Seton Accountable Care Organization, Inc. | Ascension

ACO name and location

Ascension Seton Accountable Care, Inc.
1345 Philomena Street
Suite 402
Austin, TX 78723

ACO primary contact

Claire Cook (Hensel)
512-324-9999 x 16340
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Organizational information

ACO participants:

ACO participants ACO participant in joint venture
Seton Hospitalist Service N
Capital Medical Clinic, LLP N
Austin Regional Clinic, P.A. N
Lone Star Circle of Care N

ACO governing body:

Member last name Member first name Title/position Member's voting power Membership type ACO participant legal business name/dba, if applicable
Eaves Philip CEO 1 ACO Participant Representative Seton Hospitalist Service
Huffine Dan   1 ACO Participant Representative Seton Hospitalist Service
Jesudass, MD Samson Vice Chair 1 ACO Participant Representative Seton Hospitalist Service
Meza, MD Fausto 1 ACO Participant Representative Seton Hospitalist Service
Pirwitz, MD Mark 1 ACO Participant Representative Seton Hospitalist Service
Borja Gemma 1 ACO Participant Representative Austin Regional Clinic, P.A.
Brinkman, MD Diane 1 ACO Participant Representative Austin Regional Clinic, P.A.
Chenven, MD Norman 1 ACO Participant Representative Austin Regional Clinic, P.A.
Daghestani, MD Anas President and CMO 1 ACO Participant Representative Austin Regional Clinic, P.A.
Henry Katie Chair 1 ACO Participant Representative Austin Regional Clinic, P.A.
Douglas Dalton 1 ACO Participant Representative Lone Star Circle of Care
Kroll, MD Kenneth 1 ACO Participant Representative Capital Medical Clinic, LLP
Fry, MD Liam 1 Community Stakeholder Representative N/A
Granberry Gayle 1 Medicare Beneficiary Representative N/A
Durall Adam Treasurer 0 Community Stakeholder Representative N/A

Key ACO clinical and administrative leadership:

Name ACO leadership position
Philip Eaves ACO Executive
Anas Daghestani, MD Medical Director
Rebecca Lovelace Compliance Officer
Carolina Espinoza-Strelec Quality Assurance/Improvement Officer

Associated committees and committee leadership:

Committee name Committee leader name and position
Clinical Integration Committee Jason Martin, MD, Chair
Membership and Credentialing Committee Philip Eaves, Chair
Incentive Compensation and Contracting Committee Kenneth Kroll, MD, Chair
Compliance Committee Rebecca Lovelace, 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

  • Third Agreement Period
    • Performance Year 2022: $11,739,059
    • Performance Year 2021: $8,160,833
    • Performance Year 2020: $8,818,385
  • Second Agreement Period
    • Performance Year 2019, $9,020,996
    • Performance Year 2018, $4,460,217
    • Performance Year 2017, $3,662,884
  • First Agreement Period
    • Performance Year 2016, $5,062,019
    • Performance Year 2015, $0
    • Performance Year 2014, $5,178,802

Shared Savings Distribution

  • Third Agreement Period
    • Performance Year 2022
      • Proportion invested in infrastructure: 40%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants:60%
    • Performance Year 2021
      • Proportion invested in infrastructure: 50%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants:50%
    • Performance Year 2020
      • Proportion invested in infrastructure: 50%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants: 50%
  • Second Agreement Period
    • Performance Year 2019
      • Proportion invested in infrastructure: 25.42%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants: 74.58%
    • Performance Year 2018
      • Proportion invested in infrastructure: 21.9%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants: 78.1%
    • Performance Year 2017
      • Proportion invested in infrastructure: 20.5%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants: 79.
  • First Agreement Period
    • Performance Year 2016
      • Proportion invested in infrastructure: 23.5%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants: 76.5%
    • Performance Year 2015
      • 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 2014
      • Proportion invested in infrastructure: 30%
      • Proportion invested in redesigned care processes/resources: 0%
      • Proportion of distribution to ACO participants: 70%

Quality performance results

2022 quality performance results:

ACO quality measure number Measure name  Collection Type Rate ACO mean
CAHPS-1 Getting Timely Care, Appointments, and Information CAHPS for MIPS Survey  72.65 83.96 
CAHPS-2 How Well Providers Communicate CAHPS for MIPS Survey  93.58 93.47
CAHPS-3 Patient’s Rating of Provider CAHPS for MIPS Survey  90.87  92.06 
CAHPS-4 Access to Specialists CAHPS for MIPS Survey  75.64  77.00 
CAHPS-5 Health Promotion and Education CAHPS for MIPS Survey  59.00 62.68 
CAHPS-6 Shared Decision Making CAHPS for MIPS Survey  56.08 60.97
CAHPS-7 Health Status and Functional Status CAHPS for MIPS Survey  73.34 73.06
CAHPS-8 Care Coordination CAHPS for MIPS Survey  84.33 85.46
CAHPS-9 Courteous and Helpful Office Staff CAHPS for MIPS Survey  92.22 91.97
CAHPS-11 Stewardship of Patient Resources CAHPS for MIPS Survey  31.37 25.62
001 Diabetes: Hemoglobin A1c (HbA1c) Poor Control CMS Web Interface  10.04 10.71
134 Preventative Care and Screening: Screening for CMS Web Interface  78.31 76.97
236 Controlling High Blood Pressure CMS Web Interface  84.94 76.16
318 Falls: Screening for Future Fall Risk CMS Web Interface 85.88 87.83
110 Preventative Care and Screening: Influenza Immunization CMS Web Interface 78.85 77.34
226 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention CMS Web Interface
80.00 79.27
113 Colorectal Cancer Screening CMS Web Interface
82.35 75.32
112 Breast Cancer Screening CMS Web Interface
78.69 78.07
438 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease CMS Web Interface
82.98 86.37
370 Depression Remission at Twelve Months  CMS Web Interface  8.06 16.03
479 Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups Administrative Claims  .1527 .1510
MCC1 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions for ACOs (MCC) Administrative Claims  30.37 30.97

For Previous Years’ Financial and Quality Performance Results, please visit data.cms.gov.

Payment Rule Waivers

  • Skilled Nursing Facility (SNF) 3-Day Rule Waiver:
    • Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.612.

Fraud and Abuse Waivers

ACO Participation Waiver

The following information describes each arrangement for which our ACO seeks protection under the ACO Participation Waiver, including any material amendment or modification to a disclosed arrangement.

Arrangement: Physician Group Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Austin Regional Clinic, PA
Date of arrangement: 01/01/2020
Items, services, goods or facility provided: Medical services to assigned Medicare beneficiaries
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Physician Group Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Capital Medical Clinic, LLP
Date of arrangement: 01/01/2020
Items, services, goods or facility provided: Medical services to assigned Medicare beneficiaries
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Physician Group Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Lone Star Circle of Care
Date of arrangement: 01/01/2020
Items, services, goods or facility provided: Medical services to assigned Medicare beneficiaries
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Physician Group Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Seton Hospitalist Service
Date of arrangement: 01/01/2020
Items, services, goods or facility provided: Medical services to assigned Medicare beneficiaries
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Support TIN Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Austin Geriatric Specialists
Date of arrangement: 10/01/2013
Items, services, goods or facility provided: Medical services to assigned Medicare beneficiaries
Date and nature of any amendments to the arrangement, if applicable: Amendment effective 12/01/2015 to update references for Pioneer ACO to Medicare Shared Savings Program and revise shared savings pool. Amendments effective 01/01/2016 and 01/01/2020 to revise shared savings pool.

Arrangement: Support TIN Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Hospitalist Concepts Consulting, LLC
Date of arrangement: 09/01/2013
Items, services, goods or facility provided: Medical services to assigned Medicare beneficiaries
Date and nature of any amendments to the arrangement, if applicable: Amendment effective 12/01/2015 to update references for Pioneer ACO to Medicare Shared Savings Program and revise shared savings pool. Amendments effective 01/01/2016 and 01/01/2020 to revise shared savings pool.

Arrangement: Support TIN Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Jason Martin Medical Consulting d/b/a Geriatric Post-Acute Specialists
Date of arrangement: 01/01/2018
Items, services, goods or facility provided: Medical services to assigned Medicare beneficiaries
Date and nature of any amendments to the arrangement, if applicable: Amendment effective 01/01/2020 to revise shared savings pool.

Arrangement: Support TIN Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Seton Family of Doctors (fka Tri-County Practice Association) d/b/a Seton Heart Institute and d/b/a Seton Brain and Spine Institute
Date of arrangement: 01/01/2016
Items, services, goods or facility provided: Medical services to assigned Medicare beneficiaries
Date and nature of any amendments to the arrangement, if applicable: Amendment effective 01/01/2020 to revise shared savings pool.

Arrangement: Management and Professional Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Austin Regional Clinic, PA
Date of arrangement: 01/01/2020
Items, services, goods or facility provided: Care management services to assigned Medicare beneficiaries
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Management and Professional Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Capital Medical Clinic, LLP
Date of arrangement: 01/01/2020
Items, services, goods or facility provided: Care management services to assigned Medicare beneficiaries
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Management and Professional Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Lone Star Circle of Care
Date of arrangement: 01/01/2020
Items, services, goods or facility provided: Care management services to assigned Medicare beneficiaries
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Participating Provider Agreement
Parties to the arrangement: Seton Health Alliance, Austin Regional Clinic, PA and Austin ARIA, Inc.
Date of arrangement: 12/01/2014
Items, services, goods or facility provided: Medical services to assigned patients in value-based contracts
Date and nature of any amendments to the arrangement, if applicable: Amendment effective as of 01/01/2020 to incorporate management services.

Arrangement: Participating Provider Agreement
Parties to the arrangement: Seton Health Alliance and Capital Medical Clinic, LLP
Date of arrangement: 01/01/2016
Items, services, goods or facility provided: Medical services to assigned patients in value-based contracts
Date and nature of any amendments to the arrangement, if applicable: Amendment effective as of 01/01/2017 to incorporate management services.

Arrangement: Participating Provider Agreement
Parties to the arrangement: Seton Health Alliance and Lone Star Circle of Care
Date of arrangement: 04/01/2016
Items, services, goods or facility provided: Medical services to assigned patients in value-based contracts
Date and nature of any amendments to the arrangement, if applicable: Amendment effective as of 01/01/2020 to incorporate management services.

Arrangement: Participating Provider Agreement
Parties to the arrangement: Seton Health Alliance and Toth Enterprise II
Date of arrangement: 09/01/2014
Items, services, goods or facility provided: Medical services to assigned patients in value-based contracts
Date and nature of any amendments to the arrangement, if applicable: Amendment effective as of 01/01/2021 to incorporate management services.

Arrangement: Participating Provider Agreement
Parties to the arrangement: Dell Children’s Health Alliance and Austin Health Partners PLLC
Date of arrangement: 08/28/2018
Items, services, goods or facility provided: Medical services to assigned patients in value-based contracts
Date and nature of any amendments to the arrangement, if applicable: Amendment effective as of 01/01/2020 to incorporate management services.

Arrangement: Support Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Seton Health Alliance
Date of arrangement: 07/01/2016
Items, services, goods or facility provided: Support services
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Support Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Dell Children’s Health Alliance
Date of arrangement: 07/01/2016
Items, services, goods or facility provided: Support services
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Support Services Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Providence Health Services of Waco, d/b/a Care4Texans, LLC
Date of arrangement: 01/01/2019
Items, services, goods or facility provided: Support services
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Panel Access Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Seton Health Alliance
Date of arrangement: 09/01/2014
Items, services, goods or facility provided: Access to contracted provider network
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Panel Access Agreement
Parties to the arrangement: Seton Health Alliance and Dell Children’s Health Alliance
Date of arrangement: 10/10/2014
Items, services, goods or facility provided: Access to contracted provider network
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Panel Access Agreement
Parties to the arrangement: Seton Health Alliance and Providence Health Services of Waco d/b/a Care4Texans, LLC
Date of arrangement: 01/01/2019
Items, services, goods or facility provided: Access to contracted provider network
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Accountable Care Organization Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc, Seton Health Alliance and Aetna Health, Inc.
Date of arrangement: 09/01/2014
Items, services, goods or facility provided: Accountable care organization services to Aetna covered lives
Date and nature of any amendments to the arrangement, if applicable: Amendment effective 09/01/2015 to describe the care management services provided by the ACO and add a Business Associate Agreement. Amendment effective 01/01/2016 to add participation in Aetna Performance Care Network. Amendment effective 01/01/2016 to update Clinical Performance Measures. Amendment effective 02/01/2016 to update Incentive Arrangement Financial Terms – Product Model exhibit. Amendment effective 07/01/2016 to update definition of “ACO Service Area.” Amendment effective 01/01/2017 to update Clinical Performance Measures.  Amendment effective 01/01/2019 to add New Product Financial Risk Share and Requirements exhibits. Amendment effective 01/01/2020 to update Incentive Arrangement Financial Terms – Product Model exhibit and change Trend.

Arrangement: Accountable Care Organization Attribution Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Aetna Network Services, LLC
Date of arrangement: 07/01/2020
Items, services, goods or facility provided: Accountable care organization services to Aetna covered lives
Date and nature of any amendments to the arrangement, if applicable: n/a

Arrangement: Memorandum of Understanding
Parties to the arrangement: Seton Accountable Care Organization, Inc. and Ascension Care Management Health Partners, Inc. and Ascension Health Alliance
Date of arrangement: 01/01/2019
Items, services, goods or facility provided: Accountable care organization services to Ascension covered lives in Texas
Date and nature of any amendments to the arrangement, if applicable: Amendments to extend agreement through December 31, 2021.

Arrangement: Accountable Care Organization Shared Savings Agreement
Parties to the arrangement: Seton Accountable Care Organization, Inc. and UnitedHealthcare of Texas, Inc.
Date of arrangement: 08/01/2013
Items, services, goods or facility provided: Accountable care organization services to UnitedHealthcare covered lives
Date and nature of any amendments to the arrangement, if applicable: Amendment effective 08/01/2013 to clarify definition of Allowed Spend. Amendment effective 01/01/2015 to revise Shared Savings Program Appendix – Commercial and add Performance Measures Measurement Periods 3 and 4. Amendment effective 03/15/2015 to update definitions of ACO PCP and Market PCP. Amendment effective 04/01/2014 to update definitions, Medical Group Participation section and Shared Savings Appendix Commercial and Performance Measures exhibits. Amendment effective 08/15/2015 to update Performance Measures exhibit. Amendment effective 01/01/2016 to update Performance Measures exhibit. Amendment effective 12/01/2016 to negotiate in good faith on renewal of agreement and update Attribution Methodology exhibit and the calculation of shared savings. Amendment effective 01/01/2019 to update ACO Service Area Appendix and update Shared Savings Opportunity Program Appendix – Commercial. Amendment effective 01/01/2020 to update Performance Measures Exhibit and revise Shared Savings Opportunity Payment Appendix – Commercial.

Seton Accountable Care Organization, Inc. (the “ACO”) is currently participating in the Medicare Shared Savings Program (“MSSP”) pursuant to a Participation Agreement with the Centers for Medicare & Medicaid Services (“CMS”) initially entered into effective January 1, 2014, renewed effective January 1, 2017 for a successive three-year term and renewed effective January 1, 2020 for a successive five-year term.

In accordance with the public disclosure requirement of the ACO Participation Waiver, the following describes arrangements involving the ACO and its ACO participants and ACO providers/suppliers for items, services, goods or facilities used to create, develop and/or operate the ACO, and also support the ACO in its efforts to achieve the goals of the MSSP, which are to: (i) improve the care management and coordination of care for Medicare beneficiaries assigned to the ACO; (ii) enhance its population health and quality improvement initiatives; and (iii) support efforts to design processes that promote accountability for the quality, cost and overall care delivered to ACO patients (the “MSSP Purposes”).

The ACO’s provider network (the “ACO Network”) is comprised of health care providers that have agreed to work together to, among other things, (i) participate in the MSSP through the ACO; (ii) participate in similar commercial programs and initiatives designed to manage, coordinate, and promote accountability for the quality, patient safety, cost, and overall care of patients; and (iii) provide medical and other services pursuant to contracts with third-party payers (“ACO Payor Contracts”), including ACO Payor Contracts that include value-¬≠based care programs (individually, an “ACO Network Provider,” and collectively, the “ACO Network Providers”).

The providers that are included in the ACO’s MSSP Program as ACO Participants are:

Austin Regional Clinic
Capital Medical Clinic, LLP
Lone Star Circle of Care
Seton Hospitalist Service (Previous Name: Adult Inpatient Medical Services)

The ACO’s Board of Directors has duly authorized the arrangements below and made a bona fide determination that each arrangement is reasonably related to the purposes of the MSSP:

  1. Seton Accountable Care Organization, Inc., a Texas for-profit corporation, (i) manages, coordinates, and promotes accountability for the quality, patient safety, cost, and overall care of patients, including without limitation, Medicare beneficiaries; (ii) receives and distributes shared savings from participation in the MSSP and similar programs and initiatives designed to manage, coordinate, and promote accountability for the quality, patient safety, cost, and overall care of patients; and (iii) serves as a network to arrange for the provision of medical and health services through contracts with providers, suppliers, third-party payers and employers (collectively, the “ACO Objectives”).The ACO Network Agreements (including, without limitation, the Physician Group Services Agreements and Support TIN Agreements) (i) collectively constitute an “ACO arrangement” for purposes of the MSSP Participation Waiver; (ii) such ACO arrangement is consistent with the ACO Objectives; (iii) will advance the ACO’s efforts to achieve the MSSP Goals; and (iv) is reasonably related to the MSSP Purposes.
  2. Working with Seton Health Alliance (“SHA”), a Texas certified nonprofit health corporation, Dell Children’s Health Alliance (“DCHA”), a Texas certified nonprofit health corporation, and Providence Health Services of Waco d/b/a Care4Texans, LLC (“C4T”), a Texas limited liability company, the ACO: (i) manages, coordinates, and promotes accountability for the quality, patient safety, cost, and overall care of patients, including without limitation, Medicare beneficiaries; (ii) receives and distributes shared savings from participation in the MSSP and similar programs and initiatives designed to manage, coordinate, and promote accountability for the quality, patient safety, cost, and overall care of patients; and (iii) serves as a network to arrange for the provision of medical and health services through contracts with providers, suppliers, third-party payers and employers (collectively, the “ACO Objectives”).The ACO Network Agreements (including, without limitation, the Panel Access Agreement with SHA, the Support Services Agreements between the ACO and SHA, the ACO and DCHA and the ACO and C4T, the SHA PPA, the DCHA PPA, the C4T PPA and the ACO Network Participation Addenda) (i) collectively constitute an “ACO arrangement” for purposes of the MSSP Participation Waiver; (ii) such ACO arrangement is consistent with the ACO Objectives; (iii) will advance the ACO’s efforts to achieve the MSSP Goals; and (iv) is reasonably related to the MSSP Purposes.
  3. The compensation arrangements involving the ACO, SHA, DCHA, C4T and the participating ACO Network Providers under the ACO Payor Contracts with Aetna, Blue Cross Blue Shield, UnitedHealthcare and Ascension Care Management Health Partners, Inc. and Ascension Health Alliance: (i) each constitute an “ACO arrangement” for purposes of the MSSP ACO Participation Waiver, (ii) are consistent with the ACO Objectives, (iii) will advance the Corporation’s efforts to achieve the MSSP Goals and (iv) are reasonably related to the MSSP Purposes.
  4. The Management and Professional Services Agreements with Austin Regional Clinic, PA, Capital Medical Clinic, LLP and Lone Star Circle of Care are consistent with the ACO Objectives and are reasonably related to the MSSP Purposes.
  5. The Care Management amendments to the Participating Provider Agreements with Austin Regional Clinic, PA, Capital Medical Clinic, LLP, Lone Star Circle of Care, Austin Health Partners, PLLC and Toth Enterprises II are consistent with the ACO Objectives and are reasonably related to the MSSP Purposes.