Core 4.0

C-PMI 1-3: Quality Management Program Implementation

Submited by: Tom Goddard

The Basics

This standard puts the meat on URAC's QM requirements, mandating that your program include:

  • selection and definition of performance indicators and how each is to be measured under what time frames;
  • valid and accurate measurement of processes and/or events such as errors, satisfaction (of consumers if you serve consumers directly, or clients being served); complaints (again, consumers if you are consumer-facing, and/or clients), access to your services; or outcome trends;
  • analysis of these measurements to assess whether your organization are meeting its quantifiable goals in these areas;
  • interventions designed to improve performance or correct problems, in order to meet organizational performance objectives; 
  • evaluation of the effectiveness of the implemented interventions, including barrier analysis if goals remain unmet;
  • revision of interventions in response to the evaluation of intervention effectiveness; and
  • periodic re-measurement of performance measures for as long as the organization deems such measurement appropriate.

Management Tips

While URAC doesn't specify this in the text of the standard, it is clear that these activities are at the heart of the QMC's business. It should be overseeing a comprehensive program of performance improvement that includes specific, valid measurement, interpretation of those measurements, and the design and implementation of an ongoing series of interventions to improve quality and reduce error. The QM program description should outline these activities clearly, and the QMC meeting minutes should document their implementation. 
What do you compare your performance to? It could be that your first measurement establishes the baseline, or perhaps there are national or regional measurements that serve as a good baseline.

Accreditation Tips

Desktop Review
Submit your QM program description, your QM dashboard, staff QM reports to the QMC, and/or QMC meeting minutes demonstrating compliance with all the elements of this standard. In addition, submit documentation that demonstrates the QM activities you have undertaken when your performance does not meet your goals as stated in your performance metrics.
Validation Review
The reviewer May interview both staff and leadership about your total QM program activities.
Document reviews
The reviewer will focus on QMC meeting minutes. Be sure those minutes include all reports that would be supportive of a demonstration of compliance with this standard.

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