NCQA’s Proposed Accountable Care Organization Standards
December 19, 2010
Posted by chcablogadmin in : ACO Update
On October 19, the National Committee for Quality Assurance (NCQA) issued for public comment eighty pages of proposed ACO standards with a November 19, 2010 comment deadline. The Washington, D.C. –based, twenty-year-old NCQA accredits and certifies a variety of health care organizations. Its Healthcare Effectiveness Data and Information Set (HEDIS) is probably the most widely used healthcare performance measurement tool.
NCQA began the process in April by appointing a sixteen member ACO task force including representatives from Healthcare Partners, Kaiser Permanente, Geisinger Health Plan and others
NCQA recognizes and supports that how providers organize themselves as accountable care entities is likely to vary based on existing practice structures in a region, population needs, or local environmental factors. They also note that ACOs are likely to vary widely with respect to the components of care delivery included directly. In other words, some may include a full range of services, including primary care, sub-specialists, hospitals, home care agencies, insurance products, etc. Others may be more narrowly constructed but maintain active relationships and/or formal contracts with providers across the spectrum of care.
As a minimum, NCQA is proposing that the ACO include a group of physicians with a strong primary care base and a sufficient number of other specialists to support the care needs of a defined population. The ACO would have to align providers’ clinical and financial incentives, ensure that they are clinically integrated and work seamlessly to coordinate care. The ACO would need an administrative infrastructure to manage budgets, collect data, report performance, make payments related to performance, and organize providers around shared goals. They also would expect the ACO to have the potential to simplify the care process for patients, enhance quality and reduce costs. Those achieving certification would then have to undergo reviews every two or three years.
The proposed standards are built on five guiding principles:
- A strong primary care foundation – a core of Primary Care Physicians (PCPs) with medical home capabilities.
- Reporting of reliable measures to support quality improvement and waste/inefficiency elimination to reduce cost.
- Commitment to improving quality, the patient experience and reducing cost – this includes establishing shared goals for improvement across providers, continually monitoring and analyzing clinical quality, patient experience, and cost data and application of findings via benchmarking, best practices, and peer review.
- Cooperation with stakeholders in a community or region such as by linking providers in the ACO with other delivery system components (e.g., hospitals, social service agencies and county health departments), and help with managing the full continuum of the patients’ care (e.g., from preventive services to hospital-based and nursing home care).
- Creation and support of a sustainable work force, noting that likely increased PCP demand coupled with a shrinking PCP supply calls for creating a system that supports both providers and patients.
The proposed guidelines contain one reference to pediatric practices in “Element D: Guidelines for Important Conditions.” This element requires clinicians to systematically identify patients for whom they will proactively plan and manage care. Under this provision, the guidelines call for the physician practice to implement evidence-based guidelines through point of care reminders. One of the factors (number 3 of 4 listed) subject to identification is unhealthy behaviors such as substance abuse; obesity; smoking or other tobacco use; risky sexual behavior; overuse of illegal drugs, alcohol or prescription drugs. Mental health issues may include depression. The proposed guidelines characterize conditions such as well-child care, asthma, obesity, ADHD, eczema and allergic rhinitis as among those meeting Factor 3. Another factor (number 4 of the 4) is patients with complex medical or high risk medical conditions. Relevant conditions listed as potentially meeting Factor 4 with regard to pediatric practices include children and youths with special health care needs such as sickle cell disease.
For more insight, read the proposed standards in their entirety.
You may also access the newsletter (ACO Update_12-20-10) as a document to print and share within your hospital.
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