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Although it may be unclear exactly what form the Affordable Care Act will finally take, it is relatively clear that the Accountable Care Organization will be a part of it. Clear in part because it is part of the law and should lead to improved quality and decreased cost. Clear in part because rule-making agencies are already putting together accrediting standards. Although The Joint commission has announced that they will begin accrediting in 2011, NCQA is first out of the box with proposed standards. Accreditation will likely be important as it will allow for changes in billing and collections as well as relief from some regulatory hurdles.

The guiding principles for NCQA are:

The ACO Task Force set forward the following principles to guide the development of qualifying and monitoring criteria. They are aligned with core aims in the ACO principles developed by the American College of Physicians (ACP), American Association of Family Practice (AAFP), and American Medical Group Association (AMGA).

ACOs have a strong foundation of primary care. A core of primary care providers with medical home capabilities provides the foundation for the ACO to deliver comprehensive, coordinated, patient-centered care.i,iii

ACOs report reliable measures to support quality improvement and eliminate waste and inefficiencies to reduce cost. ACOs should measure and report overall performance using nationally-accepted, validated clinical measures focused on ambulatory and inpatient care as well as measure their performance related to patient experience and costs. Valid measurement of the quality of care provided through ACOs will be essential to both ensuring that cost savings are not the result of limiting necessary care and promoting higher-quality care.ii

ACOs are committed to improving quality, improving patient experience and reducing per capita costs. ACOs should established shared goals for improvement across providers in the organizations. They should continually strive to improve patient care by monitoring and analyzing clinical quality, patient experience and cost data and apply their findings to improve these measures through tools such as benchmarking, best practices, and peer review.iii

ACOs work cooperatively towards these goals with stakeholders in a community or region. Linking providers in the ACO with other components in the delivery system such as hospitals, social services and county health departments can help organizations effectively manage the full continuum of patients’ care, from preventive services to hospital-based and nursing-home care.iv

ACOs create and support a sustainable workforce. The demand for primary care will increase as the new federal health reform law expands insurance coverage to more people. This demand combined with the shrinking supply of primary care providers signals the need to create a system that supports providers and patients.

The categories assessed include Organizational Structure, Access and Availability, Primary Care Quality, Care Management Capability, Care Coordination and Transitions, Patient Rights and Responsibilities, and Performance Reporting.

The comments close on November 19th. The proposed rules are here and  comments can be placed here.