Shared Savings Program ACO Public Reporting

ACO Name and Location

RGV ACO Health Providers, LLC
303 North D Salinas Blvd
Donna, TX 78537

ACO Primary Contact

Primary Contact Name

Jose F. Peña, MD, FACP, FACHE, CHCQM, CRC

Primary Contact Phone Number

956-969-0120

Primary Contact Email Address

jpena@rgvacollc.com

Organizational Information

 

ACO Participants

ACO Participant in Joint Venture (Enter Y or N)

Alejandro Arizmendi, MD, PLLC

N

Solo Doc, MD, PA

N

Carlos Rosas, MD, PA

N

Guillermo I. Rocha, MD, PA

N

Rio Grande Medicine, Inc.

N

Alberto Edmundo Almeida, MD, PA

N

Pedro J. Peñalo, MD, PA

N

Bandera Family Health Care, PA

N

Yasmin S. Maldonado, MD, PA

N

Melecia Fuentes, MD, PA

N

Ricardo A. Adames, MD, PA

N

Donna Medical Clinic, PA

N

Mid Valley Adult Specialists, PA

N

Diana Lozano, MD, PA

N

Family Health Center of Mission, PLLC

N

Michael W. Mann, MD, PA

N

Alfonso Ochoa, MD, PA

N

Graciela M. Leija, MD, PA

N

Rio Grande Valley Adult & Internal Medicine Specialists, PA

N

Valley Medical Arts Clinic, PA

N

Melva Palacios, MD and Chris Casso, MD, PA

N

Abreu Adult Clinic, PA

N

Shridhar Kotta, MD, PA

N

ACO governing body:

Member

Member's Voting Power –Expressed as a percentage or number

Membership Type

ACO Participant Legal Business Name/DBA,   if Applicable

Last    Name

First Name

Title/Position

Peña

Jose

Chairman;    Voting Member

1

ACO Participant Representative

Donna Medical Clinic, PA

McDougal

Pedro

Voting Member

1

ACO Participant Representative

RGV Adult & Internal Medicine Specialists, PA

Peñalo

Pedro

Voting Member

1

ACO Participant Representative

Pedro J. Peñalo, MD, PA

Soto

Jose

Voting Member

1

Medicare Beneficiary Representative

N/A

Johnson

Jere

Voting Member

1

ACO Participant Representative

Family Health Center of Mission, PLLC

Rocha

Guillermo

Voting Member

1

ACO Participant Representative

Guillermo I. Rocha, MD, PA

Arizmendi

Alejandro

Voting Member

1

ACO Participant Representative

Alejandro Arizmendi, MD, PLLC

Maldonado

Yasmin

Voting Member

1

ACO Participant Representative

Yasmin S. Maldonado, MD, PA

 

Key ACO clinical and administrative leadership:


Jose F. Peña, MD

ACO Executive

Pedro J. Peñalo, MD

Medical Director

Pedro E. McDougal, MD

Medical Director

Alejandro Arizmendi, MD

Medical Director

Diana Lozano, MD

Medical Director

Cassandra Treviño, PA-C

Compliance Officer

Pedro J. Peñalo, MD

Quality Assurance/Improvement Officer


Associated committees and committee leadership:


Committee Name

Committee Leader Name and Position

Beneficiary Engagement Committee

Jose Soto, Chair

Quality Assurance and Performance Improvement Committee

Pedro J. Peñalo, MD, Chair

Utilization Committee

Jose F. Peña, MD, Chair


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

  • Networks of individual practices of ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses

  • Third Agreement Period
    • Performance Year 2019, $7,970,108
  • Second Agreement Period
    • Performance Year 2018, $7,239,220
    • Performance Year 2017, $9,427,971
    • Performance Year 2016, $10,027,046
  • First Agreement Period
    • Performance Year 2015, $12,619,152
    • Performance Year 2014, $7,528,797
    • Performance Year 2013, $11,900,756

Shared Savings Distribution

  • Third Agreement Period
    • Performance Year 2019
      • Proportion invested in infrastructure: 21%
      • Proportion invested in redesigned care processes/resources: 11%
      • Proportion of distribution to ACO participants: 68%
  • Second Agreement Period
    • Performance Year 2018
      • Proportion invested in infrastructure: 21%
      • Proportion invested in redesigned care processes/resources: 11%
      • Proportion of distribution to ACO participants: 68%
    • Performance Year 2017
      • Proportion invested in infrastructure: 16%
      • Proportion invested in redesigned care processes/resources: 12%
      • Proportion of distribution to ACO participants: 72%
    • Performance Year 2016
      • Proportion invested in infrastructure: 28%
      • Proportion invested in redesigned care processes/resources: 4%
      • Proportion of distribution to ACO participants: 68%
  • First Agreement Period
    • Performance Year 2015
      • Proportion invested in infrastructure: 30%
      • Proportion invested in redesigned care processes/resources: 5%
      • Proportion of distribution to ACO participants: 65%
    • Performance Year 2014
      • Proportion invested in infrastructure: 30%
      • Proportion invested in redesigned care processes/resources: 5%
      • Proportion of distribution to ACO participants: 65%
    • Performance Year 2013
      • Proportion invested in infrastructure: 30%
      • Proportion invested in redesigned care processes/resources: 5%
      • Proportion of distribution to ACO participants: 65%

Quality Performance Results

2019 Quality Performance Results:

ACO#

Measure Name

Rate

ACO Mean

ACO-1

CAHPS: Getting Timely Care, Appointments, and Information

86.62

85.86

ACO-2

CAHPS: How Well Your Providers Communicate

95.59

94.11

ACO-3

CAHPS: Patients’ Rating of Provider

92.91

92.69

ACO-4

CAHPS: Access to Specialists

78.09

81.54

ACO-5

CAHPS: Health Promotion and Education

66.17

60.44

ACO-6

CAHPS: Shared Decision Making

60.15

62.78

ACO-7

CAHPS: Health Status/Functional Status

71.33

73.79

ACO-34

CAHPS: Stewardship of Patient Resources

27.95

26.17

ACO-45

CAHPS: Courteous and Helpful Office Staff

93.29

92.84

ACO-46

CAHPS: Care Coordination

85.92

86.89

ACO-8

Risk Standardized, All Condition Readmission

15.15

14.86

ACO-38

All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions

52.87

58.15

ACO-43

Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91)

1.44

1.87

ACO-13

Falls: Screening for Future Fall Risk

94.89

84.04

ACO-14

Preventive Care and Screening: Influenza Immunization

93.38

74.77

ACO-17

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

93.33

78.04

ACO-18

Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan

83.90

70.40

ACO-19

Colorectal Cancer Screening

80.69

70.76

ACO-20

Breast Cancer Screening

80.20

73.84

ACO-42

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

92.90

82.17

ACO-40

Depression Remission at Twelve Months

38.10

13.58

ACO-27

Diabetes Mellitus: Hemoglobin A1c Poor Control

7.69

13.88

ACO-28

Hypertension (HTN): Controlling High Blood Pressure

87.33

75.04

 


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

Payment Rule Waivers

  • Skilled Nursing Facility (SNF) 3-day Rule Waiver:
    • Yes, our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR 425.612.
  • Waiver for Payment for Telehealth Services:
    • Yes, our ACO clinicians provide telehealth services using the flexibilities under 42 CFR 425.612(f) and 42 CFR 425.613.