Blue Ridge ACO Public Reporting
Shared Savings Program Public Reporting
ACO Name and Location
AdvantagePoint Health Alliance – Blue Ridge, LLC
330 Seven Springs Way, Brentwood, TN 37027
ACO Primary Contact
Erin Shustack
434.425.1357
erin.shustack1@lifepointhealth.net
Organizational Information
ACO Participants:
| ACO Participants | ACO Participant in Joint Venture |
| CLINCH VALLEY MEDICAL CENTER, INC. | N |
| CLINCH VALLEY PHYSICIANS ASSOCIATES LLC | N |
| COMPLEXIONS DERMATOLOGY, PC | N |
| DANVILLE GASTROENTEROLOGY CENTER PC | N |
| DANVILLE PHYSICIAN PRACTICES LLC | N |
| DANVILLE REGIONAL MEDICAL CENTER LLC | N |
| DLP TWIN COUNTY PHYSICIAN PRACTICES LLC | N |
| DLP TWIN COUNTY REGIONAL HEALTHCARE LLC | N |
| FAMILY HEALTHCARE OF WYTHEVILLE, PC | N |
| FAUQUIER FAMILY PRACTICE PLC | N |
| FAUQUIER MEDICAL CENTER LLC | N |
| FAUQUIER PHYSICIAN PRACTICES LLC | N |
| MARTINSVILLE NEUROLOGICAL ASSOC INC | N |
| MARTINSVILLE PHYSICIAN PRACTICES LLC | N |
| PEACHTREE INPATIENT CONSULTING LLC | N |
| PIEDMONT ACCESS TO HEALTH SERVICES INC | N |
| PIEDMONT HEALTH & WELLNESS, P.C. | N |
| RALEIGH GENERAL HOSPITAL LLC | N |
| TWO RIVERS PHYSICIAN PRACTICES, LLC | N |
| WYTHE COUNTY COMMUNITY HOSPITAL, LLC | N |
| WYTHE COUNTY PHYSICIAN PRACTICES LLC | N |
ACO Governing Body:
| Member First Name | Member Last Name | Member Title / Position | Member’s Voting Power (As a percentage) | Membership Type | ACO Participant Legal Business Name, if applicable |
| Mike | Caplan | Member/Chair | 10% | ACO Participant Representative | Danville Physician Practices LLC |
| Nona | Crouse | Member | 10% | ACO Participant Representative | Clinch Valley Physician Associates LLC |
| Stephanie | Crumpton | Member | 10% | ACO Participant Representative | Danville Physician Practices LLC |
| Steve | Heatherly | Member | 10% | ACO Participant Representative | Danville Physician Practices LLC |
| Tony | Fiore | Member | 10% | ACO Participant Representative | Fauquier Physician Practices LLC |
| Michael | Moore | Member | 10% | Medicare Beneficiary Representative | N/A |
| James | Milam | Member | 10% | ACO Participant Representative | Piedmont Access To Health Services Inc |
| Stephen | Foust | Member | 10% | Community Stakeholder Representative | N/A |
| Teresa | Dix | Member | 10% | ACO Participant Representative | Wythe County Community Hospital LLC |
| Naga | Sudireddy | Member | 10% | ACO Participant Representative | Danville Physician Practices LLC |
Due to rounding, ‘Member’s Voting Power’ may not equal 100 percent.
Key ACO Clinical and Administrative Leadership:
ACO Executive: Erin Shustack
Medical Director: Mike Caplan, MD
Compliance Officer: Ashlie Heald
Quality Assurance/Improvement Officer: Carol Ann Hudson
Associated Committees and Committee Leadership:
| Committee Name | Committee Leader Name and Position |
| Quality Performance & Improvement | Monica Crews, MSN, RN, CMCN |
| Contracting & Finance | Steve Heatherly, CEO |
Types of ACO Participants, or Combinations of Participants, That Formed the ACO:
- Federally Qualified Health Center (FQHC)
- ACO Professionals in a group practice arrangement
- Hospital Employing ACO Professionals
- Network of individual practices of ACO professionals
- Rural Health Center (RHC)
Shared Savings and Losses
Amount of Shared Savings/Losses:
- Second Agreement Period
- Performance Year 2024, $1,158,041
- First Agreement Period
- Performance Year 2023, $1,720,360
- Performance Year 2022, $1,329,182
- Performance Year 2021, $0
- Performance Year 2020, $1,928,248
- Performance Year 2019A, $0
Shared Savings Distribution:
- Second Performance Period
- Performance Year 2024
- Proportion invested in infrastructure: 25%
- Proportion invested in redesigned care processes/resources: 25%
- Proportion of distribution to ACO participants: 50%
- Performance Year 2024
- First Performance Period
- Performance Year 2023
- Proportion invested in infrastructure: 25%
- Proportion invested in redesigned care processes/resources: 25%
- Proportion of distribution to ACO participants: 50%
- Performance Year 2022
- Proportion invested in infrastructure: 50%
- Proportion of distribution to ACO participants: 50%
- Performance Year 2021
- N/A
- Performance Year 2020
- Proportion invested in infrastructure: 25%
- Proportion invested in redesigned care processes/resources: 5%
- Proportion of distribution to ACO participants: 75%
- Performance Year 2019A
- N/A
- Performance Year 2023
Quality Performance Results
2024 Quality Performance Results:
Quality performance results are based on eCQMs/MIPS CQMs collection type.
| Measure # | Measure Title | Collection Type | Performance Rate | Current Year Mean Performance Rate (Shared Savings Program ACOs) |
| 321 | CAHPS for MIPS | CAHPS for MIPS Survey | 4.87 | 6.67 |
| 479* | Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups | Administrative Claims | 0.1556 | 0.1517 |
| 484* | Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions (MCC) | Administrative Claims | - | 37 |
| 001* | Diabetes: Hemoglobin A1c (HbA1c) Poor Control | eCQM | 42.15 | 28.16 |
| 134 | Preventative Care and Screening: Screening for Depression and Follow-up Plan | eCQM | 46.69 | 54.68 |
| 236 | Controlling High Blood Pressure | eCQM | 64.25 | 71.39 |
| CAHPS-1 | Getting Timely Care, Appointments, and Information | CAHPS for MIPS Survey | 85.75 | 83.7 |
| CAHPS-2 | How Well Providers Communicate | CAHPS for MIPS Survey | 92.1 | 93.96 |
| CAHPS-3 | Patient’s Rating of Provider | CAHPS for MIPS Survey | 89.81 | 92.43 |
| CAHPS-4 | Access to Specialists | CAHPS for MIPS Survey | 76.28 | 75.76 |
| CAHPS-5 | Health Promotion and Education | CAHPS for MIPS Survey | 59.56 | 65.48 |
| CAHPS-6 | Shared Decision Making | CAHPS for MIPS Survey | 62.58 | 62.31 |
| CAHPS-7 | Health Status and Functional Status | CAHPS for MIPS Survey | 74.71 | 74.14 |
| CAHPS-8 | Care Coordination | CAHPS for MIPS Survey | 84.02 | 85.89 |
| CAHPS-9 | Courteous and Helpful Office Staff | CAHPS for MIPS Survey | 91.87 | 92.89 |
| CAHPS-11 | Stewardship of Patient Resources | CAHPS for MIPS Survey | 26.56 | 26.98 |
For previous years’ Financial and Quality Performance Results, please visit: Data.cms.gov
*For Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) [Quality ID #001], Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups [Measure #479], and Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions (MCC) [Measure #484], a lower performance rate indicates better measure performance.
*For Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions (MCC) [Measure #484], patients are excluded if they were attributed to Qualifying Alternative Payment Model (APM) Participants (QPs). Most providers participating in Track E and ENHANCED track ACOs are QPs, and so performance rates for Track E and ENHANCED track ACOs may not be representative of the care provided by these ACOs' providers overall. Additionally, many of these ACOs do not have a performance rate calculated due to not meeting the minimum of 18 beneficiaries attributed to non-QP providers.
- Skilled Nursing Facility (SNF) 3-Day Rule Waiver:
- Our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR § 425.612.