Tuesday, July 31, 2012

Humana Reduces 2012 Forecast as Medicare Costs Increase

By Alex Nussbaum - Jul 31, 2012 9:34 AM CT
Humana Inc. (HUM), the second-biggest provider of Medicare benefits, fell the most in more than three years after cutting its 2012 profit forecast on higher-than- anticipated costs.
Humana tumbled 9.8 percent to $63.66 at 10:17 a.m. in New York trading, after dropping as much as 10 percent for its biggest intraday decline since March 2009. Earnings this year may be $6.90 to $7.10 a share, the Louisville, Kentucky-based health plan said yesterday in a statement. That was below the $7.88 average of 10 analyst estimates compiled by Bloomberg.
The company generated three-quarters of sales last year from Medicare, the U.S.-backed program for the elderly and disabled, and Chief Executive Officer Michael B. McCallister said that new members were proving more expensive. Humana’s results contrasted with those of Minnetonka, Minnesota-based UnitedHealth Group Inc. (UNH), the top Medicare insurer, which raised its profit outlook two weeks ago, and Aetna Inc. (AET), which forecast higher full-year earnings today.
“It was increasingly clear that Humana management had been aggressive and mispriced their retail Medicare book of business for 2012,” said Ana Gupte, a Sanford C. Bernstein & Co. analyst in New York, in a note to clients today.
Second-quarter net income fell 23 percent to $356 million, or $2.16 a share, from a year earlier, Humana said. Profit also was reduced by an 18-cent charge for a lawsuit settlement.
‘Nobody’s Happy’
“Nobody’s happy with where we are at this moment, but this company still does understand what is going on in Medicare,” McCallister told analysts on a conference call yesterday. “I’d rather be us than anybody else in this space.”
Indianapolis-based WellPoint Inc. (WLP), the second-biggest insurer, reduced its profit forecast on July 25 after citing medical costs.
Humana was hit by what McCallister called “a perfect storm” of unanticipated spending. The company’s enrollment is growing as the U.S. population ages and the new members are using more medical care. The increase in doctor visits may have come because people put off care before joining Medicare due to the weak economy, said James Murray, Humana’s executive vice president, on the call.
Among existing members, wellness visits and preventive care were also up, likely because the 2010 U.S. health-care law required insurers to promote those services, Murray said.
Humana has responded by adjusting its prices and benefits for 2013. The company is confident it can return to its normal profit margin of 5 percent by next year, McCallister said.
‘Sound’ Strategy
“Our company’s strategy is sound,” he said. “We believe the steps we are taking to address certain short-term operational challenges will put us back on the path for sustainable earnings growth.”
McCallister is scheduled to retire next year, to be replaced by President Bruce Broussard, the insurer said last year.
Aetna’s second-quarter net income fell 15 percent to $457.6 million, or $1.32 a share, the Hartford, Connecticut-based insurer said in a statement. That beat analyst estimates and Aetna also raised the upper end of its full-year profit forecast, citing growing Medicare rolls along with improved profit margins in some plans. Aetna rose less than 1 percent to $37.41.
To contact the reporter on this story: Alex Nussbaum in New York at anussbaum1@bloomberg.net

Thursday, July 26, 2012

CMS NEWS

FOR IMMEDIATE RELEASE
Thursday, July 26, 2012





Obama administration announces ground-breaking public-private partnership to prevent health care fraud

Washington - Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder today announced the launch of a ground-breaking partnership among the federal government, State officials, several leading private health insurance organizations, and other health care anti-fraud groups to prevent health care fraud. This voluntary, collaborative arrangement uniting public and private organizations is the next step in the Obama administration’s efforts to combat health care fraud and safeguard health care dollars to better protect taxpayers and consumers.

The new partnership is designed to share information and best practices in order to improve detection and prevent payment of fraudulent health care billings. Its goal is to reveal and halt scams that cut across a number of public and private payers. The partnership will enable those on the front lines of industry anti-fraud efforts to share their insights more easily with investigators, prosecutors, policymakers and other stakeholders. It will help law enforcement officials to more effectively identify and prevent suspicious activities, better protect patients’ confidential information and use the full range of tools and authorities provided by the Affordable Care Act and other essential statutes to combat and prosecute illegal actions.

“This partnership puts criminals on notice that we will find them and stop them before they steal health care dollars,” Secretary Sebelius said. “Thanks to this initiative today and the anti-fraud tools that were made available by the health care law, we are working to stamp out these crimes and abuse in our health care system.”

One innovative objective of the partnership is to share information on specific schemes, utilized billing codes and geographical fraud hotspots so that action can be taken to prevent losses to both government and private health plans before they occur. Another potential goal of the partnership is the ability to spot and stop payments billed to different insurers for care delivered to the same patient on the same day in two different cities. A potential long-range goal of the partnership is to use sophisticated technology and analytics on industry-wide healthcare data to predict and detect health care fraud schemes.

“This partnership is a critical step forward in strengthening our nation’s fight against health care fraud,” said Attorney General Holder. “This Administration has established a record of success in combating devastating fraud crimes, but there is more we can and must do to protect patients, consumers, essential health care programs, and precious taxpayer dollars. Bringing additional health care industry leaders and experts into this work will allow us to act more quickly and effectively in identifying and stopping fraud schemes, seeking justice for victims, and safeguarding our health care system.” 
The Executive Board, the Data Analysis and Review Committee, and the Information Sharing Committee will hold their first meeting in September.  Until then, several public-private working groups will continue to meet to finalize the operational structure of the partnership and develop its draft initial work plan.

The following organizations and government agencies are among the first to join this partnership:

  •      America’s Health Insurance Plans
  •       Amerigroup Corporation
  •        Blue Cross and Blue Shield Association
  •        Blue Cross and Blue Shield of Louisiana
  •        Centers for Medicare & Medicaid Services
  •        Coalition Against Insurance Fraud
  •        Federal Bureau of Investigations
  •        Health and Human Services Office of Inspector General
  •        Independence Blue Cross
  •        National Association of Insurance Commissioners
  •        National Association of Medicaid Fraud Control Units
  •        National Health Care Anti-Fraud Association
  •        National Insurance Crime Bureau
  •        New York Office of Medicaid Inspector General
  •        Travelers
  •        Tufts Health Plan
  •        UnitedHealth Group
  •  
The partnership builds on existing tools provided by the Affordable Care Act, resulting in:        
  •  Tougher sentences for people convicted of health care fraud. Criminals will receive 20 to 50 percent longer sentences for crimes that involve more than $1 million in losses;
  • Enhanced screenings of Medicare and Medicaid providers and suppliers to keep fraudsters out of the program.
  • Suspended payments to providers and suppliers engaged in suspected fraudulent activity.
The administration’s efforts to date have already resulted in a record-breaking $10.7 billion in recoveries of health care fraud over the last three years. For more information on this partnership and the Obama administration’s work to combat health care fraud, please visit:

Today's Datapoint

40% … of employers surveyed recently by Mercer indicated that, with the June 28 Supreme Court decision, they will now take action to address provisions of the health reform law, while 16% said they will wait until after the November elections to do so.

Monday, July 23, 2012

Quote of the Day

Other than the changes regarding Medicaid expansion, the impact of the Supreme Court decision for Medicare Advantage and Part D health plans is “as if it never had occurred.…The jelly in the doughnut hole is as sweet as ever.”
— John Gorman, chairman of the consulting firm Gorman Health Group, LLC, told AIS’s Medicare Advantage News.

Medicare announces updated, enhanced tools

Two websites that help Americans make informed choices about hospitals and nursing homes have been redesigned and will make more information available to the public, the Centers for Medicare & Medicaid Services (CMS) announced today.

The two sites – Hospital Compare and Nursing Home Compare – have been enhanced to make navigation easier by users, and have added important new comparison tools like findings from nursing home inspections. 

“These enhanced tools give patients, their families, and caregivers the ability to make an informed decision on where to seek care by looking at how well hospitals and nursing homes are performing on important quality measures, and” said Acting CMS Administrator Marilyn Tavenner. “Anyone looking to compare hospitals or nursing homes – not just those on Medicare – can take advantage of these websites.”

Both sites contain important data on how well these facilities perform on quality measures – such as the frequency of infections that develop in the hospital, how often patients have to be readmitted to the hospital, and the percentage of nursing residents who report having moderate to severe pain while staying in the nursing homes. Researchers will now be able to access the data on both of these sites through mobile ready applications.


On both websites, navigation has been improved for consumers, who will find large and easy to use maps for pinpointing hospitals, and new search functionalities that allow the user to input the name of a hospital. Glossaries and web resources have been enhanced to make the information easier to understand.
  
“These new updates to the Hospital and the Nursing Home Compare websites are the next stage of transparently sharing data to drive improvement in our health system,” said Patrick Conway, chief medical officer for CMS.

In addition, new information is available on each of the websites. Updates to Nursing Home Compare include:

 ·         Narratives that detail specific findings from inspections of nursing home facilities;

·         Two new measures that report a nursing home’s use of antipsychotic medications;
·         Updated data for quality measures previously available on the site; and
Additions to Hospital Compare include:
·         Two new measures that cover potential health risks of imaging services, such as exposure to unnecessary radiation; and
·         Updated data for existing quality measures.
 These two consumer tools are highly popular with patients, their families, and caregivers. In the first half of 2012 there were over 1.2 million visits to the Hospital Compare site, and over 500,000 visits to Nursing Home Compare. The sites can be found online at www.hospitalcompare.hhs.gov/ and www.medicare.gov/nhcompare/ The Eldercare Locator can be found at www.eldercare.gov. This public service of the Administration on Community Living is a nationwide service that connects older adults and their caregivers with information on senior services.

Wednesday, July 18, 2012

Quote of the Day

“Now [with the Supreme Court decision], conservative governors who said they wanted no part of a Medicaid expansion shoved down their throats from Washington have the ability to opt out without a penalty. That puts those conservative governors and their legislatures on one big hot seat. Whether or not their state gets a Medicaid expansion is now entirely up to them. It’s put up or shut up time for conservative governors and state legislators who said the ACA was an onerous expansion of federal powers over their states.”

— Robert Laszewski, president of Health Policy and Strategy Associates, LLC, told AIS’s Health Reform Week.

Friday, July 13, 2012

Today's Datapoint

$13 billion …more than was needed was spent by the U.S. on veterans enrolled in Medicare Advantage plans from 2004 to 2009, according to a new study, led by Amal Trivedi, M.D., that was published in the June 26 issue of JAMA.

Thursday, July 12, 2012

Double Trouble: Study Shows Duplicate Payments for VA/MA Enrollees

By James Gutman - July 6, 2012
Does it seem sometimes that just when one Medicare Advantage issue gets resolved, another one is sure to flare up? Well it happened again June 26, two days before the Supreme Court upheld the health reform law. Researchers in a well-publicized article published in the Journal of the American Medical Association found the federal government paid $13 billion more than necessary between 2004 and 2009 on medical care for veterans who were enrolled in MA plans. And the authors pushed for moves that would prevent such duplicate payments, which they say are growing substantially with each passing year, including authorizing the Veterans Health Administration (VA) to collect reimbursements from MA plans for covered services by repealing a provision in a more-than-75-year-old law that bars such recoupments.
Of course, the situation is more complicated than that. When veterans access care at VA facilities rather than through civilian providers, Medicare does not pay for this care. And that lowers a county's fee-for-service costs on which MA payments are based. Those lower costs then translate into lower bids by MA plans than would be the case otherwise. Nevertheless, it is clear there are substantial duplicate payments, especially on outpatient services, and the researchers, who included former VA overseer Kenneth Kizer, M.D., noted that some MA contracts had upwards of 12% of their enrollees using VA faciilities in 2009. For one contract, that of Florida's Optimum Healthcare, the figure was a whopping 15.6%.
CMS is defending the current system, but it also is pledging to review claims and payment data from the VA that it couldn't access until the health reform law was enacted. And the pressure to find cost savings will only increase given the federal government's budget-deficit situation. What do you think will come of this? And what will be the effect on MA plans located near MA facilities? Somehow, the words of the three witches early in Shakespeare's Macbeth may give an answer: "Double, double, toil and trouble; Fire burn and caldron bubble."

Today's Datapoint

108 … months in the slammer was just one part of a sentence recently handed down by the U.S. District Court for the Southern District of Texas for a former co-owner and CFO of a Houston-area home health company who participated in a $5.2 million Medicare fraud scheme.

Quote of the Day

“Because we’re many, many years into the [HIPAA] statute now, and … given [the Office for Civil Rights’] commitment to technical assistance…the tolerability of noncompliance is much, much lower now. And that’s the main message that I want to deliver about where our enforcement program is going. Against this backdrop, it’s no longer really acceptable to be noncompliant.”

— HHS Office for Civil Rights director Leon Rodriguez told the audience at a recent Washington conference, “Safeguarding Health Information: Building Assurance through HIPAA Security,” cosponsored by OCR and NIST.

Wednesday, July 11, 2012

Health care reform and taxes: a refresher course

The Business Journals by Kent Hoover, Washington Bureau Chief
Thursday, July 5, 2012, 5:45pm EDT

Health care reform includes a variety of tax penalties, tax increases and tax credits for individuals and businesses.

Take it from the U.S. Supreme Court: Health care reform wasn’t just an overhaul of the insurance market, it also was a major piece of tax legislation.
That’s why now is a good time to review all of the tax provisions in the Patient Protection and Affordable Care Act. It’s possible Congress could repeal them -- it already has repealed two provisions aimed at making sure businesses pay all the taxes they owe (expanded 1099 reporting requirements and 3 percent withholding of payments to government contractors.)
But full repeal remains a long shot. So here’s a refresher course on the tax penalties, the tax increases and the tax breaks that Congress included in health care reform:
Tax penalties
Individuals who don’t have insurance: Unless they’re exempted due to financial hardship or other reasons, individuals without insurance will pay a penalty of at least $95 in 2014, $325 in 2015 and $695 in 2016. After 2016, the penalty will be adjusted for inflation.
Employers who don’t provide insurance: Employers with 50 or more full-time workers that don’t offer coverage will be charged $2,000 per full-time employee if any of these workers receive a tax credit for their premiums from the government. The employer’s first 30 employees will be excluded from this assessment.
Even employers who do offer coverage could be subject to penalties, if any of their workers receives a premium tax credit. In this case, employers will be charged either $3,000 for each employee receiving the tax credit or $2,000 for each full-time employee, whichever is less. Again, the first 30 full-time employees will be excluded from this assessment.
Employers with fewer than 50 full-time employees aren’t subject to these penalties.
Tax increases
Taxes on specific industries:
- 10 percent tax on indoor UV tanning services went into effect in 2010.
- Manufacturers and importers of brand-name drugs began paying an annual fee in 2012, starting at $2.8 billion.
- 2.3 percent excise tax on medical devices goes into effect in 2013.
- Health insurance companies will start paying an annual fee in 2014, starting at $8 billion.
- Insurers that offer high-premium plans (i.e. “Cadillac” plans) will be subject to a 40 percent nonrefundable excise tax.
Taxes on individuals:
- Beginning in 2013, taxpayers will pay an additional 0.9 percent Medicare tax on earned income in excess of $200,000 ($250,000 for families).
- Taxpayers with an adjusted gross income (AGI) over $200,000 ($250,000 for joint filers) also will pay a 3.8 percent Medicare tax on unearned income, such as interest, dividends, rents, royalties and certain capital gains. Retirement plan distributions aren’t subject to this tax.
- The threshold for deducting unreimbursed medical expenses will be increased from 7.5 percent of AGI to 10 percent of AGI in 2013.
Tax credits
Small businesses: Businesses are eligible for a tax credit worth up to 35 percent of their share of their employees’ health premiums if they meet the following conditions:
- They employ fewer than 25 full-time equivalent workers;
- Their annual average wage is less than $50,000; and
- They cover at least 50 percent of the cost of health insurance for an employee with single coverage.
This tax credit will increase to 50 percent in 2014, and then go away after two years.
Individuals: In 2014, people with income between 133 percent and 400 percent of the federal poverty level will become eligible for tax credits or cost-sharing subsidies to help cover the cost of insurance. The amount of these credits will vary, depending on income.

Monday, July 9, 2012

HHS announces 89 new Accountable Care Organizations

2.4 million people with Medicare to receive better, more coordinated care

Health and Human Services (HHS) Secretary Kathleen Sebelius announced today, that as of July 1, 89 new Accountable Care Organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, D.C. ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare.

These 89 new ACOs have entered into agreements with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care.

“Better coordinated care is good for patients and it saves money,” said Secretary Sebelius. “We applaud every one of these doctors, hospitals, health centers and others for working together to ensure millions of people with Medicare get better, more patient-centered, coordinated care.”

Participation in an ACO is purely voluntary for providers. The Medicare Shared Savings Program (MSSP), and other initiatives related to ACOs, is made possible by the 2010 Affordable Care Act. Federal savings from this initiative could be up to $940 million over four years.

“This new group of ACOs adds to a solid foundation,” said Centers for Medicare & Medicaid (CMS) Acting Administrator Marilyn Tavenner. “The Medicare ACO program opened for business in January and, already, more than 2.4 million beneficiaries are receiving care from providers participating in these important initiatives.”

The 89 ACOs announced today bring the total number of organizations participating in Medicare shared savings initiatives to 154, including the 32 ACOs participating in the testing of the Pioneer ACO Model by CMS’s Center for Medicare and Medicaid Innovation (Innovation Center) announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. In all, as of July 1, more than 2.4 million beneficiaries are receiving care from providers participating in Medicare shared savings initiatives.


The selected ACOs operate in a wide range of areas of the country and almost half are physician-driven organizations serving fewer than 10,000 beneficiaries, demonstrating that smaller organizations are interested in operating as ACOs.   Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving.  

To ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely, an ACO must meet quality standards. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.

Beginning this year, new ACO applications will be accepted annually. The application period for organizations that wish to participate in the MSSP beginning in January 2013 is from Aug. 1 through Sept. 6, 2012. More information, including application requirements, is available at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Application.html




FACT SHEET

FOR IMMEDIATE RELEASE                                     Contact: CMS Media Relations
July 9, 2012                                                                                  (202) 690-6145


CMS names 89 new Medicare Shared Savings Accountable Care Organizations

On July 9, 2012, the Centers for Medicare & Medicaid Services (CMS) announced the selection of 89 additional Accountable Care Organizations (ACOs) to participate in the Medicare Shared Saving Program. The selected organizations will take responsibility for coordinating care for nearly 1.2 million beneficiaries in 40 States and Washington, D.C. In total, there now are 154 organizations participating in Medicare shared savings initiatives, serving over 2.4 million Medicare patients across the country.

All ACOs that succeed in reducing the rate of growth in the cost of care while providing high quality care may share in the savings to Medicare. To ensure high quality of care, ACOs will report performance on 33 measures relating to care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.

Five of the ACOs announced today applied for a version of the program that allows them to earn a higher share of any savings by also being held accountable for a share of any losses if the costs of care for the beneficiaries assigned to them increase.

Participation in an ACO is purely voluntary for providers. Because the Shared Savings Program is part of the original Medicare fee-for-service program, beneficiaries served by these ACOs will continue to have free choice about the care they receive and from whom they seek care, without regard to whether a particular provider or supplier is participating in an ACO.

Descriptions of the participating ACOs are appended to this Fact Sheet.

Background on the Shared Savings Program:

Section 3022 of the Affordable Care Act added a new section 1899 to the Social Security Act that requires the Secretary to establish the Shared Savings Program. The program is intended to encourage physicians and other providers of Medicare-covered services and supplies (e.g., hospitals and others involved in patient care), to create a new type of health care entity, an ACO, that agrees to be held accountable for improving the health and experience of care for individuals and improving the health of populations, while reducing the rate of growth in health care spending. Studies have shown that better care often costs less, because coordinated care helps to ensure that the patient receives the right care at the right time, partly because patients avoid unnecessary duplication of services and dangerous medical errors.

On Nov. 2, 2011, CMS published a final rule in the Federal Register establishing the Shared Savings Program. The final rule addressed issues relating to eligibility, governance, beneficiary rights, quality measures and performance scoring, and CMS monitoring of ACO operations. At the same time, the Innovation Center announced an Advance Payment ACO Model to test whether providing advance payments from anticipated savings could encourage certain rural and physician-based entities to apply to participate in the program, thereby increasing the speed at which ACOs can improve care for beneficiaries and generate Medicare savings.

In conjunction with the final rule, the Office of Inspector General of the Department of Health and Human Services, the Department of Justice, the Federal Trade Commission, and the Internal Revenue Service issued separate documents addressing a variety of legal issues as they apply to the Shared Savings Program. These included the interaction of the Shared Savings Program with the federal anti-kickback, physician self-referral, civil monetary penalty (the fraud and abuse laws) and antitrust laws, as well as the Internal Revenue Code regarding the tax implications for nonprofit entities seeking to participate in ACOs. The final rule, the notice of the Advance Payment ACO Model, and the final waivers in connection with the Shared Savings Program were published in the Nov. 2, 2011 Federal Register.

CMS also announced that, beginning this year, new ACO applications will be accepted annually. The application period for organizations that wish to participate in the Shared Savings Program beginning January 2013 is from August 1 through September 6, 2012. More information, including application requirements, is available at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Application.html

More information about all ACO initiatives at CMS can be found at:

More information about the Shared Savings Program can be found at:

Links to the statute, regulations, and guidance regarding the final rule, including the guidance issued by the federal agencies listed above can be found at:






SUMMARIES OF ACOS SELECTED FOR JULY 1, 2012 START DATE[1] 
Arizona Health Advantage, Inc, located in Chandler, Arizona, is comprised of networks of individual ACO practices, with 73 physicians. It will serve Medicare beneficiaries in Arizona.
John C. Lincoln Accountable Care Organization, LLC, located in Phoenix, Arizona, is comprised of partnerships between hospitals and ACO professionals, and hospitals employing ACO professionals. It will serve Medicare beneficiaries in Arizona.
Fort Smith Physicians Alliance ACO, LLC, located in Fort Smith, Arkansas is comprised of networks of individual ACO practices, with 78 physicians.   It will serve Medicare beneficiaries in Arkansas and Oklahoma.
ApolloMed Accountable Care Organization Inc., located in Glendale, California, is comprised of networks of individual ACO practices, with 130 physicians. It will serve Medicare beneficiaries in California.
Golden Life Healthcare LLC, located in Sacramento, California, is comprised of networks of individual ACO practices and partnerships between hospitals and ACO professionals, with 57 physicians. It will serve Medicare beneficiaries in California.  
John Muir Physician Network, located in Walnut Creek, California, is comprised of ACO group practices and networks of individual ACO practices, with 197 physicians. It will serve Medicare beneficiaries in California.
Meridian Holdings, Inc., located in Hawthorne, California, is comprised of ACO group practices and networks of individual ACO practices, with 60 physicians. It will serve Medicare beneficiaries in California, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, and Texas.
North Coast Medical ACO, Inc., located in Oceanside, California, is comprised of ACO group practices, hospitals employing ACO professionals, and a federally qualified health center, with 281 physicians. It will serve Medicare beneficiaries in California.
Torrance Memorial Integrated Physicians, LLC, located in Torrance, California, is comprised of partnerships between a hospital and ACO professionals, with 398 physicians. It will serve Medicare beneficiaries in California.
MPS ACO Physicians, LLC, located in Middletown, Connecticut, is comprised of networks of individual ACO practices, with 38 physicians. It will serve Medicare beneficiaries in Connecticut.  
PriMed, LLC, located in Shelton, Connecticut, is comprised of ACO group practices, with 116 physicians. It will serve Medicare beneficiaries in Connecticut.  
Accountable Care Coalition of Northwest Florida, LLC, located in Pensacola, Florida, is comprised of networks of individual ACO practices, with 60 physicians. It will serve Medicare beneficiaries in Alabama and Florida.
Accountable Care Partners, LLC, located in Jacksonville, Florida, is comprised of ACO group practices and networks of individual ACO practices, with 65 physicians. It will serve Medicare beneficiaries in Florida and Georgia.  
Allcare Options, LLC, located in Parrish, Florida, is comprised of ACO group practices and networks of individual ACO practices, with 198 physicians. It will serve Medicare beneficiaries in Florida.
Florida Medical Clinic ACO, LLC, located in Zephyrhills, Florida, is comprised of networks of individual ACO practices, with 153 physicians. It will serve Medicare beneficiaries in Florida.
FPG Healthcare, LLC, located in Orlando, Florida, is comprised of ACO group practices, with 142 physicians. It will serve Medicare beneficiaries in Florida.
HealthNet LLC, located in Boynton Beach, Florida, is comprised of networks of individual ACO practices, with 55 physicians. It will serve Medicare beneficiaries in Florida.
Integrated Care Alliance, LLC, located in Gainesville, Florida, is comprised of networks of individual ACO practices, with 115 physicians.   It will serve Medicare beneficiaries in Florida.
Medical Practitioners for Affordable Care, LLC, located in Melbourne, Florida, is comprised of networks of individual ACO practices, with 126 physicians. It will serve Medicare beneficiaries in Florida.
Palm Beach Accountable Care Organization, LLC, located in West Palm Beach, Florida, is comprised of networks of individual ACO practices, with 337 physicians. It will serve Medicare beneficiaries in Florida.  
Reliance Healthcare Management Solutions, LLC, located in Tampa, Florida, is comprised of networks of individual ACO practices, with 36 physicians. It will serve Medicare beneficiaries in Florida.    
WellStar Health Network, LLC, located in Marietta, Georgia, is comprised of partnerships between hospitals and ACO professionals, with 1,203 physicians. It will serve Medicare beneficiaries in Georgia.
Advocate Health Partners, located in Rolling Meadows, Illinois, is comprised of partnerships between hospitals and ACO professionals, with 2,237 physicians. It will serve Medicare beneficiaries in Illinois.
Chicago Health System ACO, LLC, located in Westmont, Illinois, is comprised of ACO group practices, networks of individual ACO practices, partnerships between hospitals and ACO professionals, hospitals employing ACO professionals, and federally qualified health centers, with 523 physicians. It will serve Medicare beneficiaries in Illinois.
Deaconess Care Integration, LLC, located in Evansville, Indiana, is comprised of ACO group practices, networks of individual ACO practices, partnerships between hospitals and ACO professionals and a hospital employing ACO professionals, and a rural health clinic, with 323 physicians. It will serve Medicare beneficiaries in Illinois, Indiana, and Kentucky.
Franciscan AHN ACO, LLC, located in Mishawaka, Indiana, is comprised of partnerships between hospitals and ACO professionals, with 245 physicians. It will serve Medicare beneficiaries in Indiana.
Indiana University Health ACO, Inc., located in Indianapolis, Indiana, is comprised of ACO group practices, networks of individual ACO practices, partnerships between hospitals and ACO professionals and hospitals employing ACO professionals, and a federally qualified health center, with 1,837 physicians. It will serve Medicare beneficiaries in Indiana.
Genesis Accountable Care Organization, LLC, located in Davenport, Iowa, is comprised of hospitals employing ACO professionals, with 312 physicians. It will serve Medicare beneficiaries in Illinois and Iowa.
Iowa Health Accountable Care, L.C., located in Des Moines, Iowa, is comprised of ACO group practices, networks of individual ACO practices, a combination of hospitals employing ACO professionals, a federally qualified health center and a rural health clinic, with 1,551 physicians. It will serve Medicare beneficiaries in Illinois, Iowa, and Missouri.
One Care LLC, located in Des Moines, Iowa, is comprised of partnerships between hospitals and ACO professionals, with 402 physicians. It will serve Medicare beneficiaries in Iowa.
University of Iowa Affiliated Health Providers, LC, located in Iowa City, Iowa, is comprised of partnerships between hospitals and ACO professionals, with 1,791 physicians. It will serve Medicare beneficiaries in Iowa.
Owensboro ACO, located in Owensboro, Kentucky, is comprised of networks of individual ACO practices, with 26 physicians. It will serve Medicare beneficiaries in Indiana and Kentucky.
Quality Independent Physicians, located in Louisville, Kentucky, is comprised of ACO group practices, with 74 physicians. It will serve Medicare beneficiaries in Indiana and Kentucky.  
Southern Kentucky Health Care Alliance, located in Smiths Grove, Kentucky, is comprised of networks of individual ACO practices, with 35 physicians. It will serve Medicare beneficiaries in Kentucky.
TP-ACO LLC located in Baton Rouge, Louisiana, is comprised of networks of individual ACO practices, with 50 physicians. It will serve Medicare beneficiaries in Florida, Louisiana and Tennessee.
Central Maine ACO, located in Lewiston, Maine, is comprised of ACO group practices, networks of individual ACO practices and partnerships between hospitals and ACO professionals, including a combination of hospitals employing ACO professionals. It includes 566 physicians.   It will serve Medicare beneficiaries in Maine.
Maine Community Accountable Care Organization, LLC, located in Augusta, Maine, is a federally qualified health center with 125 physicians. It will serve Medicare beneficiaries in Maine.
MaineHealth Accountable Care Organization, located in Portland, Maine, is comprised of networks of individual ACO practices, partnerships between hospitals and ACO professionals and hospitals employing ACO professionals, with 1,595 physicians. It will serve Medicare beneficiaries in Maine.
Accountable Care Coalition of Maryland, LLC, located in Hollywood, Maryland, is comprised of ACO group practices, with 109 physicians. It will serve Medicare beneficiaries in Maryland.
Greater Baltimore Health Alliance Physicians, LLC, located in Baltimore, Maryland, is comprised of partnerships between a hospital and ACO professionals and a hospital employing ACO professionals, with 399 physicians. It will serve Medicare beneficiaries in Maryland and Pennsylvania.
Maryland Accountable Care Organization of Eastern Shore LLC, located in National Harbor, Maryland, is comprised of ACO group practices, networks of individual ACO practices, with 15 physicians.   It will serve Medicare beneficiaries in Maryland.    
Maryland Accountable Care Organization of Western MD LLC, located in National Harbor, Maryland, is comprised of ACO group practices and networks of individual ACO practices, with 23 physicians.   It will serve Medicare beneficiaries in Maryland, Pennsylvania, and West Virginia.    
Circle Health Alliance, LLC, located in Lowell, Massachusetts, is comprised of partnerships between hospitals and ACO professionals, with 353 physicians. It will serve Medicare beneficiaries in Massachusetts and New Hampshire.
Harbor Medical Associates, PC, located in South Weymouth, Massachusetts, is comprised of ACO group practices, with 116 physicians. It will serve Medicare beneficiaries in Massachusetts.  
Accountable Healthcare Alliance, PC, located in East Lansing, Michigan, is comprised of networks of individual ACO practices, with 29 physicians.   It will serve Medicare beneficiaries in Michigan.
Oakwood Accountable Care Organization, LLC, located in Dearborn, Michigan, is comprised of partnerships between hospitals and ACO professionals, with 1,546 physicians.   It will serve Medicare beneficiaries in Michigan.
Southeast Michigan Accountable Care, Inc., located in Dearborn, Michigan, is comprised of ACO group practices and networks of individual ACO practices, with 333 physicians. It will serve Medicare beneficiaries in Michigan
Essential Health, located in Duluth, Minnesota, is comprised of a combination of ACO group practices, critical access hospitals, and a rural health clinic, with 1,404 physicians. It will serve Medicare beneficiaries in Minnesota, North Dakota, and Wisconsin.
Medical Mall Services of Mississippi, located in Jackson, Mississippi, is comprised of networks of individual ACO practices and a federally qualified health center, with 487 physicians. It will serve Medicare beneficiaries in Mississippi.  
BJC HealthCare ACO, LLC, located in St. Louis, Missouri, is comprised of a combination of hospitals employing ACO professionals, and rural health clinics, with 556 physicians. It will serve Medicare beneficiaries in Illinois and Missouri.
Heartland Regional Medical Center, located in St. Joseph, Missouri, is comprised of a hospital employing ACO professionals, with 199 physicians. It will serve Medicare beneficiaries in Kansas and Missouri.
Nevada Primary Care Network ACO, LLC, located in Las Vegas, Nevada, is comprised of ACO group practices and networks of individual ACO practices, with 89 physicians. It will serve Medicare beneficiaries in Nevada.
Concord Elliot ACO LLC, located in Manchester, New Hampshire, is comprised of partnerships between hospitals and ACO professionals, with 234 physicians. It will serve Medicare beneficiaries in New Hampshire.
Barnabas Health ACO-North, LLC, located in West Orange, New Jersey, is comprised of partnerships between hospitals and ACO professionals, hospitals employing ACO professionals, with 435 physicians. It will serve Medicare beneficiaries in New Jersey.
Accountable Care Coalition of Syracuse, LLC, located in Syracuse, New York, is comprised of ACO group practices, with 105 physicians.   It will serve Medicare beneficiaries in New York.
Asian American Accountable Care Organization, located in New York City, is comprised of networks of individual ACO practices, with 239 physicians. It will serve Medicare beneficiaries in New York.
Balance Accountable Care Network, located in New York City, is comprised of hospitals and networks of individual ACO practices, with 1,069 physicians. It will serve Medicare beneficiaries in New York.
Beacon Health Partners, LLP, located in Manhasset, New York, is comprised of networks of individual ACO practices, with 261 physicians. It will serve Medicare beneficiaries in New York.
Chautauqua Region Associated Medical Partners, LLC, located in Jamestown, New York, is comprised of partnerships between hospitals and ACO professionals, with 200 physicians. It will serve Medicare beneficiaries in New York and Pennsylvania.
Healthcare Provider ACO, Inc., located in Garden City, New York, is comprised of networks of individual ACO practices, with 395 physicians. It will serve Medicare beneficiaries in New York.
Mount Sinai Care, LLC, located in New York City, is comprised of networks of individual ACO practices and a hospital(s) employing ACO professionals, with 2,249 physicians. It will serve Medicare beneficiaries in New York.
ProHEALTH Accountable Care Medical Group, PLLC, located in Lake Success, New York, is comprised of ACO group practices, with 281 physicians. It will serve Medicare beneficiaries in Florida and New York.
WESTMED Medical Group, PC, located in Purchase, New York, is comprised of ACO group practices, with 250 physicians. It will serve Medicare beneficiaries in Connecticut and New York.
Cornerstone Health Care, PA, located in High Point, North Carolina, is comprised of ACO group practices, with 313 physicians. It will serve Medicare beneficiaries in North Carolina.
Triad Healthcare Network, LLC, located in Greensboro, North Carolina, is comprised of networks of individual ACO practices and a hospital employing ACO professionals, with 759 physicians. It will serve Medicare beneficiaries in North Carolina.
Mercy Health Select, LLC, located in Cincinnati, Ohio, is comprised of hospitals employing ACO professionals, with 365 physicians. It will serve Medicare beneficiaries in Indiana and Ohio.
ProMedica Physician Group, Inc., located in Toledo, Ohio, is comprised of ACO group practices and networks of individual ACO practices, with 250 physicians. It will serve Medicare beneficiaries in Michigan and Ohio.
Summa Accountable Care Organization, located in Akron, Ohio, is comprised of partnerships between hospitals and ACO professionals, with 612 physicians. It will serve Medicare beneficiaries in Ohio.
University Hospitals Coordinated Care, located in Shaker Heights, Ohio, is comprised of partnerships between hospitals and ACO professionals, with 1,770 physicians. It will serve Medicare beneficiaries in Ohio.
North Bend Medical Center, Inc., located in Coos Bay, Oregon, is comprised of ACO group practices, with 112 physicians. It will serve Medicare beneficiaries in Oregon.
Coastal Medical, Inc., located in Providence, Rhode Island, is comprised of ACO group practices, with 100 physicians. It will serve Medicare beneficiaries in Massachusetts and Rhode Island.  
Accountable Care Coalition of The Tri-Counties, LLC, located in Charleston, South Carolina, is comprised of networks of individual ACO practices, with 108 physicians. It will serve Medicare beneficiaries in South Carolina.
AnewCare LLC, located in Johnson City, Tennessee, is comprised of partnerships between hospitals and ACO professionals, with 673 physicians. It will serve Medicare beneficiaries in Tennessee and Virginia.
Cumberland Center for Healthcare Innovation, LLC, located in Nashville, Tennessee, is comprised of networks of individual ACO practices, with 33 physicians. It will serve Medicare beneficiaries in Tennessee.  
MissionPoint Health Partners, located in Nashville, Tennessee, is comprised of hospitals employing ACO professionals, with 544 physicians. It will serve Medicare beneficiaries in Tennessee.
St. Thomas Medical Group PLLC, located in Nashville, Tennessee, is comprised of ACO group practices, with 41 physicians. It will serve Medicare beneficiaries in Tennessee.  
Summit Health Solutions, located in Knoxville, Tennessee, is comprised of hospitals and ACO group practices, with 474 physicians.   It will serve Medicare beneficiaries in Tennesse.
BHS Accountable Care, LLC, located in San Antonio, Texas, is comprised of ACO group practices, networks of individual ACO practices, partnerships between a hospital and ACO professionals and a hospital employing ACO professionals, with 348 physicians.   It will serve Medicare beneficiaries in Texas.
Memorial Hermann Accountable Care Organization, located in Houston, Texas, is comprised of networks of individual ACO practices and partnerships between hospitals and ACO professionals, with 332 physicians. It will serve Medicare beneficiaries in Texas.
Methodist Patient Centered ACO, located in Dallas, Texas, is comprised of ACO group practices, networks of individual ACO practices and partnerships between hospitals and ACO professionals, with 269 physicians. It will serve Medicare beneficiaries in Texas.
Essential Care Partners, LLC, located in Austin, Texas, is a federally qualified health center with 275 physicians. It will serve Medicare beneficiaries in Texas.
Physicians ACO, LLC, located in Houston, Texas, is comprised of networks of individual ACO practices, with 75 physicians. It will serve Medicare beneficiaries in Texas.  
Texoma ACO, LLC, located in Wichita Falls, Texas is comprised of ACO group practices and networks of individual ACO practices, with 52 physicians.   It will serve Medicare beneficiaries in Texas.  
Central Utah Clinic, P.C., located in Provo, Utah, is comprised of ACO group practices, with 173 physicians. It will serve Medicare beneficiaries in Utah.
Accountable Care Coalition of Green Mountains, LLC, located in South Burlington, Vermont, is comprised of ACO group practices and networks of individual ACO practices, with 42 physicians. It will serve Medicare beneficiaries in Vermont.
Polyclinic Management Services Company, located in Seattle, Washington, is comprised of ACO group practices, with 296 physicians. It will serve Medicare beneficiaries in Washington.
Aurora Accountable Care Organization LLC, located in Milwaukee, Wisconsin, is comprised of ACO group practices, with 275 physicians. It will serve Medicare beneficiaries in Wisconsin.
Dean Clinic and St. Mary's Hospital Accountable Care Organization, LLC, located in Madison, Wisconsin, is comprised of ACO group practices and a partnership between a hospital and ACO professionals, with 701 physicians. It will serve Medicare beneficiaries in Wisconsin.
ProHealth Solutions, LLC, located in Waukesha, Wisconsin, is comprised of partnerships between hospitals and ACO professionals, with 697 physicians. It will serve Medicare beneficiaries in Wisconsin. 


[1] Source: Self-reported information from the Medicare Shared Savings Program Application for July 1, 2012 cycle