ACO Participant and Measure Information Question Title * 1. Contact Information ACO Name Name Title Email Phone Assistant Name Assistant Email Assistant Phone Question Title * 2. Who is the ACO sponsoring entity? Community Organization Hospital Insurer Physician Practice Other (please specify) Question Title * 3. What population(s) are covered within the ACO? Check all that apply. Commercial Medicaid Medicare Other (please specify) Question Title * 4. Is your ACO part of any federal/state programs or network/collaborative? Check all that apply. Brookings-Dartmouth ACO Learning Network Medicare Shared Savings Program (MSSP) Pioneer ACO Model Premier’s Partnership for Care Transformation (PACT) Population Health Collaborative None Other (please specify) Question Title * 5. Does your ACO collect performance measures? Yes No Next