The National Committee for Quality Assurance (NCQA) has announced its new Accountable Care Organization (ACO) Accreditation. This first-of-its-kind program builds on patient-centered medical homes and provides an independent evaluation of organizations’ ability to coordinate the high-quality, efficient, patient-centered care expected of ACOs. It helps providers make the challenging though much needed transition to ACOs, which will be expected to have a comprehensive and cohesive approach to primary care.
NCQA worked with consumer advocates, purchasers and experts in the fields of health care delivery, health services research and managed care to develop a comprehensive set of standards to evaluate ACOs. NCQA ACO Accreditation includes two major components: standards, an evaluation of an ACO’s structure and processes; and measures, an evaluation of an organization’s capability to report performance results.
The program evaluates organizations in seven categories:
- ACO Structure and Operations
- Access to Needed Providers
- Patient-Centered Primary Care
- Care Management
- Care Coordination and Transitions
- Patient Rights and Responsibilities
- Performance Reporting and Quality Improvement
NCQA ACO Accreditation includes three levels, representing varying degrees of capability for coordinating care and reporting and improving quality 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 two years, reflecting the expectation that these organizations will be reevaluated 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 three years.
- Level 3: designates organizations that have achieved Level 2 and demonstrate strong performance or significant improvement in measures across the triple aim.
ACOs are generally defined as provider-based entities that aim to improve the quality of health care and reduce cost growth for a group of people. In order to have sufficient patients for quality reporting and managing financial risk, ACOs need to serve at least 5,000 patients. Organizations eligible for ACO accreditation include:
- Providers in group practice arrangements
- Networks of individual practices
- Hospital/provider partnerships or joint ventures
- Hospitals and their employed or contracted providers
- Publicly governed entities that work with providers to arrange care
- Provider-health plan partnerships
Organizations that wish to apply for NCQA ACO Accreditation must complete an application. Information provided in the application will be used to determine eligibility. NCQA has information on how to apply and the data submission process available on its website. The standards are available for $250 and the survey tool is $510. The application itself is available without charge.
An Educational Assessment also is available for organizations in the early stage of ACO development or that are not currently pursuing accreditation. It provides the organization a chance to dialogue with NCQA about its performance against the standards and to receive an in depth review of areas to improve.
A brochure describing the ACO Accreditation is also available: