Governmental Recognition of URAC Accreditation
Accreditation serves as a symbol of excellence in the health care industry and provides an alternative avenue for managed care organizations to show compliance with state and federal requirements. Thirty-eight states, the District of Columbia and the federal government reference accreditation in state and federal statutes, regulations, agency publications, requests for proposals or contract language. (See map)
The value of accreditation is widely recognized by all stakeholders in the health care arena, including regulators; consumers; employers; health care providers; health insurers; purchasers; and workers’ compensation carriers. These stakeholders and experts actively participate with URAC in developing the high quality measures that URAC uses to evaluate a company’s operations and services.
VALUE TO REGULATORS
- Enables regulators to focus limited agency resources on problematic areas identified in audits.
- Provides regulators with helpful documentation (e.g., summary reports on MCO’s accreditation status).
- Facilitates use of current best practices as quality measures because standards are regularly updated.
- Keeps pace with health care advancements more readily than if undertaken by legislation/regulation.
- Affords a cost effective supplement to state oversight of MCO compliance with state regulations.
VALUE TO LEGISLATORS
- Ensures that consumer protections and patient safety are incorporated into managed care operations.
- Drives improvements in health care as a consequence of an impartial and rigorous evaluation process.
- Guarantees that health care quality standards reflect the national scope of experience.
- Supports ongoing quality improvement by continually adjusting benchmarks to reflect best practices.
- Provides transparency and accountability through nationally recognized and publicly available standards.
VALUE TO CONSUMERS
- Affords assurance that consumers will receive due process (e.g., patient appeals process).
- Provides evidence that accredited MCOs are meeting appropriate standards of care.
- Guarantees that confidential information will be appropriately and securely handled.
- Sets forth a standard of comparison in evaluating which plans best suit consumer needs.
- Incorporates consumer perspectives into the standards development process.
VALUE TO HEALTH CARE PROVIDERS
- Promotes appropriate clinical oversight of clinical processes.
- Assures same specialty peer-to-peer decision-making for physicians engaged in dispute resolution.
- Incorporates provider protections and ensures a fair and timely credentialing process.
- Complements national professional standards of practice.
- Gives providers a voice throughout the health care system.
VALUE TO HEALTH INSURERS/MEDICAL MANAGEMENT ORGANIZATIONS
- Allows multi-state MCOs to meet different states’ requirements through a single accreditation process.
- Differentiates among health insurers, giving accredited companies a marketing advantage.
- Encourages operational efficiencies that often improve results and reduce costs.
- Provides evidence that the insurer is keeping current with latest quality benchmarks and best practices.
- Reduces liability as an effective risk management tool through conformity with national standards.
VALUE TO EMPLOYERS
- Provides a measure of comparison in selecting health care vendors for employees.
- Reduces employer-purchasers’ burden of oversight of health care vendors’ operations.
- Delivers a human resources benefit to employee-consumers who value the “seal-of-approval.”
- Promotes the delivery of quality health care to employees and provides access to performance data.
- Helps to reduce disability and lost time through conformity with medical management standards.