The Basics

This important standard establishes requirements for evidence-based performance measurement of your DM program for each condition.  Your program must:

• Establish clinical processes and outcomes for each condition.  URAC gives you a lot of flexibility in the area objectives, which could include medication adherence, improvement in financial or clinical outcomes, a decline in practice pattern variability, etc.
• Measure at least two outcomes for each condition.  Measures can be outcome or process measures.
• Compare performance measures against goals for the program and report those measures to the quality management committee.

Management Tips

Documentation requirements for this standard are rigorous, particularly for organizations managing multiple conditions in the DM program.  Be sure your description of the methodology is clear and complete, and that your reporting meets the requirements of this standard.  Quality management committee meeting minutes should show a robust discussion of performance reports for each condition including how performance compares to organizational objectives.

URAC Accreditation Tips

All four elements of this standard are mandatory.

The documentation you must include both a detailed description of all your evidence-based program performance measures and sample reports of the measures.  Submit reports for each condition in the DM program. In addition, submit a couple of examples of quality management committee minutes of meetings in which performance measures were discussed.

During the onsite review, the reviewer will meet with staff or committee members and ask such questions as the following for each condition:

• What are the two measures for the condition?
• What are the performance objectives for these measures?
• What was the process for gathering the evidence on which these measures are based?
• To whom do you report the results of these measurements?