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
Alice A Lim, M.D., P.A. N
Austin Medical Group PLLC N
Camille Goff N
Endocrine and Psychiatry Center EPC LLC N
Gary L. Gilcrease MD, PA N
Hansa Bhaki 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
Physician 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
Shavano Family Practice PA 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

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 Participant Representative Privia Medical Group Gulf Coast, PLLC
Paschalis Thimos MD 1 ACO Participant Representative Privia Medical Group Gulf Coast, PLLC
Prihoda Christopher MD 1 ACO Participant Representative Privia Medical Group Gulf Coast, PLLC
Vogel Susan MD 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
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
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
    • Performance Year 2020, $5,091,075.46

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%
      • Performance Year 2020
        • Proportioninvested in infrastructure: 45%
        • Proportion invested in redesigned care processes/resources: 5%
        • Proportion of distribution to ACO participants: 50%

Quality Performance Results

2020 Quality Performance Results:

ACO# Measure Name  Rate ACO Mean
ACO-8 Risk Standardization, All Condition Readmission 14.43 15.07
ACO-38 All-Cause Readmissions for Patients with Multiple Chronic Conditions 40.58 49.50
ACP-43 Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91) 0.81 0.95
ACO-13 Falls: Screening for Future Fall Risk 86.29 84.97
ACO-14 Preventative Care and Screening: Influenza Immunization 69.20 76.03
ACO-17 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention 92.86 81.67
ACO-18 Preventative Care and Screening: Screening for Clinical Depression and Follow-up Plan 70.28 71.46
ACO-19 Colorectal Cancer Screening 74.02 72.59
ACO-20 Breast Cancer Screening 64.06 74.05
ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease 80.00 83.37
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 15.20 14.70
ACO-28 Hypertension (HTN): Controlling High Blood Pressure 73.39 72.87
ACO-40 Depression Remission at Twelve Months 31.25 13.99

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).