- How many ACO contracts does the provider hold?
- How does the ACO differentiate services for different health plans (including those outside the ACO)?
- What does the provider do differently for the ACO (compared to its traditional health plan contracts)?
- What is the provider’s road map for performance improvement and managing the cost of care?
Patients and providers
- Do the members know they are part of an ACO if it’s an attributed relationship?
- Does the provider know when it is seeing patients in the ACO?
- Is the provider aware it’s part of an ACO?
- What is the provider required to commit to?
- How does the provider gain access to needed metrics?
- Is improvement monitored?
- Are ACO-attributed patients getting different care management from those who are not part of an ACO seen by the same providers?
- How are complex patients identified? Are their needs addressed differently from others?
- If behavioral health services are offered, how is that information coordinated?
- What performance metrics are measured?
- Are the metrics reported to physicians and other providers? If so, how often?
- Are systematic improvement approaches in place to support needed redesign and monitor progress?
- Are provider payments based on quality or fee for service?
- What kind of alternative payment models are part of the ACO (e.g., bundled payments or capitation)?
- Is information on claims and authorization coordinated if a provider uses a pharmacy benefit manager?
- What portion of doctors have EMR access that supports medication management services?
- Do protocols exist to optimize efforts like generic prescribing, step therapy or utilization management?
- What information does the plan provide the ACO, and how often is it given?
- Does it have a common EMR platform for providers? How many use it? For those that don’t, how is information exchanged between the provider and the ACO?
- Do providers and care coordinators exchange information in real time?
- Do care coordinators and physicians access the same information?