ACO variation creates complexity

April 1, 2013

Infrastructure needed to ensure organizations live up to the promise of ACOs

If ACOs are a linchpin in the health system’s transition from volume to value, then every organization that calls itself an ACO should be able to verify it can execute the model successfully, according to the National Committee for Quality Assurance (NCQA), which accredits ACOs.

“Being an ACO is a very complicated set of responsibilities,” says NCQA president Margaret O’Kane. “We don’t want to have organizations mess up the concept.”

O’Kane says the managed care backlash of the 1990s is an example of what the system does not want to see happen with ACOs. Accreditation can help providers design appropriate infrastructure and stay true to the promise of accountable care. It also aligns health plans around a common set of expectations.

“What we want at the end of the day is a situation where payers are working in a similar arrangement with each ACO,” she says. “We’re in a current state where individual payers are making their own arrangements.”

And that variation can create more administrative burdens and make meeting performance measures more complex for providers.

NCQA accreditation for accountable care can be applied for Medicare and commercial arrangements.

In January 2012, six early adopters earned ACO accreditation from NCQA. For example, Crystal Run Healthcare in New York, with a level-two accreditation status, standardized certain best practices to improve care, which also reduced waste. According to CEO Hal Teitelbaum, MD, operating with one foot in the fee-for-service  world and one foot in the ACO world simply won’t work. The ACO must become an ACO throughout, rather than treating accountable care as a separate process. Another challenge is achieving internal alignment.

“Physicians and other providers and staff continue to get mixed messages from the outside world-including payers and some provider that have not adopted accountable care,” Dr. Teitelbaum says.

He says Crystal Run is considering starting its own health plan that would be built on an accountable care model.

“We live in a predominantly fee-for-service world, and we are trying to push commercial payers, sometimes kicking and screaming, to reward us for outcomes,” he says.

NCQA evaluates organizations in seven categories:

  • ACO Structure and Organizations

  • Access to Needed Providers

  • Patient-Centered Primary Care

  • Care Management

  • Care Coordination and Transitions

  • Patient Rights and Responsibilities

  • Performance Reporting and Quality Improvement