November 15, 2010
Health Law Alert
Author(s): Carolyn Jacoby Gabbay
The National Committee for Quality Assurance (NCQA) and the American Medical Group Association (AMGA) have each issued statements expressing their view on how to facilitate the success of existing and future accountable care organizations (ACOs), networks of providers furnishing services to a specified group of patients. This alert discusses the standards and principles published by NCQA and AMGA.
An accountable care organization (ACO) consists of a network of providers furnishing services to a specified group of patients. The Patient Protection and Affordable Care Act (PPACA) requires the Centers for Medicare and Medicaid Services (CMS) to promulgate regulations facilitating the creation of ACOs for Medicare enrollees by January 1, 2012. ACOs are expected to improve the administration of heath care, achieve better patient experiences and outcomes, and decrease costs by better coordinating care and monitoring quality. The National Committee for Quality Assurance (NCQA) and the American Medical Group Association (AMGA) have each issued statements expressing their view on how to facilitate the success of existing and future ACOs.
The National Committee for Quality Assurance is a non-profit organization with the mission of improving the quality of health care. The NCQA seeks to accomplish this goal by developing quality standards and performance measures for a variety of health care entities. The NCQA is seeking comments on its recently released “ACO Draft 2011 Criteria,” which it believes will help to “assess the core capabilities that increase the probability of ACO success.” The criteria are broken down into different “standards,” each having individual elements that are scored. The standards are:
The American Medical Group Association is organized for the purpose of improving “health care for patients by supporting multispecialty medical groups and other organized systems of care.” In June 2010, the AMGA released its “Accountable Care Organization Principles.” The AMGA published these principles in an effort to facilitate the regulatory development of accountable care organizations fueled by PPACA. The principles are:
These NCQA standards and AMGA principles should be considered by health care organizations as they develop their ACO strategies in response to the health care reform movement.
Carly Eisenberg assisted in the preparation of this alert.
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