Practices Eye Playing Field for Accountable Care Organizations

The trend is being driven by more than just the provisions in the Affordable Care Act, he said. The escalating cost of health care is pushing businesses and other health care purchasers to look for alternatives to keep costs down. At the same time, there are finally data to show how patients are being managed and what types of care are cost effective. Additionally, younger consumers want to access health care the same way they do their banking and shopping. “For them to be told by a practice that they can't access their laboratory data online, they'll just keep looking until they find someone who can,” Dr. Grundy said.

Another player in the ACO field is the NCQA. The not-for-profit organization offers recognition programs for physicians, hospitals, and health plans in a number of areas. Starting this summer, the organization plans to unveil its standards for ACO accreditation. The first ACOs to go through the program could receive accreditation in 2012, according to Raena Grant Akin-Deko, assistant vice president for development at the NCQA.

The standards could be a “road map” for organizations to begin to build the capabilities to become an ACO, she said. “What we've done through these standards can help people understand what the important capabilities are and give them some direction about what are the things that they should be thinking about.”

The NCQA recently concluded testing of its standards with 10 organizations that represent IPAs, multispecialty practice groups, and integrated delivery systems. One issue that came up during the testing is the importance of leadership within the ACO. “We can define structural features that are important for [ACOs], but I think you cannot underestimate the importance of leadership and the cultural change toward patient-centered care in forming these organizations,” she said.

In the first few years, ACOs may come in a variety of forms, according to Dr. Keane. “They're all going to look different and they're all going to figure out different ways to provide care and provide reports. I worry about that,” she said. “First, I think we're going to have years of total chaos. But that's what we've got right now, so it can't be worse.”

The Affordable Care Act also includes a pediatric ACO demonstration project that allows states to award incentive payments through the Medicaid program. That project is also expected to launch next year.

Alicia Ault, Frances Correa, and Naseem Miller contributed to this report.