URAC

URAC, formerly known as the Utilization Review Accreditation Commission, is a nonprofit organization promoting healthcare quality by accrediting healthcare organizations. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry.

URAC's Mission
To promote continuous improvement in the quality and efficiency of health care management through processes of accreditation and education.

History
In the late 1980's concerns grew over the lack of uniform standards for utilization review (UR) services. UR is the process where organizations determine whether health care is medically necessary for a patient or an insured individual. As a result of this public concern, URAC was founded in 1990 with a mission to improve the quality and accountability of health care organizations using UR programs.

From conception, the founders of URAC recognized that an accreditation organization would not be accepted by regulators, health care providers and consumers if controlled by industry interests. To avoid this, several operating principles were incorporated into URAC's structure and bylaws. First, URAC was set up as an organization independent of any particular stakeholder group. Second, the governing Board of Directors was established with representatives from all affected constituencies: consumers, providers, employers, regulators and industry experts. Today, over 500 committee volunteers and paid staff help run the organization.

In the mid to late 90's, URAC's mission expanded to cover a larger range of service functions found in various health care settings including the accreditation of integrated systems such as health plans to smaller organizations offering specialty services. Now, URAC serves the public good through the administration of many accreditation and certification programs.

Accreditation
Accreditation is a process by which an impartial organization (URAC) will review a company's operations to ensure that the company is conducting business in a manner consistent with national standards. URAC's accreditation process consists of a review of policies and procedures (the "desktop review") and an onsite visit to the applicant organization to determine that it is, in fact, operating according to its stated policies. If an applicant organizations passes their review, an accreditation is awarded with a valid period of two to three years after which the organization must go through the review process again to maintain their accredited status.

URAC accredits many types of health care organizations including medical management organizations (disease management, case management, health call centers, Independent review organizations, etc.), health plans (HMOs, PPOs, etc.), hospitals and health Web sites. Accreditation adds value to these organizations by providing an external seal of approval, and by promoting quality improvement within the organization as part of the accreditation process.

Accreditation Standards Development
URAC standards are developed by a committee of experts representing diverse interests in the health care community: employers, health care providers, health care organizations, insurers, and the public interest. When new standards are developed, experts from that particular area of health care delivery participate on the committee. URAC always circulates draft standards for public comment so that anyone can have input in the standards development process.

Generally, URAC updates its standards every two to three years. Occasionally changes in the health care environment necessitate making a change in the interim. URAC's Standards Committee recommends changes, which then go to URAC's Board of Directors for approval.

Education
URAC offers an array of educational programs including workshops, conferences, webinars, and audio conferences for individuals and companies in the health care industry to learn about best practices in URAC accreditation in addition to the latest updates on issues at the forefront of health care directly from industry experts and URAC staff. Many of URAC's educational programs have been approved for Nursing CEU's, CCM CEU's and other continuing education credits.

URAC Quality Summit
URAC hosts an annual conference that focuses on varying aspects of health care quality and improvement.

Best Practices in Consumer Empowerment and Protection Awards and Conference
This national event is designed to recognize those health plans, pharmacy benefit management companies, health information technology companies and health care management companies that are actively pursuing practices to advance consumer empowerment and protection in an exceptional, measurable and reproducible way.

The first awards and conference program will be held March 25-26, 2008 in Orlando Fl.

URAC Accreditation Workshops
These workshops are 1-2 day focused training sessions, conducted by URAC staff at their offices in Washington, D.C. The workshops are intensive, hands on experiences that allow ample opportunity for participants to interact with peers and URAC staff. Attendance is limited to a maximum of 25 participants who leave the workshop with a clear sense of how to put into practice what you learn, and you learn it from the source.

Accreditation standards workshops are ideal for first time applicants to understand the accreditation process in detail and for accredited companies undergoing re-accreditation as a “refresher” on both the URAC standards and the accreditation process.

Measurement
URAC's Accreditation programs constitute a threshold level of quality data used to measure health care organizations.

Government Recognition
Because of its status as an accrediting organization, many state and some federal government agencies look to URAC and similar standards organizations as the basis for consumer protection and may even refer to these standards.