Gulf Coast MSSP Information

ACO Name and Location

Privia Quality Network Gulf Coast II, LLC
1200 Binz Street, Ste 1490
Houston, TX 77004

ACO Primary Contact

Primary Contact Name Lynne Vaassen
Primary Contact Phone Number (713) 512-7001
Primary Contact Email Address lvaassen@priviahealth.com

Organizational Information

ACO Participants:

ACO Participants ACO Participant in Joint Venture
Austin Medical Group PLLC N
Alice A. Lim, M.D., P.A. N
Ami C. Foster, M.D., P.A. N
Camille Goff N
Endocrine and Psychiatry Center EPC LLC N
Hansa Bhakti Medley M.D. P.A. N
Mark J Florian MD PA N
Memorial Wellness Center PA N
Neighborhood Medical Clinic PLLC N
Panther Creek Medical Center, PA N
Physicians Group of the Woodlands N
Privia Medical Group Gulf Coast Pllc N
Pucillo Family Practice, PA N
Richard Allen Le MD PA N
San Marcos Family Medicine N
Spangler Medical Enterprises, PA N
St. Elizabeth Family Care, LLC N
Texas Endocrinology Group,PA N
The Neurology Center, P.A. N
Victor Knopp N
Gary L Gilcrease MD, PA N
Shavano Family Practice PA N

ACO Governing Body:

Member Member’s Voting Power –
Expressed as a percentage or number
Last Name First Name Title/Position Membership Type ACO Participant TIN Legal Business Name/DBA, if Applicable
Fernandez Keith MD 1 ACO Executive Privia Medical Group Gulf Coast, PLLC
Cone Mark MD 1 ACO Executive Privia Medical Group Gulf Coast, PLLC
Paschalis Thimos MD 1 ACO Participant Representative Privia Medical Group Gulf Coast, PLLC
Prihoda Chris MD 1 ACO Participant Representative Privia Medical Group Gulf Coast, PLLC
Vogel Susan MD 1 ACO Participant Representative Privia Medical Group Gulf Coast, PLLC
Patel Rakesh MD 1 ACO Participant Representative Privia Medical Group Gulf Coast, PLLC
Vaassen Lynne BSN, RN 1 ACO Participant Representative Privia Medical Group Gulf Coast, PLLC
Harrison Jaclyn MD 1 ACO Participant Representative Privia Medical Group Gulf Coast, PLLC
Dawson Daniel MD 1 ACO Participant Representative Privia Medical Group Gulf Coast, PLLC
Lee Allen MD 1 ACO Participant Representative Privia Medical Group Gulf Coast, PLLC
Dunwoody David – 1 Medicare Beneficiary Representative Privia Medical Group Gulf Coast, PLLC

Key ACO Clinical and Administrative Leadership:

 ACO Executive  Keith Fernandez, MD
 Medical Director  Keith Fernandez, MD
 Compliance Officer  Dana Fields
 Quality Assurance/Improvement Officer  Tiffany Johnson

Associated Committees and Committee Leadership:

 Committee Name  Committee Leader Name & Position
 Finance Committee   Fred Huang
 Quality Assurance Committee  Christopher Prihoda, M.D. – Chair
 Compliance Committee  Dana Fields

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

  • ACO professionals in a group practice arrangement
  • Networks of individual practices of ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses

  • First Agreement Period
    • Performance Year 2018, $4,203,425
    • Performance Year 2019, $2,470,186.33

Shared Savings Distribution

    • First Agreement Period
      • Performance Year 2018
        • Proportion invested in infrastructure: 45%
        • Proportion invested in redesigned care processes/resources: 5%
        • Proportion of distribution to ACO participants: 50%
      • Performance Year 2019
        • Proportion invested in infrastructure: 45%
        • Proportion invested in redesigned care processes/resources: 5%
        • Proportion of distribution to ACO participants: 50%

Quality Performance Results

2019 Quality Performance Results:

ACO# Measure Name  Rate ACO Mean
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 83.76 85.86
ACO-2 CAHPS: How Well Your Providers Communicate 92.54 94.11
ACO-3 CAHPS: Patients’ Rating of Provider 90.39 92.69
ACO-4 CAHPS: Access to Specialists 80.24 81.54
ACO-5 CAHPS: Health Promotion and Education 59.77 60.44
ACO-6 CAHPS: Shared Decision Making 60.34 62.78
ACO-7 CAHPS: Health Status/Functional Status 76.47 73.79
ACO-34 CAHPS; Stewardship of Patient Resources 27.62 26.17
ACO-45 CAHPS: Courteous and Helpful Office Staff 89.09 92.84
ACO-46 Care Coordination 85.53 86.89
ACO-8 Risk Standardization, All Condition Readmission 14.68 14.86
ACO-38 All-Cause Readmissions for Patients with Multiple Chronic Conditions 60.62 58.15
ACP-43 Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91) 2.01 1.87
ACO-13 Falls: Screening for Future Fall Risk 94.44 84.04
ACO-14 Preventative Care and Screening: Influenza Immunization 68.87 74.77
ACO-17 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention 73.68 78.04
ACO-18 Preventative Care and Screening: Screening for Clinical Depression and Follow-up Plan 49.82 70.40
ACO-19 Colorectal Cancer Screening 66.42 70.76
ACO-20 Breast Cancer Screening 66.94 73.84
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 79.67 82.17
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 9.82 13.88
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 70.03 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.

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 does not use the SNF 3-Day Rule Waiver, pursuant to 42 CFR §425.612.

Waiver for Payment for Telehealth Services:

  • Our ACO clinicians do not provide telehealth services using the flexibilities under 42 CFR §425.612(f) and 42 CFR §425.613.

Beneficiary Incentive Program

Our ACO does not use the Beneficiary Incentive Program (BIP) established under 42 CFR §425.304(c).