The National Committee for Quality Assurance (NCQA), a private,
not-for-profit organization that accredits and certifies health plans and other
healthcare related organizations published on Oct. 19, 2010, its
Accountable Care Organizations Criteria. The draft criteria describe the
standards NCQA believes ACOs should meet in order to ensure that an ACO has the
infrastructure necessary to function as an accountable entity and achieve
improvements in quality and reductions in costs. The draft criteria were
developed with the guidance of a multistakeholder
Accountable Care Organization Task Force assembled by NCQA.
The draft criteria are arranged into seven categories that reflect the core
capabilities ACOs should possess:
- Program Structure Operations
- Access and Availability
- Primary Care
- Care Management
- Care Coordination and Transitions
- Patient Rights and Responsibilities
- Performance Reporting
There is no indication at this time that the Centers for Medicare and
Medicaid Services (CMS) or any other regulatory agency will adopt these criteria
in establishing requirements for ACOs under the Medicare Shared Savings Program
or any other ACO initiative under the Medicare or Medicaid programs, but it is
possible that they could be relied upon by CMS and other regulatory agencies in
determining how ACOs should be structured and how their performance should be
NCQA is accepting public comments on the draft criteria until Nov. 19, 2010.
NCQA has specifically requested comments on a number of issues related to the
ACO criteria, including:
- Whether the types of specialists that should be included in the ACO
should be specified in the criteria.
- Whether the eligibility criteria captures the organization types that
have the capability to act as ACOs and whether additional structures should
- Whether measures such as Healthcare Effectiveness Data and Information
Set (HEDIS) and Meaningful Use align with stakeholder expectations for ACOs.
- Whether there are critical functions of ACOs that are not included in
the draft criteria.
It is unclear at this time what impact the NCQA criteria will have on the development
of ACOs, but it is likely that NCQA will continue to have a voice in the public
dialogue about the evolution of this healthcare delivery model and its role in
improving quality and reducing costs under healthcare reform.
If you would like to submit comments to the NCQA or if you would like to
discuss the draft criteria for ACOs, please contact one of the authors.