Program Structure: ACO Accreditation

NCQA Accountable Care Organization (ACO) Accreditation provides a roadmap for ACOs, or those seeking to become ACOs, to provide patient-centered, integrated quality care.

Program requirements

Organizations can earn NCQA ACO Accreditation by meeting a set of requirements found in the Standards and Guidelines document. These include, but are not limited to:

  • ACO Structure & Operations: Is 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 various uses, like care management and performance reporting. Does the ACO provide reports to clinicians within the ACO 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.

Types of Entities

There is no one definition for an “ACO”—a variety of organizations may be interested in NCQA 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.

Eligibility

NCQA defines an “eligible entity” as a provider-based organization that is responsible for managing the health care needs of a defined population, with the goal of simultaneously improving health and patient experience and reducing per capita costs. The organization must:

  • 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.

How NCQA Awards Accreditation

NCQA evaluates your organization against a set of standards and guidelines. Get an overview of the ACO Accreditation process.

After your organization earns NCQA Accreditation, it will also earn a certain level, from Level 1–Level 3. The levels are glide path: ACOs at Level 1 can work towards becoming Level 3. The table below gives an overview of requirements.

Level earned Points required # of must-pass elements required Performance reporting to regional collaborative or a national initiative required?
Level 1 50+ None No
Level 2 70+ 4 of 4 No
Level 3 70+ 4 of 4 Yes

Not ready? Get An ACO assessment.

NCQA’s standards create a path for providers to become ACOs—but not all aspiring ACOs will be able to meet standards right away.

For organizations just starting the ACO journey, NCQA offers an ACO Educational Assessment. This gives an organization the chance to talk with NCQA about its performance against the standard requirements and to get an in-depth review of areas that need improvement. For information, contact us through My NCQA.

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