Tips to prepare for accountable care, quality certification

Healthcare organizations will have to figure out how to overcome issues, such as a physician preference for autonomy, to successfully create and manage an accountable care organization (ACO), experts at the McGuireWoods law firm say in a paper.

The paper outlines five key questions to consider when forming an ACO:

  • What are the core competencies of ACOs, from participating providers to the administrator?
  • How will providers address physician alignment and integration barriers such as "physician attitudes favoring autonomy over coordination"?
  • How will ACOs maintain patient satisfaction and engagement when outcomes are largely dependent on patients participating in their care?
  • How will the ACO utilize health information technology?
  • What legal and regulatory issues are associated with forming an ACO, such as federal laws preventing self-referral of patients?

Meanwhile, Gregory Spencer, M.D., chief medical officer at Crystal Run Healthcare in Middletown, N.Y., describes steps the organization took to become a certified ACO through the National Committee on Quality Assurance (NCQA), in an article in Government Health IT.

Crystal Run has 300 providers in 15 locations. It achieved Joint Commission certification to standardize processes; shifted the culture toward value-based care and population management to achieve patient-centered medical home certification; became a Medicare Shared Savings Program ACO by showing how it delivered value-based care, then demonstrated those capabilities to the NCQA to achieve Shared Savings certification.

Two partner-level physicians serve as chief medical transformation officers to drive change, Spencer wrote, including the use of population-management tools such as evidence-based treatment guidelines and performance reports.

The provider group also adopted what Spencer called a three-tiered approach to technology: an electronic health record, population-management technology including dashboards highlighting the health of a physician's patients, and enterprise technology showing how doctors perform against quality metrics.

"Although the journey toward becoming an ACO has not been easy, CRH is already seeing the benefits of the work in terms of learning how to better manage the health of diverse populations," he wrote. "CRH has also adopted the mindset that becoming an ACO is not about saving money: it's about improving the quality of care the practice provides and reducing waste."

To learn more:
- read the McGuireWoods paper
- here's Spencer's article