Organizations agree to measure certain quality metrics and report them, have sufficient specialists and primary care providers on the panel and available to see patients, must have the capability to provide urgent or emergency care as well as inpatient care, community and home-based services and long-term care.
Spencer R. Berthelsen, MD, chairman and managing director of Kelsey-Seybold Clinic, said the clinic's doctors chose to go for NCQA accreditation in part out of the belief that if purchasers know an ACO's verified capabilities, "it does confer a competitive advantage."
But choosing NCQA accreditation also was important, Berthelsen says, "because there was quite a bit of market confusion as to what an ACO is. It was only partially described in the ACA (Patient Protection and Affordable Care Act) as it relates to the Medicare Shared Savings Program. But those of us in coordinated care systems understand it's much more broad than that, and applicable to all of the delivery of patient care."
He likened that confusion "to the days when it was unclear what a doctor was," and why licensing standards emerged to identify who was a physician and who was not.
Hal Teitelbaum, MD, managing partner and CEO of Crystal Run Healthcare, said all aspects of his organization has transitioned to the ACO model. "We are all ACO, all the time," he said.
He acknowledged that there have been challenges making the leap from volume to value. "This has been like turning how medicine has been practiced in this nation for many, many years on its head," he said, adding that though his area is a predominantly fee-for-service world, "we're trying to push commercial payers, sometimes dragging them kicking and screaming, to reward us for outcomes, not for transactions."