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Quality Group Unveils ACO Standards

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The National Committee for Quality Assurance (NCQA) has released the requirements it will set for organizations that want to participate in the new NCQA accountable care organization (ACO) accreditation program.

The Billings Clinic, Billings, Mont., and HealthPartners, Minneapolis, already have agreed to participate in the ACO accreditation program, according to officials at the NCQA, Washington. Those organizations hope to undergo ACO readiness exams by the end of 2012.

The NCQA will provide 3 levels of ACO entity accreditation, officials say.

To win accreditation, an entity that wants to participate in an ACO will have to meet NCQA standards in 7 areas:

  1. Program Operations.
  2. Access and Availability.
  3. Primary Care.
  4. Care Management.
  5. Care Coordination and Transitions.
  6. Patient Rights and Responsibilities.
  7. Performance Reporting.

Types of entities eligible for ACO accreditation include:

  • 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.

The NCQA got its start by developing quality reporting guidelines and accreditation programs for health maintenance organizations. The group since has branched out and has been developing quality programs for other types of health care organizations, such as preferred provider organization plans.

An ACO is supposed to be an organization that gives doctors, hospitals and other ACO providers financial incentives to make the care for a medical condition as efficient as possible, to get away from the system of having an insurer or other payer encourage provider to drive up costs by billing separately for each service provided.

The Patient Protection and Affordable Care Act of 2010 (PPACA) requires the Centers for Medicare & Medicaid Services (CMS) to try using ACOs and other new reimbursement strategies to reduce Medicare program costs.

CMS has developed the Medicare Shared Savings Program and another ACO program, the Pioneer ACO program.

Private health insurers also are participating in ACO programs.