The Basics

This standard requires that your DM program have P&Ps that

• describe the services it provides for each clinical condition;
• explain how the program works with providers to promote clinical practice that is evidence-based;
• set forth how the program promotes self-management and informed decision making by the participating patients; and
• describe how the program evaluates its outcomes.

The best thing you can do to make sure you help your program comply with this standard is to track down your organization's P&Ps that do these four things.  

Management Tips

When writing the P&P to describe the scope of the program's services, be sure to address, for each condition in the DM program, the interventions, both clinical and non-clinical.  Interventions that you describe in the P&Ps can involve education, lifestyle issues, triage, advice, and an array of other types of interventions. 

Regarding collaboration with providers, your P&Ps should include anything that demonstrates your support for collaboration with and between your consumers and their providers.  That could include assistance given to either the consumer or the provider, including giving feedback, providing general information about the DM program, teaching patients how to talk to their providers, or disseminating the latest research on the disease condition.

URAC Accreditation Tips

The two elements carry a weight of 4, and two carry a weight of 3.

The documentation required for this standard at the desktop review phase can be rather straightforward: applicants should submit a detailed description of the program -- its scope, implementation, relationship to other entities within and outside of the organization, and methods of program evaluation.  An organization chart at the DM program level also will be helpful to the reviewer as she begins to acquaint herself with the organization.

As an orienting document for the reviewer, it will be important that the program description detail which disease states are the subject of the DM program.  Furthermore, if the applicant is seeking URAC accreditation for some DM programs but not others, it should specify that in the notes submitted on AccreditNet with the program description.

The onsite reviewer will not spend much time on this standard, specifically, during the onsite review.  She will assess compliance primarily through interviews with DM staff members, making sure that what they tell her is consistent with what the program description says.  Compliance with this standard will be revealed through a demonstration of compliance with other, more specific, DM standards.