The National Committee for Quality Assurance, like the CMS, is attempting to provide a practical framework to realize the hopes for accountable care organizations.
NCQA offers standards, designations for ACOs
The not-for-profit organization unveiled a tiered set of standards for accrediting ACOs at different stages of development and sophistication, beginning Nov. 21. The standard-setting organization already has criteria for patient-centered medical homes, health plans and disease management.
Accountable care, a popular, if loosely defined, model for improving healthcare delivery and payment, offers hospitals and medical groups financial incentives to curb health spending growth and improve quality for a group of patients.
Medicare is scheduled to begin accountable care contracts with providers April 1 and July 1 under the Patient Protection and Affordable Care Act. Federal officials released final rules for the agreements in October (Oct. 24).
ACOs with at least 5,000 patients may seek one of three NCQA designations of accreditation. The first designation, or Level 1, is for those least prepared for the quality reporting and financial risks of accountable care. Designations grow more stringent for organizations that have more infrastructure to adopt the payment model.
Levels give hospitals and medical groups some flexibility as they seek to develop ACOs, said Dr. Duane Davis, vice president and chief medical officer of the Geisinger Health Plan and one of 20 members of the NCQA task force to define ACO standards.
“ACOs have never existed,” Davis said. “Anybody who thinks they know what a perfect ACO looks like is feeding you a line.” He noted that when the NCQA began work on ACO accreditation two years ago, accountable care was little more than a concept. “You have to have enough flexibility for people to evolve.”
Meanwhile, the NCQA standards offer fledgling ACOs criteria by which to measure progress. Davis said the standards offer some structure for ACO development efforts. The standards are not comprehensive and do not address financial arrangements of accountable care, he said.
Level 2 and Level 3 groups must report patient experience and performance measures; evaluate and improve patient-centered primary care; and maintain complete data for a required number of patients. Level 2 groups must earn 70 points on the NCQA 100-point evaluation scale.
Level 3 groups must earn 70 points and demonstrate performance on reducing costs and improving population health and the experience of care through state or regional measures or national benchmarks.
The NCQA's100-point evaluation for accreditation will measure performance across seven areas. They include: ACO operations, such as infrastructure to coordinate providers; access to needed providers; care management, including meaningful use of information technology; care coordination and transitions; patient rights and responsibilities; performance and quality improvement; and patient-centered primary care.
Raena Grant Akin-Deko, assistant vice president of product development for the NCQA, said the accountable care accreditation builds on patient-centered medical homes, and ACOs will be expected to have a “comprehensive and cohesive” approach to primary care.
The NCQA measures include 25 quality measures, two measures of patient experience and seven measures of utilization. Among the quality measures, which vary somewhat from the ones required for the Medicare ACO contracts, are ones that address: cancer screenings; pediatric immunization; diabetes management; medication reconciliation once patients leave the hospital; and prescription monitoring among seniors.
The utilization measures address treatment for low-back pain, asthma, cardiovascular conditions, chronic obstructive pulmonary disease, diabetes and hypertension.
The Billings (Mont.) Clinic and HealthPartners, a two-hospital system based in Bloomington, Minn., have begun to pursue accreditation. The two systems were among 10 pilot locations that performed mock surveys and interviews in early 2011 to test the accreditation.
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