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

  • 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.

Frequently asked questions