The Basics

DM 2 requires that your DM program be based on scientific evidence that is vetted by one or more clinical experts. More specifically, those evidence-based practices must:

• be periodically reviewed and updated (no less frequently than yearly) by experts;  
• be checked to make sure that the clinical practice guidelines remain relevant to the DM program design;
• be based on and explicitly reference clinical practice guidelines and other reports that are publicly available so that participating providers can access them;
• serve as the basis for the DM program's goal-setting, QI, patient education, and outcomes measurement processes;
• be modified only with the input of a content expert with experience in the medical condition.

Again, your best preparation for URAC will be to be very familiar with your DM program's clinical guidelines and the process for modifying them in the event there are new recommendations for how to manage the clinical condition.

Management Tips

Your applicable P&Ps must articulate an explicit process for handling new recommendations for the management of the clinical conditions that are the subject of your DM program.  It's important that you have a means of documenting the involvement of clinical experts, both at the initial, developmental stage of the program and later, both during the annual review and any changes between scheduled reviews.

Make sure your P&Ps require the program to make available the underlying sources (or citations to them) for the evidence-based processes.  You can do that in any of a number of ways, but the key is that participating providers need to be able to look up the research that supports your practices.

Content experts need not be doctors; their clinical expertise need only be relevant to the condition being managed in your DM program.  The experts do need to be in active practice; this is to assure that their expertise is up-to-date.

Make sure that you not only document the annual review of the processes, but that the documentation clearly demonstrate that a content expert was involved in that review.  

URAC Accreditation Tips

Every one of the six components of this standard is mandatory.

For the desktop review, you should submit:

• the P&Ps that describe the evaluation, selection, and updating process for evidence-based processes;
• recent committee minutes showing the annual review and update of the processes;
• a sample or two of mechanisms for sharing the guidelines with participating providers (e.g., a screen shot of a web site or a letter to a provider);
• a resume of a provider who serves as a content expert.

The onsite review will be a combination of a document review and interviews.  The documents to be reviewed include meeting minutes and the guidelines and research themselves.  The reviewer will talk with staff members, the program manager, and a clinical content expert.  The expert interview may be conducted by phone.