URAC Core 35 -- Clinical, Error Reduction, and Consumer Safety Requirements

One of the areas in which the new emphasis on error reduction and consumer safety is Core 37 (Core 35 in v. 2.1).  The standard requires two quality improvement projects (QIPs).  One of the QIPs must focus on consumers or client services, relate  to key quality indicators, and involve senior clinical staff oversight if it is a clinical QIP.  The other QIP must involve consumer safety (if the organization is applying for HUM, WCUM,
HCC, HP, DM, IRO, or CM accreditation), or error reduction, if the accreditation sought is not one of those listed.

There are a few key things to keep in mind about this standard and the quality improvement programs (QIPs) it mandates:

• URAC reviewers will interview the senior clinical staff person to assess his/her involvement in clinical judgments (subsection (a)(iii)).
• The requirement for patient safety applies only to certain modules (HUM, WCUM, HCC, HP, DM, IRO, and CM). All the rest of the clinical programs can use an error reduction QIP.
• A good place to look for ideas for QIPs are barriers to proper medical management, use of current triage guidelines, integration of quality information, patient access issues, sentinel events tracking, etc.
• Make sure the baseline and goals are measurable, and in the same units.
• Make sure your goal is connected to a target date for achievement.