Program eligibility criteria determine the organizations that may come through the ACO accreditation program. NCQA considers an organization’s scope and the types of providers it includes in its network. How providers are organized as accountable entities varies by a region’s existing practice structures, population needs or local environmental factors.
- Entities that provide and perform relevant functions are eligible for NCQA ACO Accreditation and include, but are not limited 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
- Provider-health plan partnerships or joint ventures
Regardless of structure, eligible entities must have a strong foundation of patient-centered 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 which evaluate Accountable Care Organizations (ACOs). The ACO Accreditation program evaluates organizations in seven domains:
1. ACO Structure and Operations
The organization clearly defines its organizational structure, demonstrates capability to manage resources and aligns provider incentives through payment arrangements and other mechanisms to promote the delivery of efficient and effective care.
2. Access to Needed Providers
The organization has sufficient numbers and types of practitioners and provides timely access to culturally competent health care.
3. Patient-Centered Primary Care
The primary-care practices within the organization act as medical homes for patients.
4. Care Management
The organization collects, integrates and uses data from various sources for care management, performance reporting and identifying patients for population health programs. The organization provides resources to patients and practitioners to support care management activities.
5. Care Coordination and Transitions
The organization facilitates timely exchange of information between providers, patients and their caregivers to promote safe transitions.
6. Patient Rights and Responsibilities
The organization informs patients about the role of the ACO and its services. It is transparent about its clinical performance and any performance-based financial incentives offered to practitioners.
7. Performance Reporting and Quality Improvement
The organization measures and publically reports performance on clinical quality of care, patient experience and cost measures. The organization identifies opportunities for improvement and brings together providers and stakeholders to collaborate on improvement initiatives.
to order the Web based 2012 ACO Standards and Guidelines.
ACO Educational Assessment
NCQA’s standards comprise a feasible path providers can follow to become ACOs. However, not all aspiring ACOs will be able to meet our standards. If qualifying standards are weak, so-called ACOs may fail to improve quality and control costs. Widespread failure could undermine support for the ACO concept. That could be catastrophic for the nation’s health and finances, thwarting gains that could make the health care delivery system better. High standards increase the likelihood that ACOs will fulfill their potential. Setting high standards is also NCQA’s duty as a nonprofit charged to improve health care quality.
For organizations just embarking on their ACO journey, NCQA offers an ACO Educational Assessment. This survey option provides an organization a chance to dialogue with NCQA about its performance against the standards and to receive an in depth review of areas to improve. For more information, or if you have questions, please email firstname.lastname@example.org.