Accreditation is a symbol of excellence in the health care industry and provides an alternative avenue for managed-care companies to demonstrate compliance with state and federal requirements. Nationwide, policymakers recognize the value of private accreditation in promoting cost efficiency and ensuring that their constituencies receive quality health care. URAC is recognized by 48 states, the District of Columbia, and six federal agencies. Additionally, both the National Association of Insurance Commissioners and the National Conference of State Legislators acknowledge the benefits that accrue from “partnerships between state regulators and private accreditation entities.”
URAC pioneered utilization management accreditation in 1990 to ensure accountability in determinations of medical necessity. As the health care industry continues to change, URAC has addressed emerging issues by revising its standards and creating new accreditation programs to keep pace with health care advancements and to help drive improvements in the industry. URAC now offers more than 30 accreditation and certification programs in the areas of health care management, pharmacy quality management, operations, and health information technology. Please see the resources provided for helpful information regarding URAC’s accreditation program standards, accredited companies, state and federal references to accreditation, and innovations in managed health care.
URAC will work with policymakers to promote compliance with state and federal requirements through accreditation, and to ensure quality health care for their constituencies.
VALUE TO REGULATORS
- Enables regulators to focus limited agency resources on problematic areas identified in audits.Enables regulators to focus limited agency resources on problematic areas identified in audits.
- Provides regulators with helpful documentation (e.g., summary reports on managed- care organizations’ 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
- Ensures 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 multistate 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.