Accountable Care Organization (ACO)
ACO overview
Humana Direct Contracting Entity, Inc., d.b.a. Humana Care Solutions is a Accountable Care Organization (“ACO”) that has partnered with primary care centers across the United States. Through this partnership, Humana Care Solutions and Participant Primary Care & Preferred Providers work together to provide improved care management and improved care coordination. As partners, we share in healthcare delivery expertise and experience, providing high-value, high-quality care.
ACO Name and location
Humana Direct Contracting Entity, Inc., d.b.a. Humana Care Solutions
500 W. Main St. Louisville, KY 40202
For inquiries:
P.O. Box 14168
Lexington, KY 40512-4168
ACO Primary Contact
- Executive Director: Gina Mooi, Humana Care Solutions
HumanaCareSolutionsDCE@humana.com
Identification of all ACO Participating and Preferred Providers
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ACO Participant and Preferred Providers
ACO Key Clinical and Administrative Leaders
- Executive Director: Gina Mooi, Humana, Inc.
- Executive Clinician: Dr. Todd Prewitt, Humana, Inc.
- Data and Analytics Leader: Alex Duarte, Humana, Inc.
- Participant Provider Engagement Leader: Sara Nassif, Humana, Inc.
- Preferred Provider Engagement Leader: Tanina Gerogiannis, Humana, Inc.
- Strategy Leader: Kerri Gilligan, Humana, Inc.
- Finance Leader: Ben Rasp, Humana, Inc.
- Operations Leader: Sarah Rosenbaum, Humana Inc.
- Compliance Leader: Teresa (Terri) Schorr, Humana, Inc.
- Legal Counsel: Jane Susott, Humana, Inc.
ACO Governing Body
- Strategic Executive: Oraida Roman, Humana, Inc.
- Clinical Executive: Dr. Brian Powers, Humana, Inc.
- Participant Provider: Dr. Alicia Brooks, Covenant Medical Group
- Participant Provider: Dr. David Kricsfeld, Encompass Medical Group
- Participant Provider: Dr. Frederick Bloom, Guthrie Medical Group
- Participant Provider: Dr. Garland Anderson, Health Leaders Network
- Participant Provider: Dr. Casey Carlisle, Health Leaders Network
- Participant Provider: Dr. Christopher Funes, Health Leaders Network
- Participant Provider: Dr. Alisa Holland, WellMed
- Participant Provider: Dr. Ketan Hira, Summit Medical Group
- Participant Provider: Dr. Aaron Jones, Summit Medical Group
- Participant Provider: Dr. Jonathan Laymance, Summit Medical Group
- Participant Provider: Dr. Bhavana Vora, Summit Medical Group
- Participant Provider: Dr. Jeremy Chrisman, The Vancouver Clinic
- Participant Provider: Dr. Kyle Lamb, The Vancouver Clinic
- Participant Provider: Dr. Craig Riley, The Vancouver Clinic
- Consumer Advocate: Rita Cuffle
- Medicare Beneficiary: Richard (Dick) Shamrell
Identification of joint ventures between or among the ACO and any of its DC Participant Providers and Preferred Providers
- None
ACO Shared Savings and Shared Losses
PY2021
- Total Shared Savings: $5.4M
- Proportion of Shared Savings invested in infrastructure, redesigned care processes, and other resources necessary to improve outcomes and reduce Medicare cost for Beneficiaries: 76%
- Proportion of Shared Savings distributed to Participant or Preferred Providers: 24%
PY2022
- Total Shared Savings: $25.6M
- Proportion of Shared Savings invested in infrastructure, redesigned care processes, and other resources necessary to improve outcomes and reduce Medicare cost for Beneficiaries: 29%
- Proportion of Shared Savings distributed to Participant or Preferred Providers: 71%
PY2023
- Total Shared Savings: $28.6M
- Proportion of Shared Savings invested in infrastructure, redesigned care processes, and other resources necessary to improve outcomes and reduce Medicare cost for Beneficiaries: 30%
- Proportion of Shared Savings distributed to Participant or Preferred Providers: 70%
ACO Quality Measure Performance
PY2021
- Overall: 100% Earn Back
- Risk-Standardized, All-Condition Readmissions (ACR) Score. 15.90
- Risk-Standardized, All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (per 100 person-years) (UAMCC) score. 29.49
PY2022
- Overall: 100% Earn Back
- Risk-Standardized, All-Condition Readmissions (ACR) Score: 15.51
- Risk-Standardized, All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (per 100 person-years) (UAMCC) score: 30.32
- Timely Follow-Up After Acute Exacerbations of Chronic Conditions (TFU) score: 71
- CAHPs Composite Score: N/A
- Getting Timely Appointments, Care, and Information Summary Survey Measure (SSM): 81.78
- How Well Provider Communicate (SSM): 94.51
- Care Coordination (SSM): 87.00
- Shared Decision-Making (SSM): 63.04
- Patient Rating of Provider (SSM): 94.11
- Courteous and Helpful Office Staff (SSM): 93.24
- Health Promotion and Education (SSM): 61.72
- Stewardship of Patient Resources (SSM): 29.65
PY2023
- Overall: 100% Earn Back
- Risk-Standardized, All-Condition Readmissions (ACR) Score. 15.13
- Risk-Standardized, All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (per 100 person-years) (UAMCC) score. 29.57
- Timely Follow-Up After Acute Exacerbations of Chronic Conditions (TFU) score. 72.71
- CAHPs Composite Score: 0.92
- Getting Timely Appointments, Care, and Information Summary Survey Measure (SSM score): 83.15
- How Well Provider Communicate (SSM score): 94.91
- Care Coordination (SSM score): 88.12
- Shared Decision-Making (SSM score): 65.15
- Patient Rating of Provider (SSM score): 93.34
- Courteous and Helpful Office Staff (SSM score): 94.08
- Health Promotion and Education (SSM score): 65.67
- Stewardship of Patient Resources (SSM score): 26.01
For more information, call 888-899-8660.