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About Mercy

Medicare Shared Savings Program

Doctors, hospitals, and health care providers establish ACOs to work together to provide higher-quality coordinated care to their patients, while helping to slow the growth of health care costs. Beneficiaries seeing health care providers in ACOs always have the freedom to choose doctors inside or outside of the ACO. ACOs have the opportunity to receive a portion of the Medicare savings generated from lowering the growth in health care costs as long as they also meet standards for high quality care.

Since ACOs first began participating in the Shared Savings Program in early 2012, thousands of health care providers have signed on to participate in the program, working together to provide better care to Medicare beneficiaries.

 

Medicare Contact Information

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

 

Integrity & Compliance Hotline

MHN ACO utilizes an anonymous reporting hotline for employees or contractors of the ACO, ACO participants, and ACO providers/suppliers, and other individuals or entities performing functions or services related to ACO activities to report suspected problems related to the ACO to the designated ACO Compliance Official. Any individual who, in good faith, reports suspected wrongdoing can make reports anonymously and always without fear of retaliation. MHN ACO encourages reporting of privacy and security incidents; policy and procedural complaints; suspected illegal activity including fraud, waste and abuse; retaliation for reporting such issues; and any other legal or ethical concerns. The two options for reporting include:

 

Participation Waivers

The MHN ACO Board of Managers (BOM) has made and duly authorized a bona fide determination that the following arrangements are reasonably related to the purposes of the Medicare Shared Savings Program. The following disclosures invoke the ACO Pre-Participation Waiver as set forth by CMS and OIG:

  • Mercy Portal. This Integration Platform is used for clinically-integrated network (CIN) collaboration and secure distribution of datasets as it relates to the ACO’s patient population. This platform allows the ACO to collaborate with ACO Participants and eligible Outside Parties on operational, financial and clinical improvement activities by integrating multiple applications on one, secure platform. The ACO provides user access of the Mercy Portal to ACO Participants and eligible Outside Parties. This arrangement allows for greater coordination and standardization of care delivery for ACO-assigned Medicare beneficiaries, which assists the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the BOM on July 27th, 2017. 

 

  • Infrastructure Creation and Provision. The ACO has invested time and resources into the development of the infrastructure necessary to ensure patient care is delivered at a higher quality and lower cost for the ACO’s patients, including ACO-assigned Medicare beneficiaries. This included market analysis and the development of operational performance measurements. The provision of this infrastructure is representative of a long-term value-based strategy for the ACO’s Medicare population, which will assist the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the BOM on July 27th, 2017.

 

  • Network Development and Configuration. The ACO has invested time and resources into the development and configuration of optimal ambulatory, acute and post-acute networks. This configuration included the restructuring of providers to ensure efficient care is delivered to the ACO’s patients, including ACO-assigned Medicare beneficiaries, which will assist the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the BOM on July 27th, 2017.

 

  • Creation of Governance and Management Structure. The ACO has created a governance and management structure to provide an optimal level of oversight to ACO operations, clinically-integrated network (CIN) activities, in addition to initiatives to improve ACO patient (including ACO-assigned Medicare beneficiaries) experience of care. This governance and management structure will enable the ACO to effectively collaborate with ACO Participants on standardization of care delivery representative of evidence-based medicine, which will assist the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the BOM on July 27th, 2017.

 

  • Umbrella Management and Provision of Management Services. The ACO has contracted with an umbrella management organization and assisted in the identification of individuals who will serve in liaison-type quality and analytical roles for the ACO. The contractual relationship between the umbrella management organization and the provision of these management services (which will be reimbursed at cost) will allow the ACO to provide a greater level of efficiency for purposes of care coordination and cost savings for ACO patients, including ACO-assigned Medicare beneficiaries. This will assist the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the BOM on July 27th, 2017. 

 

  • Consultant Support. The ACO has obtained consultant support, including legal services, for purposes of market analysis for antitrust review and establishing governance and management structure. These services have allowed the ACO to focus on the standardization of care delivery and quality improvement activities for ACO patients, including ACO-assigned Medicare beneficiaries, which will assist the ACO in improving and meeting quality performance standards of the Medicare Shared Savings Program. Approved by the BOM on July 27th, 2017.
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