1 | 2 | 3 | 4 | 5 | 6 | 7 | 8


  [Continued From Page 2]

accreditation product and the addition of measures to its existing Case Management accreditation product. To date, each measurement effort has identified a conceptual framework of measurement domains. The pharmacy measurement conceptual domains include:

  • Medication Possession Ratios (Consumers/
    Engagement)
  • Complaint Resolution Timeliness (Consumers/
    Experience)
  • Overall Consumer Satisfaction (Consumers/
    Satisfaction)
  • Call Center Performance (Consumers/Experience)
  • Overall Client Satisfaction (Client Satisfaction)
  • Therapeutic Outcomes (Clinical Outcomes)
  • Generic Dispensing Rates (Cost Effectiveness)

URAC has worked and will continue to work with other organizations to avoid redundancy and increased reporting burden whenever possible. One of the particular challenges of the measurement work in the pharmacy area concerned the unit of analysis problem.

Much of the work in pharmacy performance measurement has been done at the prescriber, pharmacist and retail pharmacy levels, not at the PBM or DTM levels. Furthermore, some existing pharmacy measures are not accessible in the public domain for adoption into regulatory, accreditation, pay-for-performance, or other purposes. Where URAC was able to access and consider other organizations’ measure development work, the URAC measure specifications acknowledge the sources that informed the development of particular measures. The specifications also identify other organizations that have developed content that may be of interest to readers.
       URAC’s accreditation programs strive to recognize and further the health care quality enhancement work of consensus driven organizations. This is particularly important to URAC in its measures development work. URAC thanks the DMAA: The Care Continuum Alliance and the Pharmacy Quality Alliance (PQA) for their support and encouragement in the development of measures that are conceptually consistent with their efforts.
       See the article on new performance measures for PBM and DTM in this issue.

 

URAC is an independent, nonprofit organization whose mission is to promote continuous improvement in the quality and efficiency of health care management through the processes of accreditation and education. To support this goal, our Board of Directors represents the full spectrum of stakeholders interested in our health care system, including consumers, employers, health care providers, health insurers, purchasers, workers’ compensation carriers and regulators.

     Incorporated in 1990, URAC pioneered utilization management accreditation by creating a nationally recognized set of standards to ensure accountability in managed care determinations of medical necessity. As the health care industry evolves, URAC continues to address emerging issues: we now offer 22 accreditation and certification programs across the health care spectrum.

     Many states have found URAC accreditation standards helpful in ensuring that managed care plans and other health care organizations are meeting quality benchmarks. Thirtyeight states and the District of Columbia currently reference one or more URAC accreditation programs in their statutes, regulations, agency publications or contracts, making URAC the most recognized national managed care accreditation body at the state level.

     At the federal level, four federal agencies recognize URAC accreditation. The Centers for Medicare and Medicaid Services recognize URAC Medicare Advantage Health Plan Accreditation for the Medicare Advantage (formerly Medicare+Choice) Program; the Office of Personnel Management recognizes all URAC accreditation programs under the Federal Employee Health Benefits Program; TRICARE/Military Health System recognizes URAC’s Health Network Accreditation; and the Department of Veterans’ Affairs recognizes URAC’s Health Call Center Accreditation.
Copyright © 2010 URAC & AMCP. All rights reserved.