The Commonwealth Fund has released 10 recommendations for the effective implementation of accountable care organizations, according to its report, titled High Performance Accountable Care: Building on Success and Learning from Experience.
The organization shared the following 10 recommendations for ACOs.
1. Strong primary care foundation. CMS should ensure all ACOs have strong primary care foundation that patients can access as a regular source of care.
2. Accountability for quality of care, patient care experience, population outcomes and total cost. ACOs should be required to agree to and be able to report measures of quality of care, patient care experiences and outcomes, or have arrangements in place to enable such reporting. Shared savings should be distributed contingent on high quality and positive patient experiences.
3. Informed and engaged patients. Patients should be notified that their providers belong to an ACO, along with the ACO’s characteristics and what it means for the care the patient will receive. Patients should retain the right to seek care from the providers of their choice, including those not participating in the ACO, unless they explicitly agree to receive care exclusively from the ACO’s providers.
4. Commitment to serving the community. CMS should make explicit commitments to serve the community, including low-income and uninsured patients.
5. Criteria for entry and continued participation that emphasizes accountability and performance. Entry criteria for ACOs should include, in the least, the availability of primary care and the capacity of the organization to ensure that patients have access to needed services across the continuum of care. Continued participation should also be based on public reporting of performance metrics.
6. Multi-payor alignment to provide appropriate and consistent incentives. CMS should actively work with providers and payors in each major market to develop multi-payor ACO arrangements — including Medicare, Medicaid and private payers — whenever possible.
7. Payment that reinforces and rewards high performance. The determination and payment of shared savings should be accomplished so that the reward for reducing costs while improving quality is received with as little delay as possible. This can be supported by prospectively determining the patients whose costs are to be used to calculate shared savings and prospectively setting the spending target for each ACO.
8. Innovative payment methods and organizational models. CMS should be prepared to apply different payment approaches, such as primary care medical home fees or bundled acute case rates, along with shared savings or risk-adjusted global fees with risk mitigation.
9. Balanced physician compensation incentives. Compensation of ACO clinicians should include incentives to deliver evidence-based care but ensure appropriate care is not withheld.
10. Timely monitoring, data feedback and technical support for improvement. Every effort should be made by public and private payors, as well as providers, to ensure transparency of information and to minimize administrative complexity. Also, CMS should work with other payors to develop robust information exchanges and standardized reports that can provide ACOs with timely feedback on comparative results.
Read the Commonwealth Fund report on effective ACO implementation.
Read more about ACOs:
– Should Specialists Join ACOs?
