Health Plan (7.4) 7.4

P-OPS 7 - Care Coordination Regarding Medication Safety

Submited by: Tom Goddard

The Basics

This standard requires that your organization promote medication safety for at-risk consumers by implementing mechanisms to address at least three areas:

  • Medication reconciliation at care transitions;
  • Knowledge of medications by members and their caregivers; and
  • Medication adherence. 
URAC defines "medication reconciliation" as "[t]he process of creating the most accurate list possible of all medications a patient is taking - including drug name, dosage, frequency, and route - and comparing that list against the physician's admission, transfer and/or discharge orders, with the goal of providing correct medications to the patient at all transition points."

Management Tips

You'll need a P&P on this one that defines your organization's criteria used to identify at-risk members. In addition, the P&P should outline strategies for promoting medication safety. The possible mechanisms and activities to demonstrate compliance with this standard include:

  • disease management activities that address caregiver knowledge of medication;
  • tracking medication adherence; and 
  • reimbursement for outsourced medication reconciliation, among many others.

Accreditation Tips

Desktop Review
For the desktop review phase of the accreditation process, you need submit only P&Ps that address, in sufficient detail, all elements of this standard.
Validation Review
During the onsite review, the reviewer will conduct staff interviews and examine the member-facing information regarding medication safety and adherence.

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