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What is an ACO?

An Accountable Care Organization (ACO) is a group of doctors and other healthcare providers who agree to work together with Medicare to give you the best possible care.

ACOs may take different approaches to giving you coordinated care. Some ACOs may have special nurses that help you set up appointments or make sure your medications are in order when you enter or leave a hospital. Other ACOs may help your doctors get you equipment for monitoring your medical conditions better at home, if you need it. Most ACOs use advanced systems that let them more carefully track your care, and make sure your doctor has the most up-to-date information about your health.

The goal of the ACO is to support your doctor in caring for you. ACOs help your doctor and healthcare providers work together more closely, by making sure they have the most up-to-date information about your health and your care. For you, this means your doctors communicate better with each other, and you avoid having duplicate tests or answering the same questions over and over. Working together, your doctors can do more to follow your health, make sure you get the best possible care, and may hire additional staff to help meet your unique care needs, depending on what works best for you.

Doctors and other healthcare providers choose to participate in an ACO because they’re committed to your care experience. They may also be rewarded for offering you better, more coordinated care. If your physician is part of the Indiana Lakes ACO, you will be notified, either in person at your next office visit or by letter.

An ACO isn’t the same as a Medicare Advantage Plan or Health Maintenance Organization (HMO). You’re still in Original Medicare, and your Medicare benefits, services, rights and protections won’t change. And you still have the right to use any doctor or hospital that accepts Medicare at any time, the same way you do now.

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Frequently Asked Questions:

How do I know my doctor is in the Indiana Lakes ACO?

ACOs must provide in-office notification of the provider’s participation in the ACO in settings in which the beneficiary receives primary care services. In addition to this, Indiana Lakes ACO has mailed information to those Medicare Fee-for-Service patients whose doctors and/or other healthcare providers are participating in the Indiana Lakes ACO.

If I have not been notified that my doctor is in the ACO, what do I need to do?

You don’t need to do anything. You’ll still be in Original Medicare, and you’ll still have the right to use any doctor or hospital that accepts Medicare, at any time.

Do I have to participate in the Indiana Lakes ACO?

You still have the right to see any doctor or hospital that accepts Medicare, at any time.

You can continue receiving care from your doctor, or you can choose to see a doctor who doesn’t participate in an ACO. It is your choice.

Can I still see all of my regular Medicare doctors and healthcare providers?

It’s important to know that:

  • You are still in Original Medicare.
  • You are still entitled to all the same Medicare services, benefits, and protections.
  • You can still go to any doctor, hospital, or other provider that accepts Medicare. Nobody can restrict which providers you see.

Can I still choose to receive services from any new doctor, hospital or healthcare provider that I want to?

You can still choose to go to any doctor, hospital, or other healthcare provider that accepts Medicare. Nobody – not even your current physician – can prevent you from seeing the doctors, hospitals or providers you want.

What information about me will the Indiana Lakes ACO have access to?

To help doctors who participate in an ACO give Medicare Fee-for-Service patients like you high quality care, Medicare wants to share some additional information about your care with them. This information includes things like doctor, hospital, and pharmacy visits in the past and moving forward. This information helps your doctor, and the other ACO providers, track the services you’ve already received, understand where you may need more care, and find ways to smooth the path for you if you have to transfer in or out of a hospital, or from the care of one doctor to another. If you decide you do not want to have the information about your care shared with the ACO, you can do so.

How can I decline to have my personal health information shared?

We value your privacy, so it’s important to know that you can prevent Medicare from sharing this information at any time.

  • Call (800) MEDICARE (800-663-4227). TTY users should call (877) 486-2048 and tell the operator you are calling to tell Medicare that you do not want your information shared with any ACO.

Also, Medicare will not share any information about alcohol and drug treatment history, if you have received such treatment.

After your phone call is received, Medicare will update its records to show that you do not want to have your data shared. If you call (800) MEDICARE, you will receive a letter confirming this change. It will take about 45 days for this change to take effect.

What if I change my mind and decide that I do want my personal health information shared in the future?

If you change your mind in the future, you can call (800) MEDICARE (800-663-4227) and tell them that you have changed you mind and that you do want your data shared. You will receive a letter confirming this change.

What if I have received alcohol and drug treatment, will that information be shared with the Indiana Lakes ACO?

To help you receive high quality care, Medicare shares general health information with the participating ACO, in this case your Indiana Lakes ACO physician. However, to protect your privacy, Medicare doesn’t share any information about treatment a Medicare Fee-for-Service patient received for alcohol and drug treatment with a participating ACO.

How long do I have to respond to say that I do not want my personal health information shared with the participating ACO?

Medicare values your privacy. For that reason, you can prevent Medicare from sharing your personal health information, or otherwise change any of your preferences, at any time.

Just call (800) MEDICARE (800-663-4227), and they can help you set your preferences the way you want them. You can also return the “Declining to Share Personal Health Information Form” to our doctor’s office.

I recently enrolled in a Medicare Advantage Plan but I also received a notice that my physician is part of the Indiana Lakes ACO, does that change anything?

Because you chose to enroll in a Medicare Advantage Plan, the notice you received about Accountable Care Organizations (ACOs) is no longer accurate. Please disregard it.

What if I am already happy with my care the way it is?

We’re glad you’re having a positive experience already. You can continue to see you doctor the way you have been. Your doctor’s participation in an ACO won’t change your benefits in any way, and decisions about your care stay with you and your doctor.

How will being in an ACO help my doctor?

Doctors participating in ACOs may have improved access to the expertise, staff, and technology they need to make sure your care is coordinated across all the places you get services. For you, this coordination could mean less paperwork to fill out at the doctor’s office, avoiding unnecessary tests, or more help for you in dealing with any health conditions.

Your doctor’s office sent me a letter, what do I need to do?

You do not need to take any additional steps to continue to receive care from your usual healthcare team. You’ll still be in Original Medicare, and you’ll still have the right to use any doctor or hospital that accepts Medicare, at any time.

I received a letter that my doctor is participating in the Indiana Lakes ACO.  What are the forms included in this letter? Do I have to fill them out?

It’s important to know that your doctor, not you, is participating in an Accountable Care Organization (ACO). You don’t have to fill out any forms or take any action to keep seeing him or her. 

The letter you got should include a form “Declining to Share Personal Health Information,” To help give you improved care, Medicare would like to share information about visits you made to doctors, hospitals, or pharmacies. This information can help your doctor and other healthcare providers give you the best possible care.

You can choose to prevent Medicare from sharing this information by either by calling 1-800 Medicare; or completing the form you got and returning it to your doctor’s office.  You should fill this form out ONLY if you don’t want Medicare to share information.  

Can I receive a written translation of the letter I received from my doctor?

For Spanish speaking patients, (800) MEDICARE (800-663-4227) can provide both a written version and verbal translation of this letter. For assistance in translating the letter to another language, (800) MEDICARE (800-663-4227) cannot provide you with a written version of the letter at this time. Please know that you can always call (800) MEDICARE (800-663-4227) to get the information verbally, over the phone.

My relative received a letter from the Indiana Lakes ACO, but they passed away recently, what do I need to do?

We are sorry to hear about your loss. These letters were sent because of your relative’s history of receiving care from their physician who is participating in the Indiana Lakes ACO. You don’t need to do anything further – over time your relative will be removed from the list of patients affiliated with the participating physician.


ACO Name and Location

Indiana Lakes ACO, LLC
200 High Park Ave
Goshen, Indiana 46526

ACO Primary Contact

Primary Contact Name

Bruce McDonald

Primary Contact Phone Number

(574) 364-2564

Primary Contact Email Address

bmcdonald@goshenhealth.com

 

Organizational Information

ACO participants:

ACO Participants

ACO Participant in Joint Venture (Enter Y or N)

Goshen Medical Practice

N

Sarah T. Krabill, M.D., Family Practice, P.C.

N

Kuhn Medical Clinic

N

Sneeze and Snooze Clinic, PC

N

Elkhart Emergency Physicians, Inc.

N

Radiology, Inc.

N

Urology Associates of Elkhart, Inc.

N

Alan H. Bierlein, MD

N

Jeffrey P. Bolduan, MD, Inc.

N

Maple City Health Care Center, Inc.

N

Padmanabha R. Betina, MD

N

Goshen Health System

N

Goshen Family Physicians

N

Goshen Hospital Association, Inc.

N

Paul H. Buller, M.D.

N

Gerig Surgical Associates, PC

N

Goshen Team Bariatrics

N

Goshen Retreat Women’s Health Center

N

Goshen Center For Cancer Care

N

Goshen Wound Center

N

Goshen Heart & Vascular

N

 

ACO governing body:

Last Name

First Name

Title/Position

Member's Voting Power

Membership Type

Legal Business Name

Barb

Meyer MD

Voting Member

1

ACO Participant Representative

Goshen Health System

Randy

Christophel

Voting Member

1

ACO Participant Representative

Goshen Hospital Assoc., Inc.

Larry

Allen MD

Voting Member

1

ACO Participant Representative

Goshen Hospital Assoc., Inc.

Dicky

Bhagat MD

Voting Member

1

ACO Participant Representative

Goshen Medical Practice

Jeffery

Bolduan MD

Voting Member

1

ACO Participant Representative

Jeffery Boulduan, MD

Ben

Bontrager

Voting Member

1

ACO Participant Representative

Goshen Hospital Assoc., Inc.

Nathanial

Dew MD

Voting Member

1

ACO Participant Representative

Gerig Surgical Associates

Bruce

Hughes, MD

Voting Member

1

ACO Participant Representative

Elkhart Emergency Physicians Inc.

Max

Mertz MD

Voting Member

1

ACO Participant Representative

Goshen Health System

Rob

Meyers

Voting Member

1

ACO Participant Representative

Goshen Health System

Jody

Neer MD

Voting Member

1

ACO Participant Representative

Goshen Health System

Thomas

Pechin MD

Voting Member

1

ACO Participant Representative

Goshen Health System

Alan

Weldy

Non-voting Member

0

ACO Participant Representative

Goshen Hospital Assoc., Inc.

Del

Good

Voting Member

1

Medicare Beneficiary Representative

n/a

 

Key ACO clinical and administrative leadership:

Larry Allen

ACO Executive

Larry Allen

Medical Director

Bruce McDonald

Compliance Officer

Max Mertz, MD

Quality Assurance/Improvement Officer

 

Associated committees and committee leadership:

Committee Name

Committee Leader Name and Position

Finance & Savings Distribution Committee

Larry Allen, MD (Chairman)

Patient Centered Medical Home Committee

Tony Pechin, MD (Chairman)

Communications & Marketing Committee

Bruce McDonald (Chairman)

Medical Management & Quality Committee

Max Mertz, MD (Chairman)

 

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
  • Partnerships or joint venture arrangements between hospitals and ACO professionals
  • Hospital employing ACO professionals
  • Federally Qualified Health Center (FQHC)

 

Shared Savings and Losses

Amount of Shared Savings/Losses

  • Second Agreement Period
    • Performance Year 2016, $1,609,812
  • First Agreement Period
    • Performance Year 2015, $0
    • Performance Year 2014, $0
    • Performance Year 2013, $0

 

Shared Savings Distribution

  • Second Agreement Period
    • Performance Year 2016
      • Proportion invested in infrastructure: 10%
      • Proportion invested in redesigned care processes/resources: 30%
      • Proportion of distribution to ACO participants: 60%
  • First Agreement Period
    • 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: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A
    • Performance Year 2013
      • Proportion invested in infrastructure: N/A
      • Proportion invested in redesigned care processes/resources: N/A
      • Proportion of distribution to ACO participants: N/A

 

Quality Performance Results

2016 Quality Performance Results:

ACO#

Measure Name

Rate

ACO Mean

ACO-1

CAHPS: Getting Timely Care, Appointments, and Information

86.57

80.51

ACO-2

CAHPS: How Well Your Providers Communicate

94.27

93.01

ACO-3

CAHPS: Patients’ Rating of Provider

93.20

92.25

ACO-4

CAHPS: Access to Specialists

86.04

83.49

ACO-5

CAHPS: Health Promotion and Education

60.00

60.32

ACO-6

CAHPS: Shared Decision Making

78.72

75.40

ACO-7

CAHPS: Health Status/Functional Status

75.21

72.30

ACO-34

CAHPS: Stewardship of Patient Resources

25.39

26.97

ACO-8

Risk Standardized, All Condition Readmission

14.25

14.70

ACO-35

Skilled Nursing Facility 30-day All-Cause Readmission measure (SNFRM)

18.16

18.17

ACO-36

All-Cause Unplanned Admissions for Patients with Diabetes

50.00

53.20

ACO-37

All-Cause Unplanned Admissions for Patients with Heart Failure

65.11

75.23

ACO-38

All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions

51.97

59.81

ACO-9

Ambulatory Sensitive Condition Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5)

9.21

9.27

ACO-10

Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8)

11.31

14.53

ACO-11

Percent of PCPs who Successfully Meet Meaningful Use Requirements

93.88

82.72

ACO-39

Documentation of Current Medications in the Medical Record

94.73

87.54

ACO-13

Falls: Screening for Future Fall Risk

70.14

64.04

ACO-14

Preventive Care and Screening: Influenza Immunization

75.76

68.32

ACO-15

Pneumonia Vaccination Status for Older Adults

79.06

69.21

ACO-16

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up

81.51

74.45

ACO-17

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

90.95

90.98

ACO-18

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

67.67

53.63

ACO-19

Colorectal Cancer Screening

63.82

61.52

ACO-20

Breast Cancer Screening

65.89

67.61

ACO-21

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

87.63

76.79

ACO-42

Statin therapy for the Prevention and Treatment of Cardiovascular Disease

78.41

77.72

ACO-27

Diabetes Mellitus: Hemoglobin A1c Poor Control

11.94

18.24

ACO-41

Diabetes: Eye Exam

52.60

44.94

ACO-28

Hypertension (HTN): Controlling High Blood Pressure

65.49

70.69

ACO-30

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

94.15

85.05

ACO-31

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

86.00

88.67

ACO-33

Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%)

84.80

79.67

 

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low samples.

Note: In the Quality Performance Results file(s) above, search for “Indiana Lakes ACO, LLC” or “Indiana Lakes ACO” to view the quality performance results. This ACO can also be found by using the ACO ID A73727 in the public use files on data.cms.gov.

Payment Rule Waivers

  • Yes, our ACO does use the SNF 3-Day Rule Waiver.

Accountable Care Organization Quality Performance Report »