FAQs: URAC’s Consumer Value Based Health Purchasing Measures Project
Q. Why is URAC developing the Consumer Value Based Health Purchasing Measures Project (CVBHPM)?
The goal of CVBHPM is to develop and maintain health care management services measures that:
- Create industry benchmarks to better inform consumers, purchasers, and policymakers in purchasing benefits and navigating health care systems;
- Assist organizations to understand how their service performance compares to other organizations for the purpose of continuous quality improvement (CQI); and
- Promote consumer protection and empowerment.
The program will be beneficial for health plans and care management vendors, as well as for consumers and purchasers of health benefits.
The measures will address dimensions of performance relevant to all types of health plans, ensuring meaningful measures will be applicable across the board. Health plans will benefit from a measurement set that is applied consistently across the continuum of health plans and that address dimensions of health plan performance that the consumer/purchaser values.
Beginning in 2008, data collected through CVBHPM will be used to create a range of baseline data for participating companies to view and anonymously assess their performance as compared with the industry baseline. Companies will be free to release their individual data to potential purchasers to demonstrate their commitment to consumer protection and quality improvement.
For consumers/purchasers, the introduction of a measurement program with standard metrics will enhance the culture of consumer protection, quality improvement, and navigating health benefits.
Q. Which URAC accreditation programs will CVBHPM affect?
The measures will be applied to health plans and care management vendors. Organizations accredited by URAC in the following areas will be the initial organizations invited to participate in the measurement program:
- Case Management
- Disease Management
- Independent Review Organization
- Health Call Center
- Health Network
- Health Plan
- Health Utilization Management
- Health Web Site
- Workers’ Compensation Utilization Management
URAC has put forward three principles for the measures:
- Performance measures should address dimensions of health plan performance that the consumer values—specifically those that concern consumer choice;
- Performance measures should target results that health plans or care management vendors are accountable for and have the ability to influence;
- Performance measures should be based on data that can be collected and reported in a consistent fashion across the continuum of health benefit plans.
The metrics themselves will fall under three broad categories:
- Service Quality
- Consumer Protection & Empowerment / Navigation
- Satisfaction with Service
Q. How are these different from other measures being collected?
URAC understands that not all health plans follow a gatekeeper model, so existing measurement programs focusing on clinical process/outcomes may not be applicable to these plans. CVBHPM is designed to give all health plans—including PPOs and open network models--a means to measure the aspects of health plan performance most valued by the consumer/purchaser. These performance measures will target areas that health plans are accountable for and have the ability to influence, and which can be consistently reported across a wide variety of plan types.
Q. How will the measures be used?
Only aggregate industry data will be publicly released during the initial two-year measurement and reporting period, although participating organizations would be free to independently release their individual data. Starting in 2008, data collected through CVBHPM will be used to create a range of baseline data for participating companies to view and anonymously assess their performance as compared with the industry baseline. URAC will later consider whether, with the consent and cooperation of participating organizations, to report individual company data to the public.
Q. What steps are URAC taking next to develop the measures?
The release of initial measurement standards for public comment in 2006 brought a number of helpful responses which helped URAC consider the scope of measures and to refine them. URAC is presently conducting further research through focus groups with employer groups and representatives from consumer groups to gain insight into measures that will help consumers better navigate the health care system. This data will be merged into a broader set of measurement criteria for Beta testing. Beta testing of the refined an revised measures is expected to take place in late 2007.