The Basics

This standard requires that your DM program have a mechanism to provide feedback to physicians and other providers to promote both quality and coordination of care for your program’s participants.  Such feedback could be in any of several forms:

• Practice profile information;
• Patient-specific feedback regarding treatment;
• Reporting quality concerns to a client health plan.

Be sure you know your program’s chosen approach(es) to providing providers with feedback.

Management Tips

There are two management responsibilities for this standard – making sure your staff knows what to do to provide providers with feedback (through P&Ps and training) and documenting instances of members of your staff providing such feedback.  Feedback can occur through such means as documented telephone calls, letters to the provider, notification through electronic medical records systems, or reports to credentialing departments or quality committees.

URAC Accreditation Tips

This standard carries a weight of 3.

At a minimum you should submit a P&P that describes your program’s approach to provider feedback.  Examples of such feedback, such as letters or reports, should also be included in your submission.

The onsite reviewer will ask members of the clinical staff such questions as:

• What kind of feedback do you provide to providers?
• Is provider feedback systematic or on a patient-specific basis?
• What would you do if you became aware of quality concerns regarding a specific provider?

In addition, the reviewer will examine provider profile reports (if you have them), consumer files, and any other records that would show implementation of your P&P regarding provider feedback.