NCQA releases ACO guidelines

Accountable care organizations have been hailed as being able to save healthcare just as often as they’ve been criticized as being too risky. In an effort to provide some sense of certainty about an ACO’s ability to reach the so-called triple aim of reducing cost, improving quality and enhancing patient experience, the National Committee for Quality Assurance (NCQA) released on Monday its standards and guidelines which are the basis of its ACO accreditation program.

“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,” said NCQA President Margaret E. O’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.”

[See also: ACO program is asking too much, says expert.]

The NCQA’s ACO accreditation program standards were developed over two years with the help of a task force of experts spanning the array of stakeholders in the healthcare industry. “Accreditation identifies which ACOs are likely to be good partners” and serves as “a roadmap and vehicle for provider-led groups to show their abilities,” the NCQA noted in briefing materials released to the media.

NCQA’s ACO accreditation standards require ACOs to demonstrate capabilities in:

  1. program operations
  2. access and availability
  3. primary care
  4. care management
  5. care coordination and transitions
  6. patient rights and responsibilities
  7. performance reporting

Additionally, to achieve the highest level of accreditation, ACOs must demonstrate annually strong performance or significant improvement on core performance measures of clinical quality, patient experience and efficiency/utilization.

[See also: ACOs don't have to be daunting, according to experts .]

NCQA’s ACO accreditation program offers three accreditation levels.

  • 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. 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.

Those who are eligible for the NCQA’s ACO accreditation program include providers in group practices, networks of individual practices, hospital/provider partnerships, hospitals and their employed or contracted providers, publicly governed entities that work with providers to arrange care and provider/health plan partnerships.

Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.