What Accountable Care Accreditation Says About a Hospital


When hospitals and health systems make the move to accountable care payment models, the transition can seem daunting. After all, the concept is less than 10 years old. Many organizations may want to make the leap, but have no idea where to begin.

That's where accreditation comes in. URAC, an independent accreditation organization, is launching an accountable care accreditation program early this fall.

Benefits of accreditation

As hospitals, health systems and other provider organizations innovate to provide more accountable care, there is no real guarantee for themselves, payers or patients that the effort will produce the desired effects of cost savings and better quality care.

"We can't stifle the innovation [in healthcare], but we also need to have assurances about the organizations that are innovating," says Kylanne Green, URAC's president and CEO. "There's a whole lot riding on what happens in healthcare today, from those of us consuming it, to those delivering it to those paying for it. [URAC is] able to provide an innovative organization with assurances about what they're doing and assurances to the public."

In other words, meeting the accountable care standards and becoming accredited will prove to payers, consumers and the healthcare industry as a whole that an organization can indeed be successful in the new, value-based healthcare landscape. So, even if the health system incurs costs from the accountable care model early on, accreditation can assure outside parties that the hospital or system is taking the proper steps to flourish in accountable care in the long term.

The roadmap

The accountable care accreditation process serves as a guide to successfully providing accountable care, according to Ms. Green. "The standards themselves actually provide guidance," she says. "It's an opportunity to educate the organizations going through the process."

URAC's accountable care accreditation process has three components, or levels: patient-centered medical homes, clinically integrated networks and accountable care organizations. There are three levels so organizations anywhere along the accountable care continuum can participate and receive accreditation for their work. Organizations can receive accreditation on each component, depending on the level the organization is at in the process of transformation.

Patient-centered medical home. This accreditation level is the basis of URAC's accountable care accreditation program. "Medical homes are the nucleolus of clinical integration, and this is the first component we would accredit," Ms. Green says.

Clinically integrated network. The CIN program examines organizations' structure and operations, information technology and data. It also examines clinical management, such as population health strategy, care coordination and what the organization uses in terms of evidence and incentives for providers.

Accountable care. This is the final component of the accreditation process. "It's a combination of the first two [components]," says Ms. Green. The difference is these organizations are clinically and financially integrated. "They are organizations that also take risk for their activities," she says.

Having the three levels of accreditation allows organizations to grow at their own pace. "It creates an organized approach to continual learning," she explains. "Being part of an accreditation process, organizations have access to information that serves to help them improve and learn from other organizations."

There are six "early adopter" organizations going through the accountable care accreditation journey, who will become accredited once the program starts later this year. The early adopters are:

•    American Specialty Group (San Diego)
•    Frontier Health (Johnson City, Tenn.)
•    Renaissance (Houston)
•    Saint Francis HealthCare Partners (Hartford, Conn.)
•    St. Vincent's Health Partners (Bridgeport, Conn.)
•    Sharp Community Medical Group (San Diego)

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