NCQA ACO Accreditation Overview

November 18, 2011
155 Views

The National Committee for Quality Assurance (NCQA) is launching a new accreditation program for Accountable Care Organizations on November 21st. ACO accreditation is an independent evaluation of healthcare delivery organizations’ ability to coordinate the high quality, efficient, patient centered care expected of ACOs. I decided to write a brief comprehensive overview based on the presentation and white paper provided by NCQA. 
Why ACO Accreditation Matters:
  • Variation in capabilities and readiness make ACOs risky for payers, patients.
  • Assures patients their ACOs focus on them and their care
  • Aligns purchasers with common expectations
  • Identifies which ACOs are likely to be good partners
  • A roadmap & vehicle for provider led groups to show their abilities
Levels of Accreditation-the program will have three levels of scoring, to allow organizations with varying levels of capability the opportunity to be accredited

Level 1
  •  For organizations in the formation or transformation stage; have not reached full ACO capability
  • Organizations have basic infrastructure and some capabilities outlined in standards.
  • Length of status: 2 years
  • 50 points
  • Must Pass Elements: None
Level 2
  • For well-established organizations that strongly demonstrate the capabilities outlined in the standards
  • Length of status: 3 years
  • 70 points
  • Must Pass Elements: Yes- Report core performance measures and patient experience, evaluate and improve patient-centered primary care, and have complete data on a minimum threshold of patients
Level 3
  • Achieve Level 2 and demonstrate strong performance or improvement across the triple aim
  • Length of status: 3 years
  • 70 points and performance against triple aim
  • Must Pass Elements: Yes: Same as Level 2
Why Measure Structure and Process? 
  • Most ACOs are not ready to be judged mainly on outcomes
  • Evidence-based standards can identify which ACOs are most likely to deliver on the triple aim
Accreditation Standards Capability
The ACO program contains 7 categories, broken into 65 elements; element -level point allocation is based on 100 points; there are 4 must pass elements. These fall into several important areas. 
  1. Program Operations-The infrastructure to coordinate providers
  2. Access & Availability- Ensure the ACO has sufficient numbers, types of practitioners, timely access to care, etc. 
  3. Primary Care- Promotes the delivery of patient centered primary care by providing patients access to patient-centered medical homes, etc. 
  4. Care Management- Collects, integrates and uses data from various sources for care management and performance reporting, etc. 
  5. Care Coordination and Transitions- Has a coordinated system to facilitate timely information exchanges between multiple providers
  6. Patient Rights and Responsibilities- States its commitment to treating patients in a matter that respects their rights and privacy, etc. 
  7. Performance Reporting- Strives to improve the quality of services by evaluating it’s performance using valid measures, make results available to the public and ACO providers
For more information:
– Read the NCQA white paper (.pdf)
– check out the NCQA presentation (.pdf)