PUBLIC INVITED TO COMMENT ON ACCOUNTABLE CARE ORGANIZATION EVALUATION CRITERIA


WASHINGTON, DC—The National Committee for Quality Assurance (NCQA) seeks public comment on criteria for Accountable Care Organizations (ACOs). The NCQA draft standards were developed with the guidance of a multi-stakeholder Accountable Care Organization Task Force, chaired by Robert Margolis, MD, CEO of the HealthCare Partners Medical Group in Torrance, California.

ACOs are provider-based organizations that take responsibility for meeting the health care needs of a defined population with the goal of simultaneously improving health, improving patient experience and reducing per capita costs. The Patient Protection and Affordable Care Act make provisions for ACOs to share in the cost savings they achieve for public purchasers; many private payers are expected to follow suit. Providers in several states are already working to establish ACOs. How they organize themselves as accountable entities will vary based on region, population needs or local environmental factors.

Ed Murphy, MD, President and CEO of Carilion Clinic thinks, “ACOs should save money and maintain quality by getting people the care they need when they need it. Providing the public an opportunity to comment on these draft standards gives stakeholders―including consumers― vital input for changing their health care.”

There is vigorous debate in policy circles today about how to qualify organizations to act as ACOs and how to evaluate their performance. Based on years of experience with measurement and evaluation, NCQA believes that we should begin with structure and process measures that tell us that an ACO has the infrastructure necessary to function as an accountable entity and achieve the triple aims. Criteria should provide a blueprint for ACO development and assess core capabilities that improve the likelihood of success. While performance measurement is critical to evaluate ACO success, it will take some time before organizations can be judged on the outcomes they achieve.

“Most potential ACOs do not have data that can be used from the start to evaluate performance. Public feedback will help with finalizing the criteria that will start these organizations to a firm foundation.” said Robert Margolis, MD, CEO of the HealthCare Partners Medical Group and Chair of the ACO Task Force.

NCQA is developing criteria that are within reach of the range of ACO configurations (e.g. “virtual” ACOs created by independent practice associations, multispecialty practices, integrated delivery systems, etc.)  and that provides consumers, policy makers and other stakeholders greater confidence in this emerging innovation.

“It is important that accountable care organizations are structured with patients in mind,” explains Kirsten Sloan, Vice President, National Partnership for Women & Families. “Having the ACO standards developed with input from patient and consumer groups will help ensure that ACOs provide genuine patient-centered care.”

As an essential part of this criteria development process, NCQA solicits comments directly from a broad range of stakeholders.

“Our goal is to help people be confident that ACOs meeting the final criteria actually can contain costs without compromising quality,” explained Margaret O’Kane, President of the National Committee for Quality Assurance. “This public comment gives stakeholders an opportunity to help shape standards and ensure that we have input from all interested parties as we work toward final criteria that everyone can support.”

The draft criteria are arranged into seven categories that reflect the core capabilities ACOs should possess:

1. Program Structure Operations (PO)
2. Access and Availability (AA)
3. Primary Care (PC)
4. Care Management (CM)
5. Care Coordination and Transitions (CT)
6. Patient Rights and Responsibilities (RR)
7. Performance Reporting (PR)

The draft criteria are at www.ncqa.org/publiccomment.aspx. The public is invited to comment from Tuesday, October 19 until 5 p.m. on Friday, November 19.

For more information, please visit www.ncqa.org.

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