Anonymous Care Coordination Failure Report for ACOs

Anonymous Care Coordination Failure Reporting for Accountable Care Organizations

Care coordination is the backbone of successful ACOs, directly impacting CMS quality metrics, patient outcomes, and shared savings calculations. When coordination breaks down—whether through communication gaps, care transitions, or systemic issues—early detection and transparent reporting are essential for continuous improvement.

This Anonymous Care Coordination Failure Report template provides ACOs with a structured, confidential channel for staff, providers, and care team members to report coordination failures without fear of retribution. By capturing detailed incident information aligned with CMS quality measures, ACOs can identify patterns, address root causes, and strengthen their care delivery systems.

Why anonymous reporting matters for ACOs

Traditional incident reporting systems often suffer from underreporting due to concerns about blame or professional consequences. Anonymous reporting removes these barriers, encouraging frontline staff to surface issues that might otherwise go unnoticed until they impact multiple patients or trigger adverse quality scores.

For ACOs managing complex patient populations across multiple care settings, this transparency is particularly critical. Coordination failures—missed referrals, medication discrepancies during transitions, lack of follow-up after hospitalization—directly affect the 23 ACO quality measures tracked by CMS and can erode the trust-based relationships that ACOs depend on.

What this form captures

This template is designed specifically for ACO workflows and includes sections for:

• Incident classification by care coordination domain (transitions, medication management, specialist coordination, information exchange)
• CMS quality metric impact assessment to help quality teams prioritize follow-up
• Patient outcome impact including hospital readmissions, ED visits, and medication errors
• Timeline and care setting details to reconstruct the sequence of events
• Contributing factors such as EHR gaps, staffing issues, or unclear protocols
• Severity assessment to enable risk-stratified response

The form uses conditional logic to adapt questions based on incident type, ensuring reporters provide relevant details without overwhelming them with unnecessary fields. Because it's built on Paperform, submissions can automatically route to your quality improvement team, trigger follow-up workflows via Stepper, or integrate with your incident management system.

How ACOs can use this template

Deploy this form across your provider network, care coordination teams, and administrative staff as part of your quality improvement infrastructure. Make it easily accessible through your intranet, staff communications, or quality dashboards. Because submissions are anonymous by default (with an optional contact field if reporters want follow-up), staff can report freely without compromising their professional standing.

Use the aggregated data to identify systemic issues, track improvement over time, and demonstrate your commitment to patient safety and quality during CMS reporting periods. With Stepper automation, you can create workflows that assign incidents to the appropriate review committees, trigger root cause analyses, or update your risk register automatically.

Building a culture of continuous improvement

Anonymous reporting isn't just about catching failures—it's about building an organizational culture where quality improvement is everyone's responsibility. For ACOs navigating value-based care contracts, this cultural shift can mean the difference between achieving shared savings targets and missing them.

Paperform's SOC 2 Type II compliance and data security features ensure that sensitive incident information remains protected, while the flexible form builder lets you customize the template to match your ACO's specific quality framework, care model, and reporting workflows. Whether you're a Medicare Shared Savings Program ACO, a Next Generation ACO, or an ACO REACH participant, this template adapts to your needs.

Start capturing the insights that drive meaningful quality improvement—try this template today and empower your care teams to speak up when coordination breaks down.