The Basics

These standards require that at least one of the quality improvement projects ("QIPs") required by P-QM 1 focuses on the prevention of acute or chronic health conditions.  The project submitted under the Florida Addendum needs to target populations with the greatest needs and must be in an area where your organization has a good chance of improving quality.

Management Tips

Documentation will be very important, so set up a standardized way of tracking QIPs.  URAC provides a form for this purpose that captures all the essential requirements.  Also, the involvement of the quality management committee in the approval and tracking of your QIPs will need to be documented in that committee's minutes.

URAC Accreditation Tips

All you need to submit are your QIP description forms.  You may also submit QM committee minutes showing committee approval of the QIPs, although that submission can wait for the onsite review if you are reluctant to submit minutes.

During the onsite review, the reviewer will want to see QM minutes for the last three years, as well as binders/files showing full documentation on the three submitted QIPs. The reviewer also will interview your medical director and senior QM staff members about the QIPs.  Have a PowerPoint presentation that summarizes your QIPs.  The essentials for that presentation are:

• definitions of measures (clear descriptions of the numerator and denominator of any fractions/percentages you provide)
• baseline -- date and measure
• goals -- in the same units of measurement as the baseline measure
• time line for achievement of goals
• interventions
• remeasurements.