The Basics

This standard sets forth the requirements for the quality improvement projects your organization will submit to URAC.  Under these standards, your quality improvement projects must:

• have clearly-defined quantifiable measures
• measure your organization's baseline performance
• re-measure performance at least annually as compared to the baseline performance
• create specific goals for performance that are an improvement over the baseline performance
• establish strategies for performance improvement
• articulate projected time frames for the achievement of performance improvement goals
• conduct a barrier analysis if the organization does not achieve its performance goals

Management Tips

URAC provides a form that you may use to document your quality improvement projects, known as the Quality Improvement Project Description Form.  While use of this form is not required for accreditation, we strongly recommend that you use it, as it will help you assess whether a particular quality improvement project is a good candidate for submission to URAC.  In addition, URAC reviewers have a strong preference for the official form, as it allows them to see all of the essential elements of your quality improvement project in a format they can understand easily.  If your project is a HEDIS study, it will qualify under this standard.

In order for the quality improvement projects to qualify under this standard, it must be underway (interventions have begun) and leased by the time of the on-site review.  If the project was completed before the review, it can be no older than one year old by the time of the on-site review.

URAC Accreditation Tips

All of the elements of these three standards carry a weight of three.

For the desktop review, all you need to submit are the quality improvement Project description forms for each of the submitted projects.

For the on-site review, prepare a PowerPoint presentation in which you can easily show not only the structure and operation of your quality program, but each of the submitted quality projects.  This presentation is typically given immediately after the opening presentation of the on-site review.  In addition, the reviewer will examine quality improvement committee meeting minutes for evidence that the committee has signed off on these projects.  Keep the presentation simple, and focus on presenting the results of your most recent measurements and on the most recent interventions.