CHESS Innovation ACO Information

ACO Governing Body

Member	Title/Position	Member’s Voting Power	Membership Type	ACO Participant TIN Legal Business Name/DBA
Jason Kihneman, MD	Chair & Voting Member	9.09%	ACO Participant	Catawba Valley Medical Group
Scott Polster, MD	Voting Member	9.09%	ACO Participant	Catawba Valley Medical Group
Dennis Johnson	Voting Member	9.09%	ACO Participant	Catawba Valley Medical Group
Kelly Singer, MD	Voting Member	9.09%	ACO Participant	Fletcher Hospital, Inc.
Christy Sneller	Voting Member	9.09%	ACO Participant	Fletcher Hospital, Inc.
Steven Burroughs	Voting Member	9.09%	ACO Participant	Fletcher Hospital, Inc.
CD Haddock	Voting Member	9.09%	Medicare Beneficiary	N/A
Heather Spry, MD	Voting Member	9.09%	Other	CHESS
Emily Volk	Voting Member	9.09%	ACO Participant	Northern Hospital District of Surry County
Lynn Lambert	Voting Member	9.09%	ACO Participant	Northern Hospital District of Surry County
Mitzi Stanish	Voting Member	9.09%	ACO Participant	Northern Hospital District of Surry County

Key ACO Clinical and Administrative
Leadership

Associated Committees and Key Leadership
Personnel

Types of ACO Participants, or Combinations of Participants that formed the ACO

• ACO professionals in a group practice arrangement
• Hospital employing ACO professionals

Shared Savings/Losses

Amount of Shared Savings/Losses:

First Agreement Period:

• Performance Year: 2022, $1,159,637.73

Shared Savings Distribution:

First Agreement Period

Performance Year: 2022

• Proportion invested in infrastructure: 5%
• Proportion invested in redesigned care processes and other resources necessary to improve outcomes and reduce Medicare costs for Beneficiaries: 35%
• Proportion of distribution to ACO Participants and Preferred Providers: 60%

Quality Performance Results

2022 Quality Performance Results

Measure #	Measure Name	Rate	ACO Mean
001	Diabetes: Hemoglobin A1c (HbA1c) Poor Control	8.97	10.71
134	Preventive Care and Screening: Screening for Depression and Follow-up Plan	89.60	76.97
236	Controlling High Blood Pressure	75.98	76.16
318	Falls: Screening for Future Fall Risk	97.71	87.83
110	Preventive Care and Screening: Influenza Immunization	67.36	77.34
226	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	93.75	79.27
113	Colorectal Cancer Screening	81.99	75.32
112	Breast Cancer Screening	83.22	78.07
438	Statin therapy for the Prevention and Treatment of Cardiovascular Disease	89.35	86.37
370	Depression Remission at Twelve Months	5.13	16.03
321	CAHPS for MIPS	N/A	N/A
479	Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups	0.1440	0.1510
484	All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions for ACOs (MCC)	27.80	30.97

Medicare Shared Savings Program 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. 

For each arrangement, provide the following information:

• Parties to the arrangement: CHESS Innovation, LLC and Circulation, Inc.
• Date of arrangement: 04/27/2022
• Items, services, goods, or facility provided: Transportation services (see link below)
• Date and nature of any amendments to the arrangement, if applicable: N/A

CHESS Innovation Transportation Assistance Program