ACO Public Reporting

ACO Name and Location:

Commonwealth Primary Care ACO
5005 S. Ash Ave Ste A-1
Tempe, Arizona 85282

ACO Primary Contact:

Primary Contact Name                  Lance Donkerbrook, CEO
Primary Contact Phone Number    480-296-1276
Primary Contact Email Address      ldonkerbrook@commonwealthaco.com

Organizational Information:

ACO Participants:

ACO Participants	ACO Participant in Joint Venture (Enter Y or N)
ANA M SIERRA DE ARAGON MD	N
Alex J. Onofrei MD, PC	N
BOWSER' GARDEN LLC	N
Cholla Medical Group, Inc.	N
DILIP C DHADVHAI MD PC	N
Dr. Kevin Chan, PC	N
East Flagstaff Family Medicine, LTD	N
Generations Family Practice, PLLC	N
HealthFirst Primary Care	N
James Nichols Md, Ltd.	N
Jigna Patel MD PLLC	N
Leon A Driss PC	N
MD24 AZ DOCTORS INC	N
Mark D. Goldberg, MD PC	N
PAGE FAMILY PRACTICE PLLC	N
PREMIER MEDICAL GROUP LLC	N
Petar N Novakovic MD PC	N
Primary Care Associates, PLLC	N
Quality of Life Medical Center, LLC	N
Ravi Gupta MD, PLLC	N
Robert J Bloomberg MD PC	N
RAJIV PARIKH MD PC	N
Ryan Internal Medicine, P.C.	N
SELLERSSPORTSMED LLC	N
The Wellness Medical Clinic Pc	N
Thomas C. Fiel DO PC	N
Timothy C. Bryan, Md, Plc	N
West Park Medical Corp	N

ACO Governing Body:

Member
Last Name	First Name	Title/Position	Member's Voting Power	Membership Type	ACO Participant TIN Legal Business Name/DBA, if Applicable
Donkerbrook	Lance	CEO	1 Vote	Voting Member
Voth	RJ	Medicare Beneficiary Representative, Board Chair	1 Vote	Voting Member
Aragon	Ana	ACO Participant Representative	1 Vote	Voting Member	ANA M SIERRA DE ARAGON MD
Bloomberg	Robert	ACO Participant Representative	1 Vote	Voting Member	Robert J Bloomberg MD PC
Gupta	Ravi	ACO Participant Representative	1 Vote	Voting Member	Ravi Gupta MD, PLLC
McGettigan	John	ACO Participant Representative	1 Vote	Voting Member	Quality of Life Medical Center, LLC
Nichols	James	ACO Participant Representative	1 Vote	Voting Member	James Nichols, Md Ltc
Novakovic	Petar	ACO Participant Representative	1 Vote	Voting Member	Petar Novakovic MD PC
Parikh	Rajiv	ACO Participant Representative	1 Vote	Voting Member	RAJIV PARIKH MD PC

Key ACO clinical and administrative leadership:

• Lance Donkerbrook                ACO Executive
• James Nichols, MD                 Medical Director
• Robert Bloomberg, MD           Compliance Officer
• Jason Jones, DO                      Quality Assurance/Improvement Officer

Associated committees and committee leadership:

Committee Name	Committee Leader Name and Position
Physician Engagement and Operations Subcommittee	James Nichols, MD - Chair
Clinical and Quality Improvement Committee	Jason Jones, DO - Chair
Compliance and Ethics Committee	Robert Bloomberg, MD - Chair

Types of ACO participants or combinations of participants that formed the ACO:

• • Network of individual practices of ACO professionals

Shared Savings and Losses:

Amount of Shared Savings/Losses

• Third Agreement Period
  • Performance Year 2020: $0
  • Performance Year 2019: $1,042,086
• Second Agreement Period
  • Performance Year 2019: $1,042,086
  • Performance Year 2018: $2,442,372
  • Performance Year 2017: $0
  • Performance Year 2016: $0
• First Agreement Period
  • Performance Year 2015: $7,404,173
  • Performance Year 2014: $0
  • Performance Year 2013: $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

• Third Agreement Period
  • Performance Year 2019
    • Proportion invested in infrastructure: 50%
    • Proportion invested in redesigned care processes/resources: 20%
    • Proportion of distribution to ACO participants: 30%
• Second Agreement Period
  • Performance Year 2019
    • Proportion invested in infrastructure: 50%
    • Proportion invested in redesigned care processes/resources: 20%
    • Proportion of distribution to ACO participants: 30%
  • Performance Year 2018
    • Proportion invested in infrastructure: 60%
    • Proportion invested in redesigned care processes/resources: 20%
    • Proportion of distribution to ACO participants: 20%
  • 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

• First Agreement Period
  • Performance Year 2015
    • Proportion invested in infrastructure: 33%
    • Proportion invested in redesigned care processes/resources: 7%
    • Proportion of distribution to ACO participants: 40%
    • Proportion of distribution to Contractual and Other Obligations: 20%
  • 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

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

Quality Performance Results

2020 Quality Performance Results:

Measure Number	Measure Name	2020 Reporting Period
		ACO Performance Rate	Mean Performance Rate (SSP-ACOs)
ACO-43	Ambulatory Sensitive Condition Acute Composite (AHRQ* Prevention Quality Indicator(PQI #91))	0.72	0.92
ACO-13	Falls: Screening for Future Fall Risk	85.36	83.21
ACO-14	Preventive Care and Screening: Influenza Immunization	83.58	75.10
ACO-17	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	95.83	79.90
ACO-18	Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan	83.53	69.15
ACO-19	Colorectal Cancer Screening	86.37	71.50
ACO-20	Breast Cancer Screening	82.26	72.92
ACO-42	Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	91.24	82.99
ACO-27	Diabetes: Hemoglobin A1c Poor Control (>9%)	9.68	13.72
ACO-28	Controlling High Blood Pressure	88.25	71.73

Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low sample size. The Centers for Medicare & Medicaid Services (CMS) also waived the requirement for ACOs to field a CAHPS for ACOs survey for PY 2020 through the Physician Fee Schedule Final Rule for Calendar Year 2021. Additionally, CMS reverted ACO-8 Risk-Standardized, All Condition Readmission and ACO-38 Risk-Standardized Acute Admission Rates for Patients with Multiple Chronic Conditions to pay-for-reporting, given the impact of the coronavirus disease 2019 (COVID-19) public health emergency (PHE) on these measures.

For Previous Years’ Financial and Quality Performance Results, please visit data.cms.gov.

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.

• Waiver for Payment for Telehealth Services:
  • Our ACO clinicians provide tele-health services using the flexibilities under 42 CFR § 425.612(f) and 42 CFR § 425.613.

Fraud and Abuse Waivers

• ACO Pre-Participation Waiver:

The following information describes each arrangement for which our ACO seeks protection under the ACO Pre-Participation Waiver, including any material amendment or modification to a disclosed arrangement.

[For each arrangement, provide the following information:

• Parties to the arrangement: N/A
• Date of arrangement: N/A
• Items, services, goods, or facility provided: N/A
• Date and nature of any amendments to the arrangement, if applicable: N/A

• 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: N/A
• Date of arrangement: N/A
• Items, services, goods, or facility provided: N/A
• Date and nature of any amendments to the arrangement, if applicable: N/A