The Basics

This standard requires that health plans have three quality improvement projects ("QIPs") as described in the Core module, rather than the usual two projects.  At least two of these projects must be clinical quality projects.

By "clinical quality", URAC means projects dealing with prevention or care of acute or chronic conditions, high-volume and/or high-risk services, and continuity and coordination of care.  This is to be distinguished from non-clinical projects such as those dealing with access and availability of services, appeals and grievances, and the like.

Management Tips

Not only should you be doing three QIPs at all times, but your P&Ps should specify you have three QIPs appropriate for submission to URAC.  Remember, while you may be doing many QIPs at any given time, not all will be appropriate for URAC submission.  

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

This is a mandatory standard.

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.