'Commonplace' ACO accreditation could raise costs

With National Committee for Quality Assurance (NCQA) in November launching accountable care organization (ACO) accreditation, experts say that ACO accreditation could become the norm.

"An accreditation process will likely become a requirement or at least, commonplace," said Dr. Charles Kennedy, Aetna's chief executive for Aetna's accountable care division, in a Managed Healthcare Executive article. "As to whether it is NCQA or other entity, I can't say, but NCQA has a strong record."

Known for certifying healthcare organizations, including patient-centered medical homes, NCQA--the independent nonprofit agency--looks at seven domains to evaluate whether a group or organization qualifies as an ACO: structures and operations, access to needed providers, patient-centered primary care, care management, care coordination and transitions, patient rights and responsibilities, and performance and quality improvement.

"Accreditation will provide a checkpoint for organizations going down that path so they can demonstrate to health plans, employer groups and individual patients that they have met the basic criteria to become an ACO," Kennedy said.

The ACO accreditation adds some standardization to the process, according to NCQA. Still in the early stages of ACO development, many groups of providers and payers are self-designating themselves as ACOs, even though they may not fall under the final 32 CMS-recognized Pioneer ACOs announced last month.

"The committee did not want people out there with training wheels on calling themselves an ACO," NCQA President Margaret E. O'Kane said in the article.

Hospitals and health systems are leading the way in ACO development. In fact, nearly two-thirds (60 percent) of surveyed ACO-identified organizations were started by hospitals and health systems, according to a Leavitt Partners report last month.

Although ACO accreditation could become commonplace, it also could up the cost of becoming an ACO, the Managed Healthcare Executive article notes. CMS has estimated that the start-up costs will be $1.7 million per ACO, based on a 2008 study of the Physician Group Practice Demonstration project. Kennedy suggested that providers work with payers to help absorb those accreditation start-up costs.

For more information:
- read the Managed Healthcare Executive article
- see the NCQA ACO accreditation categories

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