Accountable Care Organization & Direct Contracting Entity Survey

1. Current Situation

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* 1. What is your name?

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* 2. What is the name of your organization?

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* 3. What is your title?

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* 4. Which best describes your function within the organization?

Executive/Administrator

Operations/Performance

Business Development/Growth

Finance/Strategy

Business Intelligence/Analytics

Clinical

Other (please specify)

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* 5. How many ACOs or DCEs make up your organization?

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* 6. Approximately how many total Medicare FFS beneficiaries are assigned to your ACOs/DCEs?

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* 7. In what year was your organization founded?

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* 8. Which of the following best describes your organization?

Medicare Shared Savings Program (MSSP)

Direct Contracting Entity (DCE)

Next Generation ACO converting to MSSP

Next Generation ACO converting to DCE

Other (please specify)

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* 9. If your organization includes MSSP ACOs, which of the following tracks/models apply?

Basic Track A

Basic Track B

Basic Track C

Basic Track E

Enhanced Track

Track 1

Track 1+