACO Participant Representative

Family Health Center of Mission, PLLC

Rocha

Guillermo

Voting Member

1

ACO Participant Representative

Guillermo I. Rocha, MD, PA

Moquete

Manuel

Voting Member

1

Other: New Jersey Medical Director

N/A

Arizmendi

Alejandro

Voting Member

1

ACO Participant Representative

Alejandro Arizmendi, MD, PLLC

Key ACO clinical and administrative leadership:


Jose F. Peña, MD

ACO Executive

Pedro J. Peñalo, MD

Medical Director

Alejandro Arizmendi, MD

Medical Director

Manuel Moquete, MD

Medical Director

Gloria Ortiz, MD

Compliance Officer

Pedro J. Peñalo, MD

Quality Assurance/Improvement Officer

Associated committees and committee leadership:


Committee Name

Committee Leader Name and Position

Beneficiary Engagement Committee

Jose Soto, Chair

Quality Assurance and Performance Improvement Committee

Pedro J. Peñalo, MD, Chair

Utilization Committee

Jose F. Peña, MD, Chair

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

  • Networks of individual practices of ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses

  • Second Agreement Period
    • Performance Year 2016, $10,027,046
  • First Agreement Period
    • Performance Year 2015, $12,619,152
    • Performance Year 2014, $7,528,797
    • Performance Year 2013, $9,917,297

Shared Savings Distribution

  • Second Agreement Period
    • Performance Year 2016
      • Proportion invested in infrastructure: 28%
      • Proportion invested in redesigned care processes/resources: 4%
      • Proportion of distribution to ACO participants: 68%
  • First Agreement Period
    • Performance Year 2015
      • Proportion invested in infrastructure: 30%
      • Proportion invested in redesigned care processes/resources: 5%
      • Proportion of distribution to ACO participants: 65%
    • Performance Year 2014
      • Proportion invested in infrastructure: 30%
      • Proportion invested in redesigned care processes/resources: 5%
      • Proportion of distribution to ACO participants: 65%
    • Performance Year 2013
      • Proportion invested in infrastructure: 30%
      • Proportion invested in redesigned care processes/resources: 5%
      • Proportion of distribution to ACO participants: 65%

Quality Performance Results

2016 Quality Performance Results:


ACO#

Measure Name

Rate

ACO Mean

ACO-1

CAHPS: Getting Timely Care, Appointments, and Information

74.48

79.9

ACO-2

CAHPS: How Well Your Providers Communicate

92.14

92.63

ACO-3

CAHPS: Patients' Rating of Provider

91.37

91.93

ACO-4

CAHPS: Access to Specialists

84.53

83.52

ACO-5

CAHPS: Health Promotion and Education

71.07

60

ACO-6

CAHPS: Shared Decision Making

78.14

75.28

ACO-7

CAHPS: Health Status/Functional Status

70.35

71.82

ACO-34

CAHPS: Stewardship of Patient Resources

28.14

27.52

ACO-8

Risk-Standardized, All Condition Readmission

14.42

14.7

ACO-35

Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM)

18.49

18.17

ACO-36

All-Cause Unplanned Admissions for Patients with Diabetes

48.62

53.2

ACO-37

All-Cause Unplanned Admissions for Patients with Heart Failure

66.52

75.23

ACO-38

All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions

52.6

59.81

ACO-9

Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5)

8.44

9.27

ACO-10

Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8 )

15.61

14.53

ACO-11

Percent of PCPs who Successfully Meet Meaningful Use Requirements

95

82.72

ACO-39

Documentation of Current Medications in the Medical Record

100

87.54

ACO-13

Falls: Screening for Future Fall Risk

94.93

64.04

ACO-14

Preventive Care and Screening: Influenza Immunization

96.98

68.32

ACO-15

Pneumonia Vaccination Status for Older Adults

92.17

69.21

ACO-16

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up

96.67

74.45

ACO-17

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

99.51

90.98

ACO-18

Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan

93.51

53.63

ACO-19

Colorectal Cancer Screening

82.49

61.52

ACO-20

Breast Cancer Screening

83.96

67.61

ACO-21

Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented

96.77

76.84

ACO-42

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

91.25

77.72

ACO-27

Diabetes Mellitus: Hemoglobin A1c Poor Control

11.11

18.24

ACO-41

Diabetes: Eye Exam  

76.12

44.94

ACO-28

Hypertension (HTN): Controlling High Blood Pressure

90.17

70.52

ACO-30

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

93.31

85.05

ACO-31

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

96.88

88.67

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%)

96.36

79.67

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low samples.   

Note: In the Quality Performance Results file(s) above, search for “RGV ACO Health Providers, LLC” to view the quality performance results. This ACO can also be found by using the ACO ID A85439 in the public use files on data.cms.gov.

Payment Rule Waivers

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