January 2009 Edition
URAC, an independent, nonprofit, accrediting organization recently announced that the 4.0 Case Management Accreditation standards include major revisions and new measurement requirements. “These major revisions demonstrate our commitment to creating meaningful standards that will serve the industry and promote quality improvement,” said Douglas Metz, DC, chairman of URAC’s health standards committee and chief health services officer for American Specialty Health.
“Case management organizations are responsible for care coordination for the most complex cases,” he added. “These revised standards emphasize the need for high standards in patient safety, care transitions, and quality improvement within the discipline.”
URAC endeavors to include representatives from all stakeholder groups and establish meaningful quality measures for the entir e health care industry. The revisions align with the principles put forward by the National Transitions of Care Coalition, an organization dedicated to improving the quality of car e coordination and communication when patients are transferred from one level of care to another. Although URAC’s case management standards already addressed care coor dination, the revised standards elaborate significantly on the assessment process and tools available to case managers that are specific to transitions in care.
The revisions also require organizations to produce and report to URAC on a specified set of performance measures. These measures can be used by accredited organizations for internal performance improvement and for reporting to consumers, or for direct reporting to the public. In the future, URAC’s accreditation process will include public reporting of the measures. The measures include medical readmissions, timeliness of complaint resolution, overall consumer satisfaction, and measures for service dimensions for health care, behavioral health, and workers’ compensation case management programs. Other major changes to the standards include: