Commission/URAC focuses on processes

The case management standards developed by the American Accreditation HealthCare Commission/URAC in Washington, DC, were designed to focus on the overall processes of case management programs, says Kathleen Ward Douglas, RN, MPA, CCM, assistant vice president for disease management for Health International, a Scottsdale, AZ-based medical management company, and chair of Commis sion/URAC’s case management advisory committee. The standards address:

• staff training and qualifications;

• use of external resources, such as community-based services;

• oversight of staff;

• quality monitoring (outcomes, provider profiling);

• use of guidelines and protocols;

• documentation;

• process for "triaging" patients into appropriate case management;

• processes relating to risk management and analyzing costs;

• performance incentive systems;

• decision-making processes.