URAC standards broaden eligibility for accreditation
Independent CM companies may apply
If you’re an independent case management company or a case management department within a large organization, you now will be able seek accreditation under URAC’s revised Accreditation Standards for Case Management Organization.
URAC, the American Accreditation HealthCare Commission, located in Washington, DC, has revised all its accreditation standards to include Core Standards, which any organization seeking accreditation must meet, and specific standards for each type of program seeking accreditation.
For instance, case management programs must meet the Core Standards and the Case Management Organization Standards. The case management organization standards cover standards that apply uniquely to case management.
In the past, case management organizations could become accredited only if their parent organization went through the accreditation process.
Organizations that have gone through the accreditation process have found that it helps them identify areas of improvement, says Guy D’Andrea, senior vice president of URAC.
"Most of the organizations we’ve talked to feel like they are better for having done so," he adds.
Accreditation is useful for case management organizations when they develop partnerships and build business relationships, he adds.
"Trust and mutual confidence is always part of the relationship. It helps to have a third-party seal of approval. Case management organizations aren’t a bricks-and-mortar kind of business. They don’t have a lot of physical things to show. Accreditation shows that they are a substantial organization," he adds.
The new standards make it possible for independent case management organizations and for case management organizations within a larger organization to seek accreditation, according to D’Andrea.
"The revisions bring our standards up to date, improve the scoring process, and integrate our standards into the modular concept," he says.
The new case management organization standards may result in more case management organizations seeking accreditation, D’Andrea says.
"Even without revisions to our case management standards, our case management accreditation program has been our fastest-growing program over the past 18 months," he adds.
Case management organizations that previously have been through the accreditation process shouldn’t see any major changes under the new standards, D’Andrea says.
"The biggest change is in the quality management section. They will find that the standards have become more refined and more specific than in the first generation of case management standards," he adds.
The case management organization standards were released in late December 2001 for public comment through Feb. 20, 2002. They are expected to be approved by the URAC Board of Trustees this month and go into effect in October.
Organizations that already have started to apply will be able to seek accreditation under the old standards.
The case management standards apply to companies providing telephonic or on-site case management services in conjunction with a privately or publicly funded benefits program.
Among the categories the case management standards cover are policies and procedures, staff structure and qualifications, staff management and development, information management, organizational ethics, case management process, disclosure and consent, access, complaints, and definitions.
Core standards address issues such as consumer protection, confidentiality of health information, oversight of delegated functions, staff qualification and management, and quality management.
The new standards integrate the Interpretive Guide, which covers the intent of the standards, into the body of the standards.
Instead of using "shall" and "should" to indicate the importance of standards, the new version assigns each standard a weight of 1 to 5 to indicate its relative importance. Applications are scored on a scale of 0 to 4, with "0" indicating noncompliance.
The standards include primary and secondary elements. The primary element is something the standards committee believes will have a direct impact on patients or consumers. Secondary elements are features that indicate a high-quality program.
Applicants must meet all primary elements of standards that are weighted with at "5."
The accreditation process involves submitting a detailed application that includes documentation for each of the standards and a site visit conducted by URAC’s full-time accreditation review staff. Certified case managers conduct the case management reviews. During the site visit, the reviewer discusses specific areas of the case management program, based on his or her review of the application. Applicants receive an agenda before the visit.
The length of time it takes to submit an application depends on the organization’s operations — how close they are to the standards, the number of changes they have to make, and the level of resources they want to devote to the process, D’Andrea says. Once the application is submitted, it takes three or four months to go through the accreditation process.
URAC offers accreditation to a variety of organizations in the managed care industry. Among their accreditation programs: health utilization management, clinical triage and health information, claims processing, health networks, health utilization management, workers’ compensation networks, credential verification organizations, disease management, and health web sites.
Key components of URAC’s medical management study
- Companies are looking for more efficient approaches to utilization management, such as reducing the number of procedures certified, identifying groups or individual providers outside of utilization norms, and concentrating on procedures most likely to be utilized.
- Companies are linking medical management programs such as utilization management and case management or case management and disease management, and are enhancing referral and information-sharing among the programs. Stand-alone medical management organizations are most likely to link all three programs in a unified approach.
- Staffing for medical management is changing as companies shift their emphasis to case management rather than direct utilization management.
- Medical management companies rely heavily on external criteria and guidelines to assist in medical management decision making.
- Companies are working toward integrated electronic systems for medical management and quality management.
- Health care organizations are working to develop more collaborative relationships with providers, including expansion of physician-to-physician interactions, data sharing, and medical management support.
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