MSSP public reporting ACO Name and Location:

North Shore-LIJ MSSP ACO, LLC d/b/a Northwell Health ACO
2000 Marcus Avenue
New Hyde Park, New York 11042

ACO Primary Contact:

Sandy Balwan, MD
Medical Director, Northwell Health ACO
(516) 600-1351
sbalwan@northwell.edu

Organizational Information: ACO Participants:

*Participant is involved in a joint venture.

ACO Governing Body:

Key ACO Clinical and Administrative Leadership:

Executive Director

Matthew Jelavic

Medical Director

Sandy Balwan, MD

Compliance Officer

Louis DiGiovanni

Quality Assurance/Improvement Officer

Nancy Beran, MD

Associated Committees and Committee Leadership:

Performance and Distribution Committee

Chairperson:

Mark Siegelheim, MD

Members:

Sandy Balwan, MD
Steven Geier, MD
Mark Stein, MD

Clinical Performance and Quality Committee

Chairperson:

Sandy Balwan, MD

Members:

Sandy Balwan, MD
Maria Carney, MD
Parmeshwar Mahabir, MD

Network Composition and Credentialing Committee

Chairperson:

Mark Stein, MD

Members:

Steven Geier, MD
Mark Siegelheim, MD

Types of ACO Participants or Combinations of Participants that Formed the ACO:

• ACO professionals in group practice arrangements
• Networks of individual practices of ACO professionals
• Hospitals employing ACO professionals
• Partnerships or Joint Venture arrangements between hospitals and ACO professionals

Shared Savings and Losses:

Amount of Shared Savings/Losses

• Second Agreement Period
  • Performance Year 2021, $0
  • Performance Year 2020, $8,368,192.73
  • Performance Year 2019, $0
• First Agreement Period
  • Performance Year 2019, $0
  • Performance Year 2018, $0
  • Performance Year 2017, $0
  • Performance Year 2016, $0

Note: Our ACO participated in multiple performance years during Calendar Year 2019. Shared savings/losses amount reported for Performance Year 2019 therefore represents net shared savings or losses across all performance years in 2019 and is shown under all agreement periods in which the ACO operated during Calendar Year 2019.

Shared Savings Distribution

• Second Agreement Period
  • Performance Year 2021
    • 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 2020
    • Proportion invested in infrastructure: 15%
    • Proportion invested in redesigned care processes/resources: 15%
    • Proportion of distribution to ACO participants: 70%

• • Performance Year 2019
    • Proportion invested in infrastructure: N/A
    • Proportion invested in redesigned care processes/resources: N/A
    • Proportion of distribution to ACO participants: N/A

• First Agreement Period

• • Performance Year 2019
    • 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 2018
    • 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 2017
    • 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 2016
    • Proportion invested in infrastructure: N/A
    • Proportion invested in redesigned care processes/resources: N/A
    • Proportion of distribution to ACO participants: N/A

2021 Quality Performance Results

Quality performance results are based on the CMS Web Interface Measure Set.

Please note, the Quality ID#: 370 Depression Remission at 12 months measure is not included in public reporting due to low sample size.

For Previous Years’ Financial and Quality Performance Results, Please Visit data.cms.gov.

Participation Waiver Disclosure

No, our ACO does not use the SNF 3-Day Rule Waiver.

The Secretary of the U.S. Department of Health and Human Services has provided waivers of certain federal fraud and abuse laws that may otherwise limited innovation by ACOs participating in the Medicare Shared Savings Program (“MSSP”). See Final Waivers in Connection With the Shared Savings Program, 79 Fed. Reg. 62356 (Oct. 17, 2014) (“Interim Final Rule”). Pursuant to the Interim Final Rule, North Shore-LIJ MSSP ACO, Inc. (the “ACO”) seeks waiver protection for the arrangement described below:

The ACO has entered into an agreement with Northwell Health to provide a broad range of necessary management services and operational personnel to support the ACO’s operations as an ACO in the MSSP. Under the arrangement, the ACO shall compensate Northwell Health from any shared savings payments for its provision of management services, including but not limited general day-to-day operational personnel and services, financial management and accounting services, and credentialing.

The ACO’s governing body, consistent with its obligations under 42 C.F.R. § 425.106(b)(3), has made and duly authorized a bona fide determination on August 23, 2016 that the arrangement is reasonably related to the purposes of the Medicare Shared Savings Program, including, specifically, promoting accountability for the quality, cost, and overall care for a Medicare population and aiding the ACO in managing and coordinating care for Medicare fee-for-service beneficiaries.

Posted: August 23, 2016

Resources

QQuality Payment Program
Webinars and Events
Provider Information for New Medicare Cards
Beneficiary Video for New Medicare Cards
Northwell Health ACO Poster Template (must be publicly displayed in ACO participant offices)
Beneficiary Information Notice (must be distributed to beneficiaries at or before their first primary care visit of the Performance Year)
Spanish Beneficiary Information Notice
Voluntary Alignment Fact Sheet for Providers
Voluntary Alignment Fact Sheet for Beneficiaries