NCQA of­fers stan­dards, des­ig­na­tions for ACOS

Modern Healthcare - - NEWS - Melanie Evans

NCQA of­fers stan­dards, des­ig­na­tions for ACOS

The National Com­mit­tee for Qual­ity As­sur­ance, like the CMS, is at­tempt­ing to pro­vide a prac­ti­cal frame­work to re­al­ize the hopes for ac­count­able care or­ga­ni­za­tions. The not-for-profit or­ga­ni­za­tion un­veiled a tiered set of stan­dards for ac­cred­it­ing ACOS at dif­fer­ent stages of de­vel­op­ment and so­phis­ti­ca­tion, be­gin­ning Nov. 21. The stan­dard-set­ting or­ga­ni­za­tion al­ready has cri­te­ria for pa­tient-cen­tered med­i­cal homes, health plans and dis­ease man­age­ment.

Ac­count­able care, a pop­u­lar, if loosely de­fined, model for im­prov­ing health­care de­liv­ery and pay­ment, of­fers hos­pi­tals and med­i­cal groups fi­nan­cial in­cen­tives to curb health spend­ing growth and im­prove qual­ity for a group of pa­tients.

Medi­care is sched­uled to be­gin ac­count­able care con­tracts with providers April 1 and July 1 un­der the Pa­tient Pro­tec­tion and Af­ford­able Care Act. Fed­eral of­fi­cials re­leased fi­nal rules for the agree­ments in Oc­to­ber (Oct. 24, p. 6).

ACOS with at least 5,000 pa­tients may seek one of three NCQA des­ig­na­tions of ac­cred­i­ta­tion. The first des­ig­na­tion, or Level 1, is for those least pre­pared for the qual­ity reporting and fi­nan­cial risks of ac­count­able care. Des­ig­na­tions grow more strin­gent for or­ga­ni­za­tions that have more in­fra­struc­ture to adopt the pay­ment model.

Lev­els give hos­pi­tals and med­i­cal groups some flex­i­bil­ity as they seek to de­velop ACOS, said Dr. Duane Davis, vice pres­i­dent and chief med­i­cal of­fi­cer of the Geisinger Health Plan and one of 20 mem­bers of the NCQA task force to de­fine ACO stan­dards.

“ACOS have never ex­isted,” Davis said. “Any­body who thinks they know what a per­fect ACO looks like is feed­ing you a line.” He noted that when the NCQA be­gan work on ACO ac­cred­i­ta­tion two years ago, ac­count­able care was lit­tle more than a con­cept. “You have to have enough flex­i­bil­ity for peo­ple to evolve.”

Mean­while, the NCQA stan­dards of­fer fledg­ling ACOS cri­te­ria by which to mea­sure progress. Davis said the stan­dards of­fer some struc­ture for ACO de­vel­op­ment ef­forts. The stan­dards are not com­pre­hen­sive and do not ad­dress fi­nan­cial ar­range- ments of ac­count­able care, he said.

Level 2 and Level 3 groups must re­port pa­tient ex­pe­ri­ence and per­for­mance mea­sures; eval­u­ate and im­prove pa­tient-cen­tered pri­mary care; and main­tain com­plete data for a re­quired num­ber of pa­tients. Level 2 groups must earn 70 points on the NCQA 100-point eval­u­a­tion scale.

Level 3 groups must earn 70 points and demon­strate per­for­mance on re­duc­ing costs and im­prov­ing pop­u­la­tion health and the ex­pe­ri­ence of care through state or re­gional mea­sures or national bench­marks.

The Ncqa’s100-point eval­u­a­tion for ac­cred­i­ta­tion will mea­sure per­for­mance across seven ar­eas. They in­clude: ACO op­er­a­tions, such as in­fra­struc­ture to co­or­di­nate providers; ac­cess to needed providers; care man­age­ment, in­clud­ing mean­ing­ful use of in­for­ma­tion tech­nol­ogy; care co­or­di­na­tion and tran­si­tions; pa­tient rights and re­spon­si­bil­i­ties; per­for­mance and qual­ity im­prove­ment; and pa­tient-cen­tered pri­mary care.

Raena Grant Akin-deko, as­sis­tant vice pres­i­dent of prod­uct de­vel­op­ment for the NCQA, said the ac­count­able care ac­cred­i­ta­tion builds on pa­tient-cen­tered med­i­cal homes, and ACOS will be ex­pected to have a “com­pre­hen­sive and co­he­sive” ap­proach to pri­mary care.

The NCQA mea­sures in­clude 25 qual­ity mea­sures, two mea­sures of pa­tient ex­pe­ri­ence and seven mea­sures of uti­liza­tion. Among the qual­ity mea­sures, which vary some­what from the ones re­quired for the Medi­care ACO con­tracts, are ones that ad­dress: can­cer screen­ings; pe­di­atric im­mu­niza­tion; di­a­betes man­age­ment; med­i­ca­tion rec­on­cil­i­a­tion once pa­tients leave the hos­pi­tal; and pre­scrip­tion mon­i­tor­ing among se­niors.

The uti­liza­tion mea­sures ad­dress treat­ment for low-back pain, asthma, car­dio­vas­cu­lar con­di­tions, chronic ob­struc­tive pul­monary dis­ease, di­a­betes and hy­per­ten­sion.

The Billings (Mont.) Clinic and HealthPart­ners, a two-hos­pi­tal sys­tem based in Bloom­ing­ton, Minn., have be­gun to pur­sue ac­cred­i­ta­tion. The two sys­tems were among 10 pi­lot lo­ca­tions that per­formed mock sur­veys and in­ter­views in early 2011 to test the ac­cred­i­ta­tion.

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