The Basics

The standard requires that the DM program’s interventions for each condition are based on evidence.  If there is no scientific evidence to support the chosen interventions,  the interventions must be assigned to program participants based on the available data, such as the information received during the assessment/stratification process.  In addition, the standard requires that interventions are tracked for each program participant.

Interventions include such activities as:

• Education on how to take medicines and use medical equipment;
• Help with modifying behavior, such as lifestyle changes;
• Clinical monitoring;
• Provision of educational material about self-care.

Management Tips

The applicable P&P should clearly describe:

• The relationship between assessment and interventions;
• The evidentiary and theoretical basis for the selected interventions;
• The process for documenting interventions.

The ability to track interventions will be critical.  The tracking mechanism must record the participant’s assessment information, stratification level, and interventions over time.  Because interventions will vary by clinical condition, the tracking mechanism needs to be able to reflect those differences.

It may be a good idea to conduct periodic monitoring of case files to make sure that interventions are appropriate, based on the data collected in the assessment process and the resultant stratification.

URAC Accreditation Tip

The three elements of this standard are worth 3 points each.

At the desktop review phase, submit not only the applicable P&P for assigning interventions but also relevant exhibits, like referral forms, sample educational materials, or other evidence of implementation of consumer interventions.

The onsite review will involve staff interviews, including a demonstration of the intervention-tracking system(s), and an examination of consumer files for evidence of compliance with the standard.  Interview questions may include:

• What types of interventions do you suggest for consumers with [one of the conditions covered by the DM program]?
• Do the interventions vary by stratification level?
• How does the information you collect in the assessment process relate to the interventions you suggest for the participant?
• To your knowledge, on what evidence are the interventions based?
• How do you document what interventions you suggest to a participant in the program?
• How do you document a participant’s interventions?