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

AVP Values Based Programs: Dasha Runnions, Humana, Inc.
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: Wes Trail, Humana, Inc.
Finance Leader: Greg Hermann, Humana, Inc.
Operations Leader: Sarah Rosenbaum, Humana Inc.
Compliance Leader: Teresa (Terri) Schorr, Humana, Inc.
Legal Counsel: Billy Hopkins, Humana, Inc.

ACO Governing Body

Executive Director: Gina Mooi, Humana, Inc.
Clinical Executive: Todd Prewitt, Humana, Inc.
Participant Provider: Dr. Alicia Brooks, Covenant Medical Group
Participant Provider: Dr. David Kricsfeld, Encompass Medical Group
Participant Provider: Dr. Alisa Holland, WellMed
Participant Provider: Dr. Manjusri Vennamaneni, Access Health Care Physicians
Consumer Advocate: Rita Cuffle
Medicare Beneficiary: Allie Brown

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