URAC

Eligibility & Criteria

This program honors achievements of organizations that are effectively advancing the role of consumers as active participants in health care.  Four types of organizations are eligible to submit entries, and up to three entries from each of the organization types will be selected as a Best Practice Award winner:

• Health Plans
• Pharmacy Benefit Management Companies
• Health Information Technology Companies
• Health Care Management Companies

Entries will only be permitted from these four types of organizations. All entries must indicate the primary (and secondary, if applicable) organization type that best represents the company. These organizations can be independent companies or subsidiaries of larger corporations. There’s no requirement or considerations given for URAC-accredited organizations.

All entries must feature a practice that:

• Measurably demonstrates its purpose, as well as its impact on consumer empowerment and/or protection;
• Exhibits a potential for wide-spread implementation; and
• Focuses on either of three topic categories: consumer decision support, consumer/patient safety, or integrated care coordination.

Entries that do not meet the criteria for a best practice, yet represent an innovative practice, may be selected as honorable mentions.

Topic Categories

All entries must indicate the primary (and secondary, if applicable) topic category below that best represents the focus of the practice. An entry from each of the three topic categories will also be selected as a Best Practice Award winner for that category. 

Consumer Decision Support:  Practices that educate consumers on their health care needs and provide the tools and support necessary for consumers to make responsible choices and manage their own health care decisions.

These are programs/ technologies designed to directly or indirectly impact the consumer/patient where the outcome metric(s) are open (e.g. financial, satisfaction, clinical or other).  A direct impact program is between the applicant and the consumer (e.g., applicant’s web site on disease-specific education; applicant’s web site listing pricing and quality information; a social networking web site targeted to consumers with a specific disease, etc.)  An indirect impact program is between the applicant and the consumer, but is implemented, in part, by an intermediary (e.g. remote patient monitoring device that is introduced to the patient/consumer by a third party such as a hospital or clinical provider). 

Consumer/Patient Safety:  Practices that are broadly related to patient or consumer safety issues (safe, effective, patient-centered, timely, efficient and equitable) where outcomes are limited to health/clinical metrics (e.g., a measure of clinical error reduction or prevention).

Examples of programs that are “Safe” include credentialing, practice guidelines, UM/CM/DM triggers, privacy; “Effective” programs include those that relate to provider feedback, peer review, quality management programs; “Patient-centered” programs include individualized focus, and informed decision-making, patient satisfaction, consumer education, and health literacy; “Timely” programs includes timeframes/caseloads defined, enhanced care coordination;  “Efficient” programs include those involving organizational structure, policies and procedures, TQM; and “Equitable” include appeals and grievances, review criteria, and cultural sensitivity. One key factor distinguishing this topic from the other two is the requirement that the outcome metrics in this category are limited to those related to health or clinical factors.

Integrated Care Coordination:  Practices designed to enhance the integration between health care management programs and/or providers that coordinate or manage the care of consumers/patients.

These are designed to coordinate or manage the care of patients/consumers among different, often isolated, agents of care.   The outcome metric(s) are open (e.g. financial, satisfaction, clinical or other). Typically, these practices would involve some integrative activity between, medical management entities; and/or practices that enhance coordination between primary care providers and one or more specialist provider of care.

Submission Requirements

This is an online submission process; only entries submitted via the online form will be permitted (view sample of online application form). There is no entry fee, however, to ensure a comprehensive and fair evaluation of all entries, each submission will be required to provide:

• Complete company contact information;
• Letter of support from company’s CEO (acknowledging approval of submission);
• Authorization for URAC to use entry information to promote best practices outreach efforts;
• Organization type that best represents the company;
• Title of the practice and topic category that best represents the focus of the practice; and
• Narrative description of the practice (limited to 12 pages or 6000 words) to include:
• Problem Statement:  Background of the issue/problem that the practice is designed to solve and the extent to which the practice fits into one of the three topics categories. 10%*
• Practice Description: Summarize the intervention part of the practice, including the implementation process.  Describe the degree to which the intervention/ program addresses the problem detailed in the “problem statement”.  Describe the primary and secondary goal(s) of the project. 20%*
• Practice Process Metrics: Describe the metric(s) (definition, numerator, and denominator) used to measure the process /intervention of the practice.  Describe the results of these metrics, showing both numerator and denominator values. 20%*
• Targeted Outcomes Metrics: Describe the metric(s) (definition, numerator, and denominator) used to measure the outcomes targeted by the practice.  Describe the results of these outcome metrics, showing both numerator and denominator.  Describe the change in the targeted outcome metric(s) from baseline. Describe how it compared to the expected results without the practice, e.g.  from a reference group. 20%*
• Methodology: Acknowledge factors besides your practice that could have influenced the results in the outcome metrics.  Describe how you are dealing with these issues.  Describe the methods used to take all or some of these into account (or why you were unable to do so). Describe the estimated benefit of the practice on consumers/patients. 20%*
• Relevance: Address the extent to which the practice could be implemented elsewhere and become a national “best practice.”  Supply a useful cost estimate of the practice (e.g. PMPM). 10%*

*indicates scoring weight

Upon receipt of your entry via the online submission form, you will receive an email notification that your entry has been received. After the submission deadline, all entries will be reviewed to confirm that they are complete and conform to the submission guidelines. During this initial review, we will contact you directly if there are any questions about your entry. URAC reserves the right to reject incomplete entries and reassign topic categories and/or organization types.

Award Winners

All selected awards winners will be notified via mail and/or e-mail by December 1st, 2007 and required to present their award winning practice as part of an educational session during the Best Practices Conference and Exhibit scheduled for March 25-26, 2008 at the Rosen Shingle Creek Hotel in Orlando, Florida.  Each winning organization will receive four complimentary registrations for representatives of the organization to participate in the conference as speakers and/or attendees.  The conference will conclude with an awards dinner ceremony in honor of all awards winners - mark your calendar now as a placeholder.

A limited number of guest rooms are available for conference participants at the Rosen Shingle Creek Hotel at a discounted rate of $209 per night plus tax. To make hotel reservations, please contact the hotel directly by phone before February 24, 2008 and request the URAC Group Rate.

Rosen Shingle Creek Hotel
9939 Universal Blvd.,
Orlando, Florida 32819
(866) 996-9939
Reservations (866) 996-6338

To access the submission form, click here.

For awards judges, click here, click here.