MS MSSP Community Health Center Enhanced

Evelyn Cayson

ACO Primary Contact

Location

Aledade Accountable Care 43, LLC

4550 Montgomery Ave Ste 950N
Bethesda, MD 20814

ACO Participants	ACO Participant in Joint Venture
AARON E HENRY COMMUNITY HEALTH	N
ACCESS FAMILY HEALTH SERVICES, INC.	N
AMITE COUNTY MEDICAL SERVICES INC	N
CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC	N
CENTRAL MISSISSIPPI HEALTH SERVICES, INC.	N
CLAIBORNE COUNTY FAMILY HEALTH CENTER	N
COASTAL FAMILY HEALTH CENTER INC	N
DELTA HEALTH CENTER, INC.	N
EAST CENTRAL MISSISSIPPI HEALTH CARE INC	N
FAMILY HEALTH CARE CLINIC INC	N
FAMILY HEALTH CENTER INC	N
G A CARMICHAEL FAMILY HEALTH CENTER INC	N
GREATER MERIDIAN HEALTH CLINIC, INC.	N
JEFFERSON COMPREHENSIVE HEALTH CENTER, INC.	N
MALLORY COMMUNITY HEALTH	N
MANTACHIE RURAL HEALTH CARE, INC	N
NORTH MISSISSIPPI PRIMARY HEALTH CARE INC	N
NORTHEAST MISSISSIPPI HEALTH CARE INC	N
OUTREACH HEALTH SERVICES,INC.	N
SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	N

Member First Name	Member Last Name	Member Title/Position	Member's Voting Power (Expressed as a percentage)	Membership Type	ACO Participant Legal Business Name
RASHAD	ALI	Board Member	4.34782609	ACO Participant Representative	Family Health Center Inc
JANICE	BACON	Board Member	4.34782609	ACO Participant Representative	Central Mississippi Health Services, Inc.
JILL	BISHOP	Board Member	4.34782609	ACO Participant Representative	East Central Mississippi Health Care Inc
EVELYN	CAYSON	Board Member/Chair	4.34782609	Other	Aledade
ROZELLE	CHAPMAN	Board Member	4.34782609	ACO Participant Representative	Mallory Community Health
JASMIN	CHAPMAN	Board Member	4.34782609	ACO Participant Representative	Central Mississippi Civic Improvement Association, Inc
JAMES	COLEMAN	Board Member	4.34782609	ACO Participant Representative	G A Carmichael Family Health Center Inc
KATRINA	COLLINS	Board Member	4.34782609	ACO Participant Representative	Jefferson Comprehensive Health Center, Inc.
JOHN	FAIRMAN	Board Member	4.34782609	ACO Participant Representative	Delta Health Center, Inc.
MARGARET	GRAY	Board Member	4.34782609	ACO Participant Representative	Family Health Care Clinic Inc
ANGEL	GREER	Board Member	4.34782609	ACO Participant Representative	Coastal Family Health Center Inc
JAMES	HODGES	Board Member/Medicare Beneficiary Representative	4.34782609	Medicare Beneficiary Representative	Delta Health Center, Inc.
SABRINA	HOWZE	Board Member	4.34782609	ACO Participant Representative	Outreach Health Services, Inc.
WILBERT	JONES	Board Member	4.34782609	ACO Participant Representative	Greater Meridian Health Clinic, Inc.
AURELIA	JONES-TAYLOR	Board Member	4.34782609	ACO Participant Representative	Aaron E Henry Community Health
KEVIN	KOEHLER	Board Member/ACO Medical Director	4.34782609	ACO Participant Representative	Access Family Health Services, Inc.
GRANT	MCKINNEY	Board Member	4.34782609	ACO Participant Representative	Mantachie Rural Health Care, Inc
CHRISTINA	NUNNALLY	Board Member/Compliance Committee Leader	4.34782609	ACO Participant Representative	North Mississippi Primary Health Care Inc
JAMES	OLIVER	Board Member	4.34782609	ACO Participant Representative	Claiborne County Family Health Center
JANICE	ROBINSON	Board Member	4.34782609	ACO Participant Representative	Southeast Mississippi Rural Health Initiative, Inc.
CLIFTON	RODGERS	Board Member	4.34782609	ACO Participant Representative	Northeast Mississippi Health Care Inc
MARILYN	SUMERFORD	Board Member	4.34782609	ACO Participant Representative	Access Family Health Services, Inc.
SALLY	TOLER	Board Member	4.34782609	ACO Participant Representative	Amite County Medical Services Inc

Executive Director: Evelyn Cayson
Medical Director: Dr. Kevin Koehler
Compliance Officer: Amy Youtz
Quality Assurance / Improvement Officer: Dr. Emily Maxson

Committee Name	Committee Leader Name and Position
Compliance Committee	Christina Nunally / Compliance Committee Leader

A network of individual practices of ACO professionals.

First Agreement Period

Performance Year 2021, $10,354,386
Performance Year 2020, $8,355,542

First Agreement Period

Performance Year 2021
- Proportion invested in infrastructure: 9%
- Proportion invested in redesigned care processes/resources: 40%
- Proportion of distribution to ACO participants: 51%
Performance Year 2020
- Proportion invested in infrastructure: 9%
- Proportion invested in redesigned care processes/resources: 40%
- Proportion of distribution to ACO participants: 51%

2021 CMS WEB INTERFACE QUALITY PERFORMANCE RESULTS:

Measure #

Measure Name

Rate

ACO Mean

Measure #: 1

Diabetes: Hemoglobin A1c (HbA1c) Poor Control2

14.20

12.46

Measure #: 134

Preventative Care and Screening: Screening for Depression and Follow-up Plan

90.03

74.38

Measure #: 236

Controlling High Blood Pressure

59.09

74.87

Measure #: 318

Falls: Screening for Future Fall Risk

73.98

87.03

Measure #: 110

Preventive Care and Screening: Influenza Immunization

60.55

80.52

Measure #: 226

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

85.96

80.97

Measure #: 113

Colorectal Cancer Screening

57.94

73.63

Measure #: 112

Breast Cancer Screening

57.45

75.11

Measure #: 438

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

85.15

84.24

Measure #: 321

CAHPS for MIPS3

N/A

Measure #: 479

Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups2

---

0.1540

Measure #: MCC1

All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions for ACOs (MCC)2

31.35

33.94

CAHPS-1

Getting Timely Care, Appointments, and Information

88.46

84.67

CAHPS-2

How Well Providers Communicate

95.24

93.56

CAHPS-3

Patient’s Rating of Provider

92.79

92.19

CAHPS-4

Access to Specialists

82.29

78.80

CAHPS-5

Health Promotion and Education

63.64

61.61

CAHPS-6

Shared Decision Making

62.15

60.89

CAHPS-7

Health Status and Functional Status

72.71

71.78

CAHPS-8

Care Coordination

87.60

85.66

CAHPS-9

Courteous and Helpful Office Staff

92.31

91.88

CAHPS-11

Stewardship of Patient Resources

36.29

24.71

Please note, the Quality ID #: 370 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size.

For Previous Years’ Financial and Quality Performance Results, Please Visit data.cms.gov.

Payment Rule Waivers

Skilled Nursing Facility (SNF) 3-Day Rule Waiver: N/A

Waiver for Payment for Telehealth Services: N/A

Fraud and Abuse Waivers

ACO Pre-Participation Waiver: N/A

ACO Participation Waiver: N/A