The Basics

The promotion of informed decision-making by the consumer is the key to DM 5.  Thus, the standard's emphasis is on decision support tools, educational materials, getting the consumer involved in helping develop his/her DM plan and goals, and the potential involvement by family and friends in helping the consumer make informed decisions.
Specifically, this standard requires that your organization’s P&Ps promote patients’ decision-making.  Specifically, the P&Ps must spell out:

• What information the DM program makes available to patients to support their clinical decision-making (e.g., print materials, Web sites, and education provided by staff members);
• Which decision support tools it makes available to patients;
• How the program engages patients in decisions about the DM plan (e.g. letters, calls, or emails);
• How the program collaborates with the patient on the creation, documentation, and monitoring of the patient’s individual goals; and
• How a family member or legal guardian is asked to give consent (written or verbal) in order to communicate on the patient’s behalf with your organization.

This last section is for minors or other consumers without the legal or clinical capacity to make decisions regarding their health care without assistance. The DM program documentation must foresee this possibility and provide a mechanism in anticipation of that eventuality.

Management Tips

This standard has a wide reach, covering such decision support tools as educational videos and brochures, Web sites, and information delivered in-person. The communication suggested by this standard, it should be noted, is a collaborative one, not a one-way flow from the DM organization to the consumer.

Note that, because nothing in URAC-land is considered to have happened unless it is documented, it is incumbent on the organization to have a mechanism to record the process of collaborating with consumers to establish and monitor the consumer's health goals.  A compliant P&P will not suffice.

URAC Accreditation Tips

Each of the five elements of this standard bears a scoring weight of 4.
At the desktop review phase, you should submit:

• a program description and/or P&Ps describing the consumer engagement (including goal-setting) process; and
• descriptions or screen shots of decision support tools your staff members provide to consumers.

In addition, you may also want to submit flow charts depicting the program’s system of contacting and collaborating with patients about their care management.

The onsite review will include a review of two- or three-dozen patient files in an effort to verify that patients were involved in decision making, particularly about goal-setting.  In addition, the reviewer will interview staff members about their process of involving consumers and ask for a demonstration of clinical decision support tools that the staff members use.