An Accountable Care Organization (ACO) is a group of health care providers that have agreed to work together to provide seamless, comprehensive care for a specific patient population. The group could be made up of group practice providers, networks of individual practices, hospitals, provider-health plan partnerships or publicly governed entities. These providers choose to come together to form an ACO because of a shared goal to improve the quality of care and patient experience, while simultaneously reducing costs.
ACOs have the potential to achieve better quality at lower cost because they create financial incentives to improve care coordination and health care delivery across the spectrum of providers who participate in a patient’s care. This means sharing data and information, sharing accountability for the health of patients, and sharing best practices that lead to high-quality, efficient, patient-centered care.
The National Committee for Quality Assurance (NCQA) ACO Accreditation is voluntary, and evaluates whether a health care organization has the infrastructure for accountability. This means that the organization must have the ability to deliver coordinated, patient-centered care; to improve clinical quality; to enhance the patient experience; and to reduce costs through quality clinical practices. These standards must cross all settings where care is provided: primary care, outpatient specialty visits and inpatient hospital stays.
The Children’s Hospital of Philadelphia chose to apply for ACO accreditation to show that it is able to meet all of these requirements, and to demonstrate that it will be transparent about its capabilities and performance. This accreditation establishes CHOP as a national leader in the movement toward accountable health care delivery, focused on both quality and value.
CHOP has long been recognized for optimal patient outcomes, but while evaluating results is critical, it is also necessary to assess performance against evidence-based criteria. The Hospital’s commitment to data collection, analysis, integration and sharing is crucial to our ACO accreditation. CHOP’s ability to collect, manage and transform information can provide clarity about the key steps and components needed to improve the way the organization delivers care, providing better experience, better health and lower cost for patients.
To receive accreditation, the Hospital underwent a rigorous assessment that focused on the evaluation of 14 standards comprised of 65 elements that include: ACO structure and operations, access to needed providers, patient-centered primary care, care management, care coordination and transitions, patient rights and responsibilities, and performance reporting and quality improvement.
ACOs focus on patient needs and help to unite the medical home with a larger community of health care providers. For patients, accreditation includes important patient protections. Accreditation helps patients identify providers who are dedicated to providing the care they need, when they need it.
CHOP is the only children’s hospital in the country to earn accreditation and is among the first five organizations to be accredited nationally. NCQA requires ACOs to publicly report their performance and to provide performance reports to providers for quality improvement. Not only is transparency important as a concept, it is also the foundation for initiating improvement.
For more information about NCQA’s ACO Accreditation and other NCQA evaluation programs, visit www.ncqa.org or contact NCQA Customer Support at 888-275-7585.