About Qualuable

About Qualuable

Championing a patient-centered approach to care, Qualuable Medical Professionals is an Accountable Care Organization (ACO) promoting collaboration among healthcare providers of Northeast Tennessee and Southwest Virginia. Working together and with Medicare, sharing information and responsibility, we're utilizing best practice protocols and pathways to significantly improve not only the health of those we're privileged to serve but the overall health of the communities in which we live.

Deriving our name from the blending of quality, value and ability, Qualuable Medical Professionals is committed to the provision of patient-centered care of improved quality and value.

Qualuable is pleased to be a Medicare ACO.


ACO Name and Location

Qualuable Medical Professionals, LLC
2323 N. John B Dennis Hwy
Kingsport, TN 37660

ACO Primary Contact

Dr. Scott Fowler
scott.fowler@qualuable.com
423-857-2091




ACO participants in joint ventures between ACO professionals and hospitals:

No participants are involved in a joint venture between ACO professionals and hospitals

Qualuable Governing Body
  • Dr. Scott Fowler, President & Chairman of the Board, ACO Participant, Holston Medical Group
  • Dr. Ron Blackmore, Vice Chair, ACO Participant, State of Franklin Healthcare Associates
  • Dr. James Hansen, Voting Member, ACO Participant, State of Franklin Healthcare Associates
  • Dr. Steve Adkins, Voting Member, ACO Participant, Holston Medical Group
  • Dr. Kenny Hopland, Voting Member, ACO Participant, Medical Care PLLC
  • Dr. Robert Funke, Voting Member, ACO Participant, Mountain Region Family Medicine
  • Mr. Steve Hopland, Voting Member, ACO Participant, CEO of Medical Care PLLC
  • Dr. Kevin Misischia, Voting Member, ACO Participant, Mountain Region Family Medicine
  • Dr. Reid Blackwelder, Voting Member, ACO Participant, Medical Education Assistance Corporation (ETSU Family Medicine)
  • Dr. Thomas Jernigan, Voting Member, ACO Participant, Medical Education Assistance Corporation (ETSU Internal Medicine)
  • Dr. D. Nelson Gwaltney, Voting Member, ACO Participant, Bristol Surgical Associates
  • Dr. John Chandler, Voting Member, ACO Participant, Appalachian Orthopedic Associates
  • Dr. Mark Woodard, Voting Member, ACO Participant, Northeast Tennessee Emergency Physicians PC
  • Mr. Ernest E. Williams, Jr., Voting Member, Medicare Beneficiary Representative

Key Clinical and Administrative Leadership Personnel:
  • ACO Executive: Scott R. Fowler
  • Co-Medical Director: Dr. David Moulton
  • Co-Medical Director: Dr. Shelton Hager
  • Compliance Official: Dr. Richard Gendron
  • Quality Assurance/Improvement Officer: Dr. Richard Gendron
  • Chief Administrative Officer: Rich Panek
  • Chief Operations Officer: Michael Longhouser
  • Chief Financial Officer: Craig Hewitt
  • Vice President of Provider Relations: Brant Kelch
  • Chief Technology Officer: Wesley Combs

Associated Committees and Committee Leadership:
  • Contracting & Finance Committee: Dr. Ronald Blackmore, Chair
  • Communications/Marketing Committee: Danielle Krueger
  • Health Information Technology Committee: Steven Cox, Chair
  • Compliance Committee: Dr. Richard Gendron, Chair
  • Clinical Transformation Committee: Dr. David Moulton and Dr. Shelton Hager, Co-Chairs
  • Quality, Clinical Process & Population Health Improvement Committee: Dr. David Moulton
  • Care Coordination Committee - Dr. Shelton Hager, Chair
  • Beneficiary/Patient Engagement - Dr. Rick Whiles, Chair
  • Data Aggregation Analysis & Reporting Committee - Laura Quillen, Chair

Types of ACO Participants, or combinations of participants, that formed the ACO:
  • Network of individual practices of ACO professionals

Shared Savings and Losses:
Amount of Shared Savings/Losses
Agreement period beginning 2013, Performance Year 1: 2013 $6,709,522
Agreement period beginning 2013, Performance Year 2: 2014 $7,406,111
Agreement period beginning 2013, Performance Year 3: 2015 $5,020,639

Shared Savings Distribution
  • Agreement period beginning 2013, Performance Year 1
    • Proportion invested in infrastructure: 28%
    • Proportion invested in redesigned care process/resources: 0%
    • Proportion of distribution to ACO participants: 72%

  • Agreement period beginning 2013, Performance Year 2
    • Proportion invested in infrastructure: 25%
    • Proportion invested in redesigned care process/resources: 0%
    • Proportion of distribution to ACO participants: 75%

  • Agreement period beginning 2013, Performance Year 3
    • Proportion invested in infrastructure: TBD
    • Proportion invested in redesigned care process/resources: TBD
    • Proportion of distribution to ACO participants: TBD

Payment Rule Waivers:
ACO does not utilize the SNF 3-Day Rule Waiver
No, our ACO does not use the SNF 3-Day Rule Waiver

Quality Performance Results Table
Measure Number Performance Measure 2012 Reporting Period 2013 Reporting Period 2014 Reporting Period
ACO Performance Rate Mean Performance Rate for all ACOs ACO Performance Rate Mean Performance Rate for all ACOs ACO Performance Rate Mean Performance Rate for all ACOs
ACO-1 Getting Timely Care, Appointments, and Information Not in Operations 81.69 81.66 81.48 84.00 80.13
ACO-2 How Well Your Doctors Communicate Not in Operations 92.84 94.60 92.96 95.21 92.39
ACO-3 Patients' Rating of Doctor Not in Operations 91.86 92.49 92.06 93.43 91.58
ACO-4 Access to Specialists Not in Operations 85.11 88.03 85.12 87.49 83.97
ACO-5 Health Promotion and Education Not in Operations 56.61 55.91 58.38 56.42 58.29
ACO-6 Shared Decision Making Not in Operations 73.99 75.75 74.53 74.57 74.60
ACO-7 Health Status/Functional Status Not in Operations 70.35 66.54 71.12 69.51 71.10
ACO-8 Risk Standardized, All Condition Readmissions Not in Operations 15.42 15.76 14.90 15.29 15.15
ACO-9 ASC Admissions: COPD or Asthma in Older Adults Not in Operations 1.13 1.12 1.17 1.04 1.08
ACO-10 ASC Admission: HF Not in Operations 1.09 1.08 1.20 1.13 1.19
ACO-11 Percent of Primary Care Providers Who Successfully Attested for the EHR Incentive Program Incentive Payment Not in Operations 59.87 74.67 66.21 87.30 76.71
ACO-12 Medication Reconciliation Not in Operations 72.37 94.24 73.56 96.20 82.67
ACO-13 Falls: Screening for Fall Risk Not in Operations 28.27 38.45 39.57 69.52 45.60
ACO-14 Influenza Immunization Not in Operations 50.58 66.67 56.93 76.21 57.51
ACO-15 Pneumococcal Vaccination Not in Operations 48.62 64.61 54.76 73.97 55.03
ACO-16 Adult Weight Screening and Follow-up Not in Operations 53.91 50.99 61.61 73.19 66.75
ACO-17 Tobacco Use Assessment and Cessation Intervention Not in Operations 80.12 73.48 84.01 85.48 86.79
ACO-18 Depression Screening Not in Operations 22.48 37.34 31.19 55.00 39.27
ACO-19 Colorectal Cancer Screening Not in Operations 50.21 66.81 59.30 69.64 56.14
ACO-20 Mammography Screening Not in Operations 62.23 69.57 62.05 82.00 61.41
ACO-21 Proportion of Adults who had blood pressure screened in past 2 years Not in Operations 71.56 73.87 74.25 78.10 60.24
ACO-22* Hemoglobin A1c Control (HbA1c) (<8 percent) Not in Operations Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
ACO-23* Low Density Lipoprotein (LDL) (< 100 mg/dL) Not in Operations Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
ACO-24* Blood Pressure (BP) < 140/90 Not in Operations Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
ACO-25* Tobacco Non-Use Not in Operations Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
ACO-26* Aspirin Use Not in Operations Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
ACO-27 Percent of beneficiaries with diabetes whose HbA1c in poor control (>9 percent) Not in Operations 25.94 16.12 22.11 12.02 20.35
ACO-28 Percent of beneficiaries with hypertension whose BP < 140/90 Not in Operations 63.22 69.84 67.79 71.48 68.02
ACO-29 Percent of beneficiaries with IVD with complete lipid profile and LDL control < 100mg/dl Not in Operations 63.22 56.83 55.44 62.81 57.29
ACO-30 Percent of beneficiaries who use Aspirin or other antithrombotic Not in Operations 52.02 69.78 76.35 92.29 80.79
ACO-31 Beta-Blocker Therapy for LVSD Not in Operations 72.60 80.75 79.82 61.32 82.71
ACO-32* Drug Therapy for Lowering LDL-Cholesterol Not in Operations Not Applicable Not Applicable Not in Operations Not Applicable Not Applicable
ACO-33* (ACE) Inhibitor or (ARB) Therapy for Patients with CAD and Diabetes and/or (LVSD) Not in Operations Not Applicable Not Applicable Not in Operations Not Applicable Not Applicable
ACO-34 Stewardship of Patient Resources Not in Operations Not Applicable Not Applicable Not in Operations Not Applicable Not Applicable

Measure Number Measure Name 2015 Reporting Period
ACO Performance Rate Mean Performance Rate (SSP- ACOs)
ACO-1 CAHPS: Getting Timely Care, Appointments, and Information 79.36 80.61
ACO-2 CAHPS: How Well Your Providers Communicate 94.84 92.65
ACO-3 CAHPS: Patients’ Rating of Provider 93.65 91.94
ACO-4 CAHPS: Access to Specialists 85.32 83.61
ACO-5 CAHPS: Health Promotion and Education 57.96 59.06
ACO-6 CAHPS: Shared Decision Making 75.45 75.17
ACO-7 CAHPS: Health Status/Functional Status 71.68 72.30
ACO-34 CAHPS: Stewardship of Patient Resources* 29.51 26.87
ACO-8 Risk Standardized, All Condition Readmission 14.71 14.86
ACO-35 Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM)* Readmission 19.13 18.07
ACO-36 All-Cause Unplanned Admissions for Patients with Diabetes* 49.38 54.60
ACO-37 All-Cause Unplanned Admissions for Patients with Heart Failure* 71.92 76.96
ACO-38 All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions 58.64 62.92
ACO-9 Ambulatory Sensitive Condition Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI) #5) 1.06 1.11
ACO-10 Ambulatory Sensitive Conditions Admissions: Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8) 0.82 1.04
ACO-11 Percent of Primary Care Physicians who Successfully Meet Meaningful Use Requirements 91.67% 76.22%
ACO-39 Documentation of Current Medications in the Medical Record* 86.15% 84.07%
ACO-13 Falls: Screening for Future Fall Risk 84.04% 56.46%
ACO-14 Preventive Care and Screening: Influenza Immunization 84.70% 62.03%
ACO-15 Pneumonia Vaccination Status for Older Adults 82.31% 63.73%
ACO-16 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up 85.71% 71.15%
ACO-17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 94.97% 90.16%
ACO-18 Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan 76.38% 45.25%
ACO-19 Colorectal Cancer Screening 77.83% 60.06%
ACO-20 Breast Cancer Screening 82.50% 65.67%
ACO-21 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 90.63% 70.04%
ACO-40 Depression Remission at Twelve Months* 0.00% 6.11%
ACO-27 Diabetes Mellitus: Hemoglobin A1c Poor Control 12.42% 20.38%
ACO-41 Diabetes: Eye Exam* 62.58% 41.05%
ACO-28 Hypertension: Controlling High Blood Pressure 76.46% 69.62%
ACO-30 Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic 93.52% 83.82%
ACO-31 Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 88.98% 87.22%
ACO-33 Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%) 89.02% 77.73%

CAHPS = Consumer Assessment of Healthcare Providers and Systems, PQI = Prevention Quality Indicator, LVSD = left ventricular systolic dysfunction, ACE = angiotensin-converting enzyme, ARB = angiotensin receptor blocker, CAD = coronary artery disease.

*= Measure required beginning Reporting Year 2015.

N/A= Reporting on the depression remission measure is not required for 2015, as indicated by N/A


For more information on how to interpret scores on the above quality performance measures, see:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/MSSP-QM-Benchmarks.pdf


Public Description of Waiver

Last updated on February 15, 2017