Program Structure: ACO Accreditation
Below are some frequently asked questions about NCQA Accountable Care Organization Accreditation. If you don’t see what you’re looking for, you can ask a question through My NCQA.
What is ACO accreditation?
ACOs have the potential to get better quality at lower cost by aligning incentives to promote coordination and transform health care delivery. NCQA ACO Accreditation evaluates whether ACOs deliver high-quality, patient-centered, integrated accountable care. NCQA’s ACO standards and guidelines incorporate whole-person care coordination throughout the health care system.
How does ACO accreditation help my organization?
The NCQA standards focus on an organization’s structure and how it delivers integrated and coordinated care, and on performance reporting, transparency and quality improvement. By learning these standards, performing a gap analysis and applying the standards, an organization can identify potential deficiencies in care delivery and improve care. Not only is this good for patients, but by standardizing processes to improve care, an organization can lower overall health care costs and become an attractive partner with which to contract.
NCQA ACO Accreditation is earned by meeting a set of requirements found in the Standards and Guidelines document. These include, but are not limited to:
- ACO Structure & Operations: Are the necessary infrastructure and leadership in place to move health care systems toward the triple aim of better health, lower costs and better patient experience? How does the ACO determine provider payment and contracting arrangements?
- Access to Needed Providers: Does the ACO provide the full range of health care services to patients (e.g., primary care, tertiary care, community and home-based services)?
- Patient-Centered Primary Care: Does the ACO practice patient-centered care methods and provide access to patient-centered medical homes?
- Care Management: How does the ACO provide resources for patients and practitioners to support care management activities?
- Care Coordination and Transitions: How does the ACO facilitate information exchange across providers and sites of care.
- Patient Rights and Responsibilities: Does the ACO communicate its performance to patients? Is it transparent about performance-based payment arrangements with providers?
- Performance Reporting and Quality Improvement: Does the ACO collect, integrate and disseminate data for care management, performance reporting and other uses? Does the ACO provide reports to its clinicians to assist with quality improvement?
As part of ACO accreditation, organizations must:
- Monitor patient experience and up to 40 measures of clinical quality and cost.
- For Level 2 accreditation: Be able to collect and report these measures.
- For Level 3 accreditation: Show strong performance or significant improvement on these measures.
Where can I find the Standards and Guidelines?
Find the Standards & Guidelines document, survey tool and application in the NCQA Store.
What organizations are eligible for ACO accreditation?
Some entities that may be eligible for ACO accreditation 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.
- Medicare Shared Savings Program ACOs.
Organizations must also:
- Be a health care delivery organization or provide health care services through an organized delivery system.
- Have a governance structure and support systems for participating providers.
- Have a process for monitoring and evaluating participating providers in the ACO against the organization’s goals for clinical quality, patient experience and costs for the defined population.
- Include primary care practices as participants in the ACO.
- Perform functions stated in the ACO standards and guidelines, either directly or through a service agreement with providers.
- Provide care for at least 5,000 patients using the quality systems evaluated in the ACO standards and guidelines when the application and agreement are submitted.
Find full eligibility criteria in the Standards and Guidelines document.
Earning ACO accreditation
Organizations must go through a survey process that involves submitting documentation to NCQA. See a step-by-step process.
What does ACO accreditation cost?
The price varies by organization. Contact NCQA for pricing information.
How long does it take to earn ACO accreditation?
It depends on how many program requirements have been implemented at sites. After survey submission, it takes approximately 60–90 days for NCQA to determine accreditation. We recommend that organizations perform a gap analysis and begin implementing changes from 9–12 months before the date when they want to earn accreditation.
Organizations that do not have a current ACO accreditation and want to learn more should contact NCQA.
Organizations with a current ACO accreditation that want to talk to someone about their current status or about renewing should submit a question through My NCQA.
Have other organizations earned ACO accreditation?
Find organizations that have earned accreditation in the NCQA Report Card.