Response to Proposed URAC Measurement Guidelines Drives Development of Relevant, Timely PPO Metrics

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In response to public comment, URAC announces move to develop metrics specifically relevant to the PPO industry.

There is a genuine need for ongoing, meaningful metrics that demonstrate how accredited organizations deliver on their service commitment to consumers and clients. URAC’s measurement program is designed to enhance consumer education and empowerment while providing a means of comparison for health plans to improve quality.

Robust comments and suggestions from the PPO industry to an initial set of URAC health care management service measures introduced in September has underscored the need for metrics specifically relevant to the PPO industry.

The Consumer Value Based Health Purchasing Measures Project (CVBHPM), which will be applied across nine of URAC’s accreditation programs, targets measurement of health care management services to promote consumer protection and quality improvement. Rather than focus on clinical measures, URAC’s program will initially collect relevant information about consumer protection and empowerment and quality data for comparison across three general categories: service quality, consumer protection and empowerment, and satisfaction with services.

“We are moving forward to develop measures that take into account the broad array of benefit designs PPO plans offer, yet still will provide quality measures relevant to employers, purchasers and consumers,” said Alan Spielman, URAC’s president and chief executive officer. “PPOs don’t follow a gatekeeper model, so metrics applicable to an HMO may not fit the PPO model. These health plans fulfill a valuable role in today’s market by offering purchasers a range of plan types and consumers a wide choice of providers. URAC’s metrics program will be pertinent for health plans of all types while recognizing the diversity in this market.”

URAC has put forward three principles for CVBHPM:

  •     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 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.

“Measurement is a key point of discussion now in the PPO industry,” said Robert L. Crocker, MD, chairman of URAC’s Board of Directors and chief medical officer for American Specialty Health. “There is a genuine need for ongoing, meaningful metrics that demonstrate how accredited organizations deliver on their service commitment to consumers and clients. URAC’s measurement program is designed to enhance consumer education and empowerment while providing a means of comparison for health plans to improve quality.”

CVBHPM will be phased in over several years and will be applied to URAC accreditation programs for Health Plan, Health Network, Health Utilization Management, Case Management, Disease Management, Health Call Center, Independent Review Organization, Health Web Site, and Workers’ Compensation Utilization Management.

URAC offered the initial set of measures for public comment in late 2006 and received a number of comments that have contributed to the further refinement of CVBHPM. The organization is conducting research to receive further input from purchasers and consumers as the standards development process advances.

URAC intends to Beta test the measures and begin collecting data from them in 2007. 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. 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. URAC will later consider whether, with the consent and cooperation of participating organizations, to report individual company data to the public.

Sample measures would include tracking client or consumer satisfaction rates, complaint rates, provision of care coordination and consumer navigation tools, provision of price and quality transparency and provision of quality incentives.

CVBHPM will also give employers and purchasers the option to ask URAC-accredited companies to voluntarily release their individual measures so purchasers can make an “apples to apples” comparison of health plan performance.

“Our call for comments yielded valuable input, and we are seeking further input from purchasers, employers and consumers to ensure CVBHPM is germane and adds value,” said John P. DuMoulin, MS, CAE, URAC’s vice president of government relations and product development. “Our goal is to create a monitoring program that underscores the value of URAC accreditation and provides URAC with a new measurement capabilities to accelerate adoption of quality best practices.”

Frequently Asked Questions about the program:

http://www.urac.org/resources/CVBHPMFAQ.aspx

About URAC

URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit http://www.urac.org.

Note to Editors: If you would like to interview URAC CEO Alan P. Spielman, contact Health2 Resources at 703-319-0957

This press release was distributed through eMediawire by Human Resources Marketer (HR Marketer: http://www.HRmarketer.com) on behalf of the company listed above.

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Karla Hurter
URAC
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