The National Committee for Quality Assurance has convened a task force to study the concept of accountable care organizations, and this fall it plans to release its recommendations for what qualifying criteria these organizations should meet.
The task force includes representatives from organizations that consider themselves to be ACOs or that are developing plans to launch one. The diverse group has been working on setting out specific criteria – from governance structures to the ability to manage financial risk – that will help ACOs to succeed in the coming years.
“The idea [of ACOs] is mom and apple pie, and it's terrific to talk about in its generalities,” said Tricia Barrett, vice president of product development at the National Committee for Quality Assurance (NCQA). “But as soon as you start talking about specifics, you realize that nobody's talking about the same thing.”
Over the past few months, task force members have delved into the details and found some common ground, she said, recognizing that there will be a variety of ways to run an ACO. For example, there is consensus within the task force that primary care and the principles of the patient-centered medical home need to be at the foundation of the ACO. The extent to which specialists and hospitals are part of the same legal entity, rather than contracted with primary care physicians, will depend on the dynamics in individual marketplaces, she said.
The task force is also making headway on the specific qualifying criteria that ACOs should meet to demonstrate that they are set up for success. For example, task force members generally agree that there should be rules around the composition of provider networks within ACOs. This would ensure that patients have a certain level of access to both primary care and specialist physicians.
Performance measurement will also be a critical way to evaluate ACOs, Ms. Barrett said.
The NCQA task force members are also focused on ensuring that there are consumer protections built into the ACO structure. Consumers need to be considered in the design and policies of an ACO so that they have a full understanding of what their obligations and rights are, Ms. Barrett said.