CHESS Innovation ACO Information

CHESS Innovation Governing Body

Member	Title/Position	Member’s Voting Power	Membership Type	ACO Participant TIN Legal Business Name/DBA
Yates Lackey	Voting Member	10%	ACO Participant	Wake Forest University Health Sciences
Richard Lord, MD	Voting Member	10%	ACO Participant	Wake Forest University Health Sciences
Bradley Clark	Voting Member	10%	ACO Participant	Wake Forest University Health Sciences
Scott Polster, MD	Voting Member	10%	ACO Participant	Catawba Valley Medical Group
Kimberly Crews	Voting Member	10%	ACO Participant	Catawba Valley Medical Group
Heather Spry, MD	Voting Member	10%	ACO Participant	Wake Forest Health Network, LLC
Jason Kihneman, MD	Voting Member	10%	ACO Participant	Catawba Valley Medical Group
Elisabeth Stambaugh, MD	Chair and Voting Member	10%	ACO Participant	Wake Forest Health Network, LLC
Barbara Geddie	Voting Member	10%	Medicare Beneficiary & Consumer Advocate
Robert Dough, MD	Voting Member	10%	ACO Participant	Wake Forest University Health Sciences

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 1:

Shared Savings Distribution:

First Agreement Period:

Performance Year:

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

Quality Performance Results

Payment Rule Waivers

Skilled Nursing Facility (SNF) 3-Day Rule Waiver:

• Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.612.

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. 

• • 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