What URAC Accreditation Is, and Why it Matters

| | Utilization Review

Group of doctors

URAC, an independent, non-profit organization, promotes health care quality through its accreditation, education and measurement programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, providing a symbol of excellence for organizations to validate their commitment to quality and accountability.

Offering the largest array of accreditation programs in the United States; URAC accredits many types of health care organizations, some that review the entire organization, such as the health plan standards, and some that focus on quality within a single functional area in an organization, e.g. case management or credentialing.

Any organization that meets the standards, including hospitals, HMOs, PPOs, TPAs and provider groups can seek accreditation. URAC accreditation is accepted nationwide with a few states requiring URAC accreditation for companies to do certain types of business while several states also recognize URAC accreditation to meet state regulatory requirements in lieu of separate reporting to the state.

One accreditation program URAC offers specific to the workers’ compensation industry, known as Workers’ Compensation Utilization Management (WCUM), addresses the unique aspects of the workers’ compensation environment and injured workers. Through broad-based governance and an inclusive standards development process, all stakeholders are represented across the health care industry.

When asking the bigger question of why accreditation matters, I am reminded of the quote by Sophocles,

“All men make mistakes, but a good man yields when he knows his course is wrong, and repairs the evil…”

For example, workplace accidents, while down by more than 65% since 1970 according to OSHA, still account on average for more than 12 deaths every day with falls responsible for over half of those deaths. When seeking treatment for those workplace accidents, according to a study published in the Journal of Patient Safety[2] from September 2013, medical errors are now the third-leading cause of death in America, third only to heart disease and cancer.  Where does one go from here and who can we trust?

Growing transparency and the accountability that comes with it, is bringing awareness about healthcare providers’ performance to the public’s eye and exposing where weaknesses and gaps exist making transparency an extremely powerful driver in fueling positive change and repairing “evils”.

Achieving URAC accreditation is just the first of many great strides an organization will take in demonstrating their commitment and accountability to quality health. The key to success is ensuring you don’t just “comply” with standards and regulations because you have too but committing because your organizations culture is one that truly believes it is the right thing to do.

[2] Journal of Patient Safety: September 2013 – Volume 9 – Issue 3 – p 122–128 doi: 10.1097/PTS.0b013e3182948a69  
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