New NCQA Accreditation Program Identifies ACOs That Are Most Likely To Succeed 

Minnesota, Montana Groups Are Early Adopters

Washington, DC—On November 21, the National Committee for Quality Assurance (NCQA) will release the standards and guidelines that compose its new Accountable Care Organization (ACO) Accreditation program.

The program provides a roadmap for provider-led organizations to demonstrate their ability to reach the triple aim: reduce cost, improve quality and enhance the patient experience.

To maximize accreditation’s usefulness for a variety of ACOs and ACO partners, the NCQA program:
 
  • Aligns with many aspects of the Medicare Shared Savings Program
  • Addresses expectations common among private purchasers
  • Uses three levels of accreditation to signify differing levels of ACO readiness and capability.

The Billings Clinic of Billings, MT, and HealthPartners of Minneapolis, MN, are the first organizations to commit to using NCQA Accreditation to demonstrate their readiness as ACOs. Both organizations will undergo a full survey of their ACO capabilities between March 1 and December 31, 2012.

“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.”

Alignment With CMS, Other Purchaser Initiatives

Accreditation is designed to meet the needs of various payers—health plans, employers, Medicaid and Medicare. The program defines common requirements that stakeholders can use to drive providers to improve.

Standards and Measures

Accreditation standards require ACOs to demonstrate capabilities in seven areas:

  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
     

Themes include expectations of ACOs’ leadership, including organizational structure and governance; patient-centered primary care as the foundation for good ACO care; resources to manage population health, such as care coordination and care transitions; transparency and aligning incentives to improve quality across providers; resource stewardship.

In addition to performance against the standards, the highest level of accreditation hinges on demonstrated strong performance or significant improvement on core performance measures of clinical quality, patient experience and efficiency/utilization submitted annually.

Accreditation Levels

The NCQA program includes three accreditation levels that signal how ready organizations are to participate in innovative payment arrangements and value-based purchasing. 
 

  • 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, and 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.

Eligibility

ACOs are generally defined as provider-based entities that aim to improve the quality of health care and reduce cost growth for a group of people. In order to have sufficient patients for quality reporting and managing financial risk, ACOs need to serve at least 5,000 patients.
Organizations eligible for ACO accreditation include:

  • 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
     
 
ABOUT NCQA
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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Media Contacts

Andy Reynolds
202-955-3518  

Apoorva Stull
202-955-3567