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. |
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 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. |
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