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Can ACOs Deliver? NCQA Launches Program to Help Purchasers Decide

By John Reichard, CQ HealthBeat Editor

November 14, 2011 -- The National Committee for Quality Assurance (NCQA)—an independent industry group that government and businesses rely on to better gauge the quality of health care—previewed a program that it intends to launch next week to accredit accountable care organizations (ACOs).

Purchasers, including Medicare, Medicaid and commercial insurers, are likely to increasingly rely on ACOs to lower costs and improve quality in fee-for-service medicine. Analysts say health care is inefficient and poorly organized under that type of payment system and that ACOs are a way to begin coordinating services and improving quality.

But as doctors, hospitals and other types of providers team up to form ACOs, purchasers don't know if they can deliver. Enter the new NCQA accreditation program.

"Not every group of providers that wants to call itself an ACO has what it takes to accomplish this vital mission," said an NCQA briefing paper on the new program. The rating effort provides "independent evaluation of organizations' abilities to coordinate and be accountable for the high-quality, efficient, patient-centered care expected from ACOs."

NCQA will classify organizations that are accredited under the program as level one, level two or level three. Level three means an organization is most advanced in its capacity to deliver savings and higher quality, and level one mean it is least advanced. But level one will still be a mark of distinction in the marketplace, separating an ACO from other organizations that have no accreditation.

Tricia Barrett, vice president for product development at NCQA, said that initially she expects most accredited groups to be level one or level two. The standards for achieving level three status will be announced next spring.

NCQA officials announced that two organizations have stepped forward to undergo accreditation, and they may be announced as achieving that status the middle of next year. They are the Billings Clinic in Billings, Montana, and HealthPartners in Minneapolis-St. Paul.

Medicare is soon expected to announce ACOs it is contracting with, but just because an organization is approved by Medicare does not confer NCQA accreditation; likewise, NCQA accreditation says nothing about whether an organization has met Medicare standards. However, the standards are expected to be similar, Barrett said.

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