The Basics

This standard both requires that the organization establish a quality management committee and establishes the minimum requirements for the operation of that committee.

In this post I will summarize what a QMC should look like and do. I use the term “must” where we found, in either standards or interpretive information accompanying the standards, specific reference to the QMC. I use “should” where we have concluded, based upon our years of experience with URAC-accredited companies’ QMCs, the QMC should be involved to be fully consistent with URAC’s view of QMCs.

Composition

The QMC must have as members:

• a member of senior management with the authority and responsibility for the overall operation of the quality management program 
• at least one participating provider or a mechanism to receive input from participating providers, for programs that have participating providers (e.g., Health Plan, Health Network, Pharmacy Benefit Management).

Charter

• The QMC must be “granted authority for quality management by the organization’s governing body” (i.e., the Board of Directors) .

Meetings

• The QMC must meet at least quarterly and maintain minutes at all its meetings.

Reports the QMC must receive

The QMC must receive, periodically:

• reports on progress in meeting quality improvement goals
• analyses of consumer complaints and appeals
• reports on ongoing compliance with URAC standards
• reports on objectives and approaches utilized in the monitoring and evaluation of QM activities
• tracking and trending reports of key indicators relevant to the scope of the entire organization and related to consumer and health care services
• reports on the implementation of action plans to improve or correct identified problems

Reports the QMC should receive

The QMC should receive periodic reports on:

• the results of consumer satisfaction surveys
• the organization’s performance with respect to its standards to assure that consumers or clients have access to services

Reports the QMC must make

• The QMC must provide “on-going reporting to the organization’s governing body.” 

Specific decisions it must make and actions it must take

The QMC must:

• approve the quality improvement projects to undertake
• annually evaluate the effectiveness of the QM program
• annually review and update the written description of the organization’s QM program 

Specific decisions it should make and actions it should take

The QMC should:

• approve the organization’s mechanism to respond on an urgent basis to situations that pose an immediate threat to the health and safety of consumers 

Ongoing activities of the QMC

The QMC must:

• provide guidance to staff on quality management priorities and projects;
• monitor progress in meeting quality improvement goals

Management Tips

First-time applicants for URAC accreditation often encounter the challenge of finding or creating a Quality Management Committee (“QMC”) within their organizations. This sometimes is “finding” because a committee by another name may already exist and need only a bit of tweaking to comply with URAC’s requirements for such a committee. In fact, an organization may have two or three committees that are likely candidates for such a designation, and therefore must either elevate one of the committees to that position or create a “super-QMC” to pull together the activities of the other committees. Other organizations will find it advantageous to create a new QMC out of whole cloth.

URAC Accreditation Tips

This elements of this standard has a weight of either 2 or 3.

As is true for nearly all of the quality management standards, the basic document to submit to support the standard is the quality management program description.  In addition, for the standard, you should submit either a formal quality management program evaluation or minutes from a meeting of the quality management committee in which the committee evaluated the program's effectiveness.

To prepare for the on-site review, make sure that you flag the portions of the quality management committee minutes that specifically support each element of this standard.