NCQA CONVENES EXPERTS TO DEFINE CRITERIA FOR ACCOUNTABLE CARE ORGANIZATIONS

WASHINGTON, D.C. — The National Committee for Quality Assurance (NCQA), a leader in health care quality for 20 years, has convened a multi-stakeholder Accountable Care Organization (ACO) Task Force to help develop a consensus on ACO qualifying and monitoring criteria.

Accountable Care Organizations (ACOs) are provider based organizations that take accountability for both the quality and costs of health care for a defined population. The ACO builds on the patient-centered medical home; these organizations minimally include primary care and may include sub-specialists and hospitals. By coordinating and integrating care, policymakers hope ACOs can simplify the care process for patients, enhance quality, improve efficiency and reduce costs. Under the new health reform law, groups of providers who voluntarily meet certain criteria, including quality measurement, may form ACOs and share in the cost savings they achieve for public purchasers.

Chaired by Robert Margolis, MD, CEO of the HealthCare Partners Medical Group, the NCQA ACO Task Force will be instrumental in defining requirements flexible enough to accommodate the variety of emerging ACO models.

“We want to be sure that accountable care organizations (ACOs) are positioned for success through more organized, higher quality and more efficient operations. We also need to be sure that patients understand the advantages of better organized care,” explained Margaret O’Kane, President of the National Committee for Quality Assurance. “NCQA is excited to work with this a very sophisticated group of stakeholders to map the capabilities that will lead to success on all these fronts.”

Regardless of the organizational structure, ACOs will need to have a strong primary care foundation. Substantial evidence shows that comprehensive primary care coupled with coordination across the care continuum can lead to higher quality and lower costs. Additionally, research shows that strong, consistent leadership, alignment of goals and incentives throughout the care delivery system and comprehensive performance measurement and reporting may be important contributors to the success of provider organizations aiming to improve the value of care. NCQA’s Task Force will build on research and experience from medical home evaluation and work towards consensus to develop initial qualifying criteria and ongoing performance monitoring of ACOs.

In addition to Dr. Margolis, Task Force members include:  

• Lawrence Casalino, MD, PhD, Chief, Division of Outcomes & Effectiveness Research, Livingston Farrand Associate Professor of Public Health, Weil Cornell Medical College
• Jay Crosson, MD , Executive Director, The Permanente Foundation
• Nicole DeVita, Rph, MHP, Senior Director, Alternative Quality Contracts Consultative Support, Blue Cross Blue Shield of Massachusetts
• Duane Davis, MD, Vice President, Chief Medical Officer, Geisinger Health Plan
• Joseph Francis, MD, MPH, Chief Quality and Performance Officer, Department of Veterans Affairs
• Stuart Guterman, Assistant Vice President, The Commonwealth Fund
• George Isham, MD, Medical Director & Chief Health Officer, Health Partners
• Julie Lewis, Health Policy Director, The Dartmouth Institute
• Phil Madvig, MD, Associate Executive Director, The Permanente Medical Group
• Dolores Mitchell , Executive Director, Group Insurance Commission of Massachusetts
• Edward Murphy, MD, President and CEO, Carilion Clinic, Roanoke, Va.
• Gordon Norman, MD, MBA, Executive Vice President, Chief Innovation Officer, Inverness Medical Innovations/Alere Inc.
• Cathy Schoen, Senior Vice President, The Commonwealth Fund
• Jeff Stensland, PhD, Principal Policy Analyst, MedPAC
• Susan Stuard, Executive Director, THINC Inc.
• John Toussaint, MD, President and Founder, Thedacare Center for Healthcare Value
• Woody Warburton, MD, Professor & Division Chief, Family Medicine, Duke University Medical Center
• Nicholas Wolter, Chief Executive Officer, The Billings Clinic

As a leader in patient-centered health quality measurement and evidence-based standards, NCQA is eager to work with these experts to expand on its work supporting delivery system redesign.

 “As the country moves to implementation of the new health care reform policies, this group will be essential in setting transparent and measurable criteria for accountable care organizations,” explains Robert Margolis, MD, CEO of the HealthCare Partners Medical Group and Chair of the ACO Task Force. “Accountable care organizations need flexible qualifying criteria as well as rigorous measures for reporting and benchmarking across the Triple Aim of improving quality, improving the patient experience and reducing waste.”
 
NCQA hopes to release a report in late summer 2010 outlining the committee’s recommendations for ACO evaluation criteria.

About the National Committee for Quality Assurance

Celebrating its 20th anniversary in 2010, NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.

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