URAC

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URAC
Type Nonprofit
Industry Healthcare
Founded 1990
Headquarters Washington, DC, United States
Key people Kylanne Green, President and CEO
Products Accreditation, Education and Measurement Services
Employees over 60
Website http://www.urac.org

URAC, formerly known as the Utilization Review Accreditation Commission, is a nonprofit organization promoting healthcare quality by accrediting healthcare organizations.

Mission[edit]

URAC's mission is to promote continuous improvement in the quality and efficiency of health care management through processes of accreditation, education and measurement.

History[edit]

In the late 1980s concerns grew over the lack of uniform standards for utilization review (UR) services. UR is the process where organizations determine whether health care is medically necessary for a patient or an insured individual. As a result of this public concern, URAC was founded in 1990 with a mission to improve the quality and accountability of health care organizations using UR programs.

From conception, the founders of URAC recognized that an accreditation organization would not be accepted by regulators, health care providers and consumers if controlled by industry interests. To avoid this, several operating principles were incorporated into URAC's structure and bylaws. First, URAC was set up as an organization independent of any particular stakeholder group. Second, the governing board of directors was established with representatives from all affected constituencies: consumers, providers, employers, regulators and industry experts. Today, over 500 committee volunteers and paid staff help run the organization.

In the mid-to-late 1990s, URAC's mission expanded to cover a larger range of service functions found in various health care settings including the accreditation of integrated systems such as health plans to smaller organizations offering specialty services.

Accreditation[edit]

The URAC Accreditation Seal

URAC's accreditation process consists of a review of policies and procedures and an onsite visit to the applicant organization to determine that it is, in fact, operating according to its stated policies. If an applicant organizations passes their review, an accreditation is awarded with a valid period of two to three years after which the organization must go through the review process again to maintain its accredited status.

URAC accredits many types of health care organizations across the care continuum including health plans (HMOs, PPOs, etc.), health care management organizations (disease management, case management, patient-centered health care homes, health call centers, Independent review organizations, etc.), and health websites.

Accountable Care Case Management Claims Processing Clinical Integration Consumer Education and Support
Core Organizational Quality Comprehensive Wellness Credentials Verification Organization Disease Management Drug Therapy Management
Health Call Center Health Content Provider Health Network Health Plan Health Provider Credentialing
Health Utilization Management Health Web Site HIPAA Privacy HIPAA Security Independent Review Organization
Mail Service Pharmacy Medicare Advantage Deeming Program Patient Centered Medical Home Practice Achievement Pharmacy Benefit Management Specialty Pharmacy
Uniform External Review Workers' Compensation Health Network Workers' Compensation Utilization Management Workers' Compensation Property and Casualty Pharmacy Benefit Management

Health Insurance Marketplace Health Plan Accreditation[edit]

Beginning in 2014, the Affordable Care Act (ACA) will ensure almost every American has health insurance and access to an expanded choice of health plans through Health Insurance Marketplaces, otherwise known as Exchanges. The law also requires every Exchange to be composed of health plan issuers accredited by an HHS-approved accrediting entity. URAC’s Health Plan Accreditation program has proudly earned this HHS approval, making it eligible to accredit issuers participating on Exchanges in all 50 states and the District of Columbia. URAC’s accreditation signifies an issuer has undergone and passed a rigorous, independent, top-to-bottom review of every aspect of its operation, including the quality of care and level of service they provide their enrollees.

Accreditation standards development[edit]

URAC standards are developed by a committee of experts representing diverse interests in the health care community: employers, health care providers, health care organizations, insurers, and the public interest. When new standards are developed, experts from that particular area of health care delivery participate on the committee. URAC always circulates draft standards for public comment so that anyone can have input in the standards development process.

Education[edit]

Educational programs include workshops, conferences, webinars and audio conferences for individuals and companies in the health care industry to learn about best practices in URAC accreditation in addition to the latest updates on issues at the forefront of health care directly from industry experts and URAC staff. Many of URAC's educational programs have been approved for Nursing CEU's, CCM CEU's and other continuing education credits.[citation needed]

See also[edit]

External links[edit]