Starting Nov. 21, the National Committee on Quality Assurance will begin to accredit accountable care organizations.
The program offers three levels of accreditation based on the readiness of the ACO. As with the NCQA's recognition program for patient-centered medical homes, achieving accreditation at each level will be based on accruing a certain number of points by meeting standards and fulfilling some “must-pass” criteria.
NCQA officials said that they decided to establish the new program while ACOs are still in their infancy in order to provide payers and patients with some assurance about the model. The idea is to let everyone know that if a group of providers calls themselves an ACO, then they have adhered to a set of principles and are doing the right things for patients, Margaret E. O'Kane, NCQA president, said during a press briefing to announce the program.
Accreditation also offers a “roadmap” for groups that aspire to be ACOs, Ms. O'Kane said, by outlining the elements needed to qualify as an ACO. “If you can meet these standards, you can be an ACO.”
The NCQA is launching its accreditation program as many physicians and hospitals are still trying to figure out if they could operate as an ACO. On Oct. 20, the Centers for Medicare and Medicaid Services released its final rule spelling out how an ACO should be structured and how providers in the organization would be paid by Medicare. Ms. O'Kane said that NCQA officials tried to align their accreditation standards with the Medicare rules as much as possible.
NCQA will offer accreditation to 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, and partnerships with providers and health plans. ACOs will need to serve at least 5,000 patients to quality for the NCQA program.
ACOs that seek accreditation will be evaluated on 65 elements, including 4 “must-pass” items. The elements fall into the following seven broad categories:
▸ Program operations. ACOs must have the infrastructure necessary to coordinate providers.
▸ Access and availability. ACOs must have sufficient numbers and types of providers, as well as timely access to care. NCQA said that the range of providers should include primary care, specialty care, urgent/emergency/inpatient care, community- and home-based services, and long-term care.
▸ Primary care as the foundation. The NCQA accreditation program builds on the standards in its patient-centered medical home recognition program.
▸ Care management. This requirement includes providing population health programs.
▸ Care coordination and transitions. The ACO must have a coordinated system for timely information exchange across multiple providers.
▸ Patient rights and responsibilities. ACOs must have a process for patient complaints, and a way for patients to restrict access to their data.
▸ Performance reporting. ACOs must measure their performance and publicly report the results.
ACOs that seek NCQA accreditation will also be evaluated using 40 measures of clinical quality, patient experience, and efficiency and utilization.
The program is the product of 2 years of discussions by the NCQA's ACO Task Force, which includes patients, policy experts, representatives from integrated health systems, and physicians. NCQA also evaluated 2,200 public comments and pilot tested the standards among integrated delivery systems, multispecialty practice groups, and independent practice associations.