Call Yourself an ACO? Prove It
For the time being, Fisher says, there are between 60 and 100, "actually closer to 100," organizations that are going forward with some model of an ACO, either just with private payers or through one of the pilots within the Medicare Shared Savings Program whose final rules were just announced late last month.
"We have to be conscious that there may be people trying to take advantage of this model to play an old game and continue business as usual," Fisher says. But so far, of the ones organized by private payers that he's seen, "I think an awful lot of the activity is trying to help them do the right thing for patients."
7 measures of ACO competence
The accreditation process measures the competence of an ACO in these seven areas.
- It has the infrastructure to coordinate providers and collaborates with stakeholders to improve quality of care, patient experience and manage financial resources. This includes the ability to arrange "payment for ACO professionals and working with payers to determine reimbursement."
- It has sufficient numbers and types of practitioners to provide timely access and monitors its effectiveness in meeting needs and preferences of its patients.
- It provides patients access to patient-centered medical homes and evaluates the ability of primary care practices to deliver that care.
- It collects, integrates and uses data for care management and performance reporting, focusing on the capture of information in electronic systems and assuring that practitioners can access it.
- It can assure that providers can share information about a patient in a timely way, ensuring rapid identification of "patients at risk of transitioning."
- It respects the rights and privacy of patients, restricts access to data, and has a method for patients to submit complaints.
- It strives to improve services by evaluating its performance using valid measures and making results available to the public and ACO providers.
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