Program identifies accountable care organizations likely to succeed

November 30, 2011

How likely is your accountable care organization to reach the "triple aim" of reducing costs, improving quality, and enhancing the patient experience? You may find a roadmap in the just-released standards and guidelines that comprise the National Committee for Quality Assurance's ACO accreditation program.

How likely is your accountable care organization (ACO) to reach the “triple aim” of reducing costs, improving quality, and enhancing the patient experience? You may find a roadmap in the just-released standards and guidelines that comprise the National Committee for Quality Assurance’s (NCQA’s) ACO accreditation program.

To maximize accreditation’s usefulness for a variety of ACOs and ACO partners, the NCQA program:

• aligns with many aspects of the Medicare Shared Savings Program,
• addresses expectations common among private purchasers, and
• uses three levels of accreditation to signify differing levels of ACO readiness and capability.

“NCQA accreditation is an independent evaluation of whether an ACO really can coordinate and be accountable for the efficient, patient-centered care expected of ACOs,” says NCQA President Margaret E. Kane. "Accreditation can assure patients that their ACO focuses on their care, and it shows payers and providers which ACOs are likely to be good partners.”

Accreditation standards require ACOs to demonstrate capabilities in seven areas:

• program operations,
• access and availability,
• primary care,
• care management,
• care coordination and transitions,
• patient rights and responsibilities, and
• performance reporting.

The NCQA program includes three accreditation levels that signal how ready organizations are to participate in innovative payment arrangements and value-based purchasing.

Level 1 designates organizations in formative or transformative stages that meet some standards but are not yet fully capable ACOs. This status lasts 2 years, reflecting the expectation that these organizations will be re-evaluated more quickly for strengthened capabilities.

Level 2 designates organizations with the best chance of achieving the triple aim. These entities demonstrate a broad range of ACO capabilities, and this status lasts 3 years.

Level 3 designates organizations that have achieved Level 2 and demonstrate strong performance or significant improvement in measures across the triple aim.

The Billings Clinic in Billings, Montana, and HealthPartners of Minneapolis, Minnesota, are the first organizations to commit to using NCQA accreditation to demonstrate their readiness as ACOs. Both organizations will undergo a full survey of their ACO capabilities between March 1 and December 31, 2012.

ACOs are generally defined as provider-based entities that aim to improve the quality of healthcare and reduce cost growth for a group of people. To have sufficient patients for quality reporting and managing financial risk, ACOs need to serve at least 5,000 patients.

NCQA is a private, nonprofit organization that accredits and certifies a wide range of healthcare organizations.

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