ACO Formation and Contracting in North Carolina
PDFMost public information about ACO formation in North Carolina concerns those ACOs that have contracted with CMS.
CMS has approved the North Carolina entities listed below to participate in federal ACO programs. All of these ACOs are participating in the MSSP, except Coastal Carolina Quality Care, Inc., an eastern North Carolina-based entity that is participating in the Advanced Payment ACO program.
- Accountable Care Coalition of Caldwell County, LLC, formed by Caldwell Memorial Hospital and Collaborative Health Systems
- Accountable Care Coalition of Eastern North Carolina, LLC, formed by Atlantic Integrated Health Network and Collaborative Health Systems
- AnewCare Collaborative, LLC, a Johnson City, Tennessee-based limited liability company that is affiliated with Mountain States Medical Group and the Crestpoint Health Insurance Company
- Bayview Physician Services, P.C. (d/b/a Bayview Physicians Group), a Norfolk, Virginia-based physician group serving patients in northeastern North Carolina
- Carolinas ACO, LLC, formed and managed by a physician
- CaroMont Medical Group, a Gastonia-based regional health system
- Central Virginia Accountable Care Collaborative, LLC, a Virginia entity
- Coastal Carolina Quality Care, Inc., a North Carolina corporation owned by physicians who are members of Coastal Carolina Health Care, P.A.
- Cornerstone Health Care, PA, a central North Carolina-based multispecialty physician group
- Duke Connected Care, LLC, owned by Duke Integrated Network, Inc.
- Meridian Holdings, Inc., a multistate corporation that includes providers serving patients in and around Charlotte
- Physicians Healthcare Collaborative LLC, formed by Wilmington Health, an eastern North Carolina multispecialty group practice
- Triad Healthcare Network, LLC, formed by Moses H. Cone Memorial Hospital, Inc.
- WakeMed Key Community Care, LLC, formed by Key Physicians and WakeMed Health & Hospitals
Some of these federally contracted ACOs have also entered into ACO-type reimbursement agreements with private payors. While information on agreements between ACOs and private payors is not necessarily publicly available, the following federally contracted North Carolina ACOs have publicly announced ACO arrangements with private payors:
- AnewCare Collaborative, LLC, which is affiliated with Crestpoint Health Insurance Company
- Cornerstone Health Care, PA, which, in conjunction with Wake Forest Baptist Medical Center, has entered into accountable payment agreements with UnitedHealthcare and Cigna
- Physicians Healthcare Collaborative LLC, which, in conjunction with New Hanover Regional Medical Center, has entered into an accountable payment agreement with BlueCross BlueShield of North Carolina
- WakeMed Key Community Care, LLC, which has entered into accountable payment agreements with BlueCross BlueShield of North Carolina and Cigna
Several other North Carolina-based providers, while not participating in federal ACO programs, have also begun to enter into innovative agreements with private payors. Under these agreements, the parties operate under a model that requires or provides incentives for a new degree of clinical integration that is similar to ACO-type activity.
- Boice-Willis Clinic, PA, a multispecialty group practice in northeast North Carolina, which has entered into an accountable payment agreement with Cigna
- Cape Fear Valley Health System, an eastern North Carolina regional health system, which has entered into an accountable payment agreement with BlueCross BlueShield of North Carolina
- Carolinas Healthcare System, a Charlotte-based health system, which has entered into an accountable payment agreement with Aetna
- Novant Health, which has entered into an accountable payment agreement with Cigna
According to records of the North Carolina Secretary of State, several entities have been organized in North Carolina with possible plans to operate as ACOs, including the following:
- Accountable Care Coalition of Charlotte, LLC, a manager-managed LLC formed by Collaborative Health Systems
- Accountable Care Organization of Union County, LLC
- Pinehurst Accountable Care Network, Inc., formed by Pinehurst Surgical Group and Pinehurst Medical Clinic
- Sandhills Accountable Care Alliance, LLC
- UNCHCS Accountable Care I, LLC, a manager-managed LLC formed by UNC Hospitals
- UNCHCS Accountable Care II, LLC, a manager-managed LLC formed by UNC Hospitals
- UNCHCS Accountable Care III, LLC, a manager-managed LLC formed by UNC Hospitals
