BMC Integrated Care Services and the Medicare Shared Savings Program

BMC Integrated Care Services (BMCICS) promotes the highest quality of coordinated patient care, patient safety and cost effective care among its participating providers through our integrated and coordinated managed care contracts and related medical management programs.

Medicare Designates BMCICS as an Accountable Care Organization (ACO).

BMCICS provides information to physicians and their staff on our managed care contracts, their requirements and their implementation processes.

Our medical management program supports our providers in promoting high-quality, efficient care by:

• Minimizes variations in practice by monitoring, quality and effectiveness
• Monthly quality reports
• Provides prior authorizations for medically necessary or medically appropriate care
• Conducts provider and member surveys
• Credentials and re-credentials providers

Provider FAQ
Beneficiary FAQ

Contact Information

Phone: 617.478.3525
Fax: 617.897.0860
MSOGroupBox@BMCHP-wellsense.org

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Public Reporting

ACO Name and Location

BMC Integrated Care Services, Inc.
One Boston Medical Center Place
Boston, Massachusetts 02118

ACO Primary Contact

Primary Contact Name	Priscilla O'Heir
Primary Contact Phone Number	617-414-1673
Primary Contact Email Address	priscilla.oheir@bmc.org

ACO Participants

ACO Participants	ACO Participant in Joint Venture (Enter Y or N)
Trustees of Boston University	Y
Child Health Foundation of Boston, Inc.	Y
Mattapan Community Health Center, Inc.	Y
Manet Community Health Center Inc.	Y
Codman Square Health Center, Inc	Y
South Boston Community Health Center, Inc.	Y
Boston University Mallory Pathology Associates, Inc.	Y
Internal Medical Associates-NeighborHealth	Y
Boston University Obstetrics and Gynecology Foundation, Inc.	Y
BUMC Otolaryngologic Foundation Inc	Y
Boston University Affiliated Physicians, Inc.	Y
Boston University General Surgical Associates, Inc.	Y
Boston University Medical Center Radiologists, Inc.	Y
Boston Emergency Physician Foundation, Inc.	Y
Boston University Medical Center Urologists, Inc.	Y
Boston University Neurosurgical Associates, Inc.	Y
Boston Medical Center Corporation	Y
Boston University Dermatology, Inc.	Y
Boston University Family Medicine, Inc.	Y
Boston University Orthopaedic Surgical Associates, Inc.	Y
Boston University Psychiatry Associates, Inc.	Y
Boston University Neurology Associates, Inc.	Y
DOT HOUSE HEALTH INC.	Y
Upham's Corner Health Committee, Inc.	Y
Evans Medical Foundation Inc	Y
Boston University Radiation Oncology, Inc.	Y
Boston University Medical Center Anesthesiologists Inc	Y
Boston University Eye Associates Inc	Y
Harbor Health Services Inc	Y
Harvard Street Neighborhood Health Center Inc	Y

ACO Governing Body

Key ACO Clinical and Administrative Leadership

Michael Olsen	ACO Executive michael.olsen@bmc.org
Jason Worcester	Medical Director jason.worcester@bmc.org
Craig Bennett	Compliance Officer
Jason Worcester	Quality Assurance/Improvement Officer

Associated Committees and Committee Leadership

Committee Name	Committee Leader Name and Position
Finance/Budget Committee of Boston Accountable Care Organization Inc.,	William Creevy, MD – President of Boston University Medical Group
Quality Committee	Jason Worcester, MD - Medical Director, Boston Acountable Care Organization

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

• Partnerships or joint venture arrangements between hospitals and ACO professionals

Shared Savings and Losses

Amount of Shared Savings/Losses

• Third Agreement Period
  • Performance Year 2023, $6,691,841
  • Performance Year 2022, $6,544,936
  • Performance Year 2021, $4,671,498
• Second Agreement Period
  • Performance Year 2020, $7,087,868
  • Performance Year 2019, $2,352,403
  • Performance Year 2018, $1,905,632
• First Agreement Period
  • Performance Year 2017, $0
  • Performance Year 2016, $0
  • Performance Year 2015, $4,217,885

Shared Savings Distribution

• Third Agreement Period
  • Performance Year 2023
    • Proportion invested in infrastructure: 20%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 80%
  • Performance Year 2022
    • Proportion invested in infrastructure: 20%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 80%
  • Performance Year 2021
    • Proportion invested in infrastructure: 20%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 80%
• Second Agreement Period
  • Performance Year 2020
    • Proportion invested in infrastructure: 20%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: N/A 80%
  • Performance Year 2019
    • Proportion invested in infrastructure: 20%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 80%
  • Performance Year 2018
    • Proportion invested in infrastructure: 20%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 80%
• First Agreement Period
  • 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
  • Performance Year 2015
    • Proportion invested in infrastructure: 0%
    • Proportion invested in redesigned care processes/resources: 0%
    • Proportion of distribution to ACO participants: 100%

Quality Performance Results

2023 Quality Performance Results:

Quality performance results are based on CMS Web Interface.

Measure #	Measure Name	Rate	ACO Mean
001	Diabetes: Hemoglobin A1c (HbA1c) Poor Control[1]	10.20	9.84
134	Preventative Care and Screening: Screening for Depression and Follow-up Plan	76.73	80.97
236	Controlling High Blood Pressure	65.08	77.80
318	Falls: Screening for Future Fall Risk	84.55	89.42
110	Preventive Care and Screening: Influenza Immunization	73.77	70.76
226	Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	75.44	79.29
113	Colorectal Cancer Screening	70.63	77.14
112	Breast Cancer Screening	83.06	80.36
438	Statin Therapy for the Prevention and Treatment of Cardiovascular Disease	92.44	87.05
370	Depression Admission at 12 Months	14.29	16.58
321	CAHPS for MIPS[3]	7.49	6.25
479	Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Groups[1]	0.1472	0.1553
484	Clinician and Clinician Group Risk - Standardized Rates for Patients with Multiple Chronic Conditions[1]	N/A	35.39

Please note, [1] a lower performance rate corresponds to higher quality. [2]For PY 2022 the CMS Web interface measures Quality ID #438 and Quality ID #370 do not have benchmarks, and therefore were not scored. [3] CAHPS for MIPS is a composite measurment so numerator, denominator and performance rate values are not applicable (N/A). The CAHPS for MIPS composite score is circulated as the average number of points across Scored Summary Measures (SSMs) (86 FR 65256). Refer to table 5 for details on CAHPS for MIPS Performance.

CAHPS for MIPS Measures:

Measure ID	Measure Name	Reported Performance Rate	Current Year Mean Performance Rate (SSP ACOs)
CAHPS-1	Getting Timely Care, Appointments, and Information	82.50	83.68
CAHPS-2	How Well Providers Communicate	94.39	93.69
CAHPS-3	Patient’s Rating of Provider	94.81	92.14
CAHPS-4	Access to Specialists	79.84	75.97
CAHPS-5	Health Promotion and Education	74.91	63.93
CAHPS-6	Shared Decision Making	59.36	61.60
CAHPS-7	Health Status and Functional Status	69.00	74.12
CAHPS-8	Care Coordination	87.39	85.77
CAHPS-9	Courteous and Helpful Office Staff	92.38	92.31
CAHPS-11	Stewardship of Patient Resources	31.57	26.69

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 telehealth services using the flexibilities under 42 CFR §425.612(f) and 42 CFR §425.613.

Patient Advisory Committee – BMC Integrated Care Services, Inc. 

The needs and desires of the patient population of BMC Integrated Care Services is at the forefront of our work. To that end, the BMC Integrated Care Services, as a part of its governance structure, has a Patient Advisory Committee. The purpose of the Committee is to assist the Board in meeting its responsibilities to ensure that the interest of the ACO’s patients, and their families, are met. The Committee has appointed a consumer representative to sit on the BMC Integrated Care Services’ Board of Directors, and intends to recommend a consumer or consumer advocate to represent patients with disabilities to the Board or one of its Committees, in the near future.