- Program Overview
- Standards Summary
- Standards At-a-Glance
- Accredited Companies
- URAC's Accreditation Process
Disease
Management Accreditation Standards Summary
Accreditation Overview.
Disease management has become an important part of many health plans’ strategies for improving the health of members. By focusing attention of resources on members with significant health risks and needs, health plans can improve health status and conserve resources.
To reach its full potential, a disease management program should adopt a comprehensive approach to assessing and responding to the needs of health plan members. With the assistance of a committee of disease management experts, URAC developed the Disease Management Standards to provide a benchmark to promote quality in disease management programs.
Please note: In addition to the specific standards described below, organizations seeking Disease Management Accreditation must also comply with the Core Standards.
DM Program Scope and Objectives.
The DM Standards require a disease management organization to develop documents that address how it involves patients and providers in the DM process, and how it evaluates its own activities. For each health condition covered by the DM program, the disease management organization develops a clinical approach based on available evidence and research.
Performance Measurement and Reporting.
The disease management organization develops a valid process to evaluate and report its performance. Such a process is based on reliable and consistent sources of data, and must provide results specific to each health condition within the scope of the DM program. The performance measurement process also accounts for consumers’ satisfaction with the DM program and seeks feedback from health care providers.
Population Management.
The disease management organization implements a standard, consistent process to identify consumers that will participate in the DM program, and to evaluate the health needs of each participant. The disease management organization involves consumers in the DM process by providing consumers with information on how disease management works and what information they can expect to receive.
Program Design.
The disease management organization implements a process to assess the health condition of each participant, taking into account cases where more than one chronic health condition may be present. Such assessment is conducted according to a standard process. Based on the assessment results, the disease management organization implements interventions that are designed to respond to the specific health needs of the patient. Decision-support tools used during the DM process are evidence-based and reviewed and updated at least annually. The disease management organization ensures that patients have telephonic access to disease management organization staff to provide answers to questions about the DM process and to provide direction in emergency medical situations.
CLICK HERE for a list of standards you must comply with in order to obtain accreditation.