ACO Name and Location. ACO Primary Contact. Organizational Information

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1 ACO ame and Location Adirondacks ACO, LLC 75 Beekman Street Plattsburgh, ew York ACO Primary Contact Primary Contact ame Karen L. Ashline Primary Contact Phone umber Primary Contact Address Organizational Information ACO participants: ACO Participants William Pelton Stephen Hausrath Kristin Ambler, MD Zbigniew Wolczynski Russell Rider Glens Falls Hospital, Inc. Champlain Valley Physicians Elizabethtown Community Hospital Medical Associates of Saranac Lake, P.C. Hudson Headwaters Health etwork Adirondack Internal Medicine & Pediatrics, PC Debra Clark, MD Adirondack Medical Center ACO Participant in Joint Venture (Enter Y or )

2 Baywood Surgical Associates, PC Viqar Qudsi Irongate Family Practice Associates, PLLC Alice Hyde Medical Center Kevin McCullum Adirondack Pulmonary & Sleep Medicine PLLC University Of Vermont Medical Group Y- PLLC Plattsburgh Medical Care, PLLC Adirondack Medical Practice, LLC Lake City Primary Care, PLLC Peru Family Medicine, PLLC Primary Care Health Partners-Adirondack LLC ACO governing body: Member Last ame First ame Title/Position Member's Voting Power Membership Type Rugge John Chair, MD 1 ACO Participant Slingerland David MD 1 ACO Participant Tournier Chris CFO 1 ACO Participant ACO Participant TI Legal Business ame/dba, if Applicable Hudson Headwaters Health etwork Hudson Headwaters Health etwork Hudson Headwaters Health etwork

3 Mundy Stephens CEO 1 ACO Participant Brumsted John MD 1 ACO Participant Beguin David MD 1 ACO Participant Ambler Kristin MD 1 ACO Participant Shugrue Dianne CEO 1 ACO Participant Hammond Patti VP 1 ACO Participant Getman Sylvia CEO 1 ACO Participant Buck Elizabeth MD 1 ACO Participant Filion Paul MD 1 ACO Participant Burton Eric CEO 1 Community Stakeholder Mannix Martin Voting Member Medicare Beneficiary University of Vermont Health etwork CVPH University of Vermont Health etwork Medical Group Primary Care Health Partners, Y LLC Kristin Ambler. MD Glens Falls Hospital, Inc. Glens Falls Hospital, Inc. Adirondack Medical Center Adirondack Internal Medicine & Pediatrics, PC Irongate Family Practice Associates, PLLC AHI A Key ACO clinical and administrative leadership: Todd Moore ACO Executive Wouter Rietsema Medical Director Kirsten Pope Compliance Officer Wouter Rietsema Quality Assurance/Improvement Officer Associated committees and committee leadership: Committee ame Committee Leader ame and Position Population Health David Beguin, MD Chair Community and Beneficiary Engagement Crystal Carter, Chair Finance Chris Tournier, Chair Data Governance Kevin Gallagher, MD Chair

4 Types of ACO participants, or combinations of participants, that formed the ACO: ACO professionals in a group practice arrangement etworks of individual practices of ACO professionals Hospital employing ACO professionals Critical Access Hospital (CAH) billing under Method II Federally Qualified Health Center (FQHC) Shared Savings and Losses Amount of Shared Savings/Losses First Agreement Period o Performance Year 2016, $0 o Performance Year 2015, $0 o Performance Year 2014, $0 Shared Savings Distribution First Agreement Period o Performance Year 2016 Proportion invested in infrastructure: /A Proportion invested in redesigned care processes/resources: /A Proportion of distribution to ACO participants: /A o Performance Year 2015 Proportion invested in infrastructure: /A Proportion invested in redesigned care processes/resources: /A Proportion of distribution to ACO participants: /A o Performance Year 2014 Proportion invested in infrastructure: /A Proportion invested in redesigned care processes/resources: /A Proportion of distribution to ACO participants: /A

5 Quality Performance Results 2016 Quality Performance Results: ACO# Measure ame Rate ACO Mean ACO-1 CAHPS: Getting Timely Care, Appointments, and Information ACO-2 CAHPS: How Well Your Providers Communicate ACO-3 CAHPS: Patients' Rating of Provider ACO-4 CAHPS: Access to Specialists ACO-5 CAHPS: Health Promotion and Education ACO-6 CAHPS: Shared Decision Making ACO-7 CAHPS: Health Status/Functional Status ACO-34 CAHPS: Stewardship of Patient Resources ACO-8 Risk-Standardized, All Condition Readmission ACO-35 Skilled ursing Facility 30-Day All-Cause Readmission Measure (SFRM) ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure ACO-38 ACO-9 ACO-10 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5) Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8 ) ACO-11 Percent of PCPs who Successfully Meet Meaningful Use Requirements ACO-39 Documentation of Current Medications in the Medical Record ACO-13 Falls: Screening for Future Fall Risk ACO-14 Preventive Care and Screening: Influenza Immunization ACO-15 Pneumonia Vaccination Status for Older Adults ACO-16 ACO-17 ACO-18 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan ACO-19 Colorectal Cancer Screening ACO-20 Breast Cancer Screening

6 ACO-21 Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented ACO-42 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control ACO-41 Diabetes: Eye Exam ACO-28 Hypertension (HT): Controlling High Blood Pressure ACO-30 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic ACO-31 ACO-33 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%) Please note, the ACO-40 Depression Remission at 12 months quality measure is not included in public reporting due to low samples. For 2016 Quality Performance Results please visit: Initiatives-Medicare-Shared-Savin/2016-Shared-Savings-Program-SSP-Accountable-Care- O/3jk5-q6dr/data For 2015 Quality Performance Results please visit: Initiatives-Medicare-Shared-Savin/Medicare-Shared-Savings-Program-Accountable-Care-O/x8vaz7cu For 2014 Quality Performance Results please visit: Initiatives-Medicare-Shared-Savin/Medicare-Shared-Savings-Program-Accountable-Care-O/uccehhpu ote: In the Quality Performance Results file(s) above, search for Adirondacks ACO, LLC to view the quality performance results. This ACO can also be found by using the ACO ID A27492 in the public use files on data.cms.gov. Payment Rule Waivers o, our ACO does not use the SF 3-Day Rule Waiver.

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