A Look at URAC Approval

| | Evidence Based Medicine, Utilization Review

Lisa Robinson URAC Article May 2018
Healthcare is a complex industry, and mistakes can have far reaching effects. According to the Indiana State University Sycamore Center for Wellness, medical errors are now the third leading cause of death. The numbers are grim. The estimates run from as low as 200,000 people to 400,000 people dying annually from medical errors.

In response to these alarming statistics, Dr. Joe Kiani, founder of the Patient Safety Movement Foundation, stated in a recent U.S. News & World Report article, “The only way to do something about it is for the entire ecosystem of people involved in health care – whether it’s doctors and nurses and hospital administration, or medical technology companies or government or patients – commit themselves. It can’t be just talk. It’s got to be action.”

The role of Utilization Review Organizations (UROs) in reviewing requests for treatment for injured workers is integral to a healthy healthcare ecosystem. Unfortunately, disparities in minimum performance expectations, quality standards, and fragmented processes across UROs can leave accountability unattended and the safety of injured workers at risk.

California is one of many states to recognize URAC accreditation as a highly valuable tool in the utilization review process, now requiring UROs to become URAC accredited by June 1, 2018. The value for UROs is they will have the infrastructure in place to comply with a nationally accepted set of standards and best practices and provide assurances they are in compliance with UR requirements.

However, it should be understood that URAC accreditation is not just a check off list of things to do and be done, but a dedicated organizational commitment to rise to a higher level of industry performance. It is an arduous process to both obtain and maintain, but the rewards can be plentiful for everyone involved in the utilization review process. More importantly, it helps UROs make a positive contribution to the healthcare ecosystem by ensuring care is not only medically necessary, but safe.

Lisa Robinson

Director of Quality and Medical Technology for UniMed Direct, Lisa works hand-in-hand with the technology department to design and build advanced clinical decision support within the ReviewStat system. Her intent is to help clients, physicians and all other related healthcare professionals better manage the utilization review process.