As the Department of Veterans Affairs (VA) prepares to award contracts for managing its Community Care Network in four regions nationwide, organizations should keep in mind the importance of delivering sustainable, local healthcare solutions.
The VA, which has extended its Request for Proposal (RFP) response deadline to April 28, 2017, plans to consolidate its Community Care Programs to streamline processes and develop high-performing networks that improve access to care for veterans and their families. Accreditation is mandatory for successful bidders prior to starting contracted work.
“When you think about Community Care Networks, don’t just think about access – think about management,” said URAC President and CEO Kylanne Green. “There will be a significant number of management functions that will be required in addition to having providers available.”
URAC accreditation provides the durability needed when applying national best practices to local circumstances. URAC accreditation is not prescriptive in how organizations meet the standards. In building a network to service large geographic regions, organizations will provide services to different communities and different veteran populations – each with unique needs.
“Promotion of innovation is very important, but has to be sustainable – you can’t ask communities to do things that they ordinarily wouldn’t do and expect them to be able to sustain that over time,” said Green. “What we do aligns with the VA’s need to provide access to one community at a time.”
The VA has taken a deliberate approach in the way it has structured the RFP to ensure that there are specific quality management elements in place, said Aaron Turner-Phifer, the director of government relations at URAC. The VA needs to ensure veterans are getting quality care when and where they need it.
Bidders awarded a contract must be accredited for network management, credentialing, medical administration, and IT systems, before they begin their contracted work. The optional tasks under medical administration – case management, care coordination, and disease management – must also be accredited if these elements are included. Since the delivery of service date is 12 months after the contract is signed, organizations will have 12 months to get the appropriate accreditations.
Because organizations bidding on the VA contract will need to provide a national network of providers covering a wide range of healthcare services, they may need to use subcontractors.
“If companies are interested in being a primary contractor, but don’t necessarily have the functions related to the requirements, there are many URAC-accredited organizations that have years of quality improvement and accreditation success to choose from,” said Green.
Also, URAC’s accreditation programs that are naturally aligned with services required in the RFP (but that do not require accreditation) include Pharmacy Benefit Management and Health Call Center. Demonstrating URAC accreditation in these areas can underscore your expertise and distinguish your services.
If your organization already earned URAC accreditation, organizations can leverage best practices when responding to the VA’s RFP.
Highlight the aspects of quality in your organization,” said Green. “Go back and look at the URAC standards, how they are structured, and what they say, to validate what’s been done.