ACO Entity Agreements:

Participation Agreements with Providers:  Premier Patient Healthcare, LLC has entered into participation agreements with each of the primary care and specialty providers listed in “Premier Patient Healthcare, LLC’s Network of Providers” pursuant to which the providers agree to participate in the ACO and are eligible to receive a portion of any savings generated.  These agreements set forth the duties and responsibilities of Premier Patient Healthcare, LLC and the participating providers to deliver high-quality, coordinated care and improve the overall health of our patients.

ACO Participation Waiver Disclosure:

The Secretary of U.S. Department of Health and Human Services has provided waivers of certain federal laws that may otherwise limit innovation by ACOs. In accordance with the public disclosure requirements of the ACO Participation Waivers set forth in 80 Fed. Reg. 66725 (Oct. 29, 2015), the applicable arrangements are described below:

Premier Patient Healthcare, LLC has formed an integrated network of health care providers organized for the purposes of improving the quality and efficiency of health care services provided to our patients.

Agreement with Quest Diagnostics:  The parties to the arrangement include Premier Patient Healthcare, LLC (“Premier”) and Quest Diagnostics Clinical Laboratories, Inc. (“Quest”). The agreement is effective as of March 11, 2016. Under the agreement, the parties will coordinate with each other to meet requirements for reporting quality and cost measures, establish clinical and administrative systems to support chronic disease management and population health strategies, and evaluate and address the health needs of Premier’s patient population. Quest will make available laboratory testing services to Premier’s providers, and Premier will integrate and use this information in Premier’s data analytics programs, reporting measures, and care coordination and intervention strategies. The agreement includes a series of potential grants to develop infrastructure and redesigning care processes to allow for high quality and efficient service delivery for patients whereby Premier must meet certain quality metrics to be eligible. This arrangement allows the parties to promote accountability for the quality, cost and overall care for the ACO’s patients and manage and coordinate care for these individuals.

With respect to each of the arrangements above, the ACO’s governing body has made and duly authorized a bona fide determination that the arrangement is reasonably related to the purposes of the Medicare Shared Savings Program.

Agreement with Arlington Medical Imaging, LLC – The agreement is effective as of February 1, 2014 : The parties to the arrangement include Premier Patient Healthcare, LLC and Arlington Medical Imaging LLC.  Arlington Medical Imaging LLC will provide diagnostic imaging and interpretation services as a preferred provider and Premier Patient Healthcare, LLC will provide management services, including marketing, scheduling, eligibility verification, pre-authorization, and billing and collections.

Agreement with Encompass – The agreement is effective as of May 20, 2014:  The parties to the arrangement include Premier Patient Healthcare, LLC (“Premier”) and Advanced Homecare Management, Inc. d/b/a Encompass Home Health & Hospice (“Encompass”). Encompass will provide home health and hospice services as well as care coordination, transitional care management services, and post-acute care services as a preferred provider of Premier. Premier will provide certain management services to Encompass, including data analytics, quality metrics, and administrative services associated with participation in an ACO.

Agreement with Choice Cancer – The agreement is effective as of December 11, 2014:  The parties to the arrangement include Premier Patient Healthcare, LLC (“Premier”) and Gregory A. Echt, MD, PA d/b/a Choice Cancer Care (“Choice Caner”). Choice Cancer will provide oncology services and patient education, care coordination in both an inpatient and outpatient setting, transitional care management services, and post-acute care and other services (such as early detection, screening, and intervention) to oncology patients as a preferred provider of Premier. Premier will provide certain management services to Encompass, including data analytics, quality metrics, and administrative services associated with participation in an ACO.

Agreement with CPL – The agreement is effective as of June 1st, 2015:  The parties to the arrangement include Premier Patient Healthcare, LLC and Clinical Pathology Laboratories, Inc. (CPL); the agreement is effective as of June 1, 2015. The parties are working together to support the healthcare needs, including chronic disease management and care coordination needs, of our Medicare Shared Savings Program (MSSP) ACO providers and patients through a healthcare informatics and preferred provider arrangement whereby CPL will serve as Premier Patient Healthcare, LLC’s preferred provider of certain laboratory testing services, and Premier Patient Healthcare, LLC will provide certain ACO-related administrative services.. As part of the arrangement, the ACO providers/suppliers will have the option to participate in a voluntary Population Health Informatics Program in which they will be given access to informatics capabilities to improve outcomes, promote efficiency and lower systemic costs. The Program will allow ACO providers to better evaluate, manage and coordinate the care of their ACO patients, including identifying high-risk patients, leading to high-quality care while reducing unnecessary costs associated with poorly-managed chronic conditions.

Medicare Advantage Arrangement with GulfQuest: The arrangements by and among Premier Patient Healthcare, LLC (Premier), Sybrid Health, LLC (Sybrid), PPHC Advantage, LLC (PPHC Advantage) and GulfQuest, L.P. (GulfQuest) involve two agreements. The agreement between Sybrid and PPHC Advantage is effective as of May 28, 2015, and the agreement between GulfQuest and PPHC Advantage is effective as of May 29, 2015. The agreements establish the provision of marketing and management services, as well as GulfQuest’s provision of management and administrative services to PPHC Advantage to assist with the development of population health management and the quality improvement infrastructure. As a result of the arrangements, the ACO will develop population health management strategies and a quality improvement infrastructure that better serves the needs of ACO providers/suppliers and expands the professional medical services available to patients under certain benefit programs.

Medicare Advantage Arrangement with HealthSpring:  The agreement is effective as of May 29, 2015. The parties to the arrangement include Premier Patient Healthcare, LLC (Premier), Sybrid Health, LLC (Sybrid), PPHC Advantage, LLC (PPHC Advantage) and HealthSpring Life & Health Insurance Company, Inc. (HealthSpring). The arrangement involves the coordination of professional medical services to be provided to the customers of HealthSpring’s benefit programs, and accountability for the quality, cost, and overall care of ACO patients.

Amendment to Agreement with Arlington Medical Imaging, LLC:  The amendment is effective as of March 1, 2015. The parties to the amendment include Premier Patient Healthcare, LLC and Arlington Medical Imaging LLC. The amendment revises the services that are performed by Premier Patient Healthcare, LLC under the original arrangement so that Premier Patient Healthcare, LLC provides marketing services to Arlington Medical Imaging LLC but does not provide other management services, including scheduling, eligibility verification, pre-authorization, and billing and collections. Arlington Medical Imaging LLC remains a preferred provider of Premier Patient Healthcare, LLC for diagnostic imaging and interpretation services.

With respect to each of the arrangements above, the ACO’s governing body has made and duly authorized a bona fide determination that the arrangement is reasonably related to the purposes of the Medicare Shared Savings Program.

For general questions or additional information about Accountable Care Organizations, please visit www.medicare.gov/acos.html or call 1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048.