Posted

Cheryl Clark, for HealthLeaders Media, September 24, 2012
 

Provider groups that claim to be accountable care organizations now have a way to prove it through an accreditation program offered by the National Committee for Quality Assurance.

“Since the idea of ACOs became something that people got excited about in the last couple of years, many organizations are saying ‘I’m an ACO, I’m an ACO,’ ” says Sarah Thomas, vice president of public policy and communications for the NCQA, a private non-profit healthcare measurement group in Washington, D.C.

“But not all organizations have what it takes to be able to deliver on the promise of the Triple AIM, which is better quality, better experience and at a lower cost. This program is designed to help purchasers and consumers know which ACOs have met our tough tests to deliver on that promise.”

By the end of the year, Thomas says, “the public will know the names of several organizations that have passed our tough review.” Many more of the 100 or so self-labeled ACOs around the country are expected to seek similar scrutiny in 2013.

The NCQA, which also has set quality criteria for accreditation of medical homes, health insurance plans, employer wellness programs, multicultural health initiatives, and many other improvement efforts, has established dozens of specific criteria these ACOs must demonstrate.

For example, there are key measures providers must meet to demonstrate high quality in childhood disease and obesity prevention. They also must show that they meet certain processes of care expected for patients with cardiovascular, respiratory, blood glucose, musculoskeletal, and behavioral health issues.

The NCQA also has established criteria for competency in medication management, access and availability, utilization, and especially care coordination, so that physicians and hospitals make sure patients get what they need after they leave an acute care or clinic setting.

Other measures cover cancer screening, prescription drug use, and immunizations.

Last November, the NCQA announced its ACO accreditation program, and identified the basic competencies these groups are expected to have, or the structure of the ACO accreditation program.

For example, ACOs can only be accredited if it has a sufficient number of certain types of providers to serve the population, if it collects and uses data to measure improvement, and if it has a way to protect patient privacy.

Also last November, the NCQA also set forth three levels of accreditation, Level 1 (50 points), Level 2 (70 points plus four “must pass” measures, and Level 3 (all of Level 2, shows improvement and maintains standards for three years).

With the latest announcement this month, the NCQA has identified the specific measures (Healthcare Effectiveness Data Information Set or HEDIS) and other criteria each ACO must meet. For example, practitioners must show that they maintain good blood pressure and cholesterol control for their patients who have cardiovascular disease.

These measures must be demonstrated throughout the provider ACO network, from physician’s office to physician’s office to clinic to acute care hospital to skilled nursing facility or hospice.

Thomas says that the organizations that meet accreditation criteria can show that they “look to find more efficient patterns of care that prevent people from ending up in the hospital or emergency room. They would be looking for opportunities to keep people from getting sick, rather than erecting barriers.”

She adds, “hospitals are very dangerous places. It’s a good thing to have your care managed outside the hospital and not end up in a crisis situation.”

Measures that scrutinize an ACO’s efficiency, utilization, and overuse will reflect how well providers avoid antibiotics in adults with acute bronchitis, unnecessary use of imaging studies for patients with low back pain, and will measure all-cause readmissions.  Relative resource use or RRU measures expected in the future will look at costs for asthma, heart and lung diseases, diabetes and hypertension.

Surveys measuring patient experience will also be a component of the final score.

Those organizations receiving accreditation will be named on the NCQA website, Thomas says. Eventually, if the data is statistically strong enough, specific scores will be posted for each ACO. Still to be disclosed is the precise weight each of the NCQAs measures will have in determining an ACO’s score.

In January, the NCQA named six organizations that agreed to be first to undergo the accreditation process to be an ACO. The results will be announced by Dec. 31, Thomas says.

They are:

•  Billings Clinic, Billings, MT

•  Children’s Hospital of Philadelphia, Philadelphia, PA

•  Crystal Run Healthcare, Middletown, NY

•  Essentia Health, Duluth, MN

•  HealthPartners, Minneapolis, MN

Kelsey-Seybold Clinic, Houston, TX

Thomas says that the accreditation criteria may be applied to organizations working within Medicare ACO, or health plan models as well, although some of the criteria, such as measures for pediatric care or drug abuse and behavioral health care, are keyed for a population younger than age 65.

 

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