URAC Core 32 -- Quality Management Committee Checklist

First-time applicants for URAC accreditation often encounter the challenge of finding or creating a Quality Management Committee (“QMC”) within their organizations. This sometimes is “finding” because a committee by another name may already exist and need only a bit of tweaking to comply with URAC’s requirements for such a committee. In fact, an organization may have two or three committees that are likely candidates for such a designation, and therefore must either elevate one of the committees to that position or create a “super-QMC” to pull together the activities of the other committees. Other organizations will find it advantageous to create a new QMC out of whole cloth.

In this post I will summarize what a QMC should look like and do. I use the term “must” where we found, in either standards or interpretive information accompanying the standards, specific reference to the QMC. I use “should” where we have concluded, based upon our years of experience with URAC-accredited companies’ QMCs, the QMC should be involved to be fully consistent with URAC’s view of QMCs.

Composition

The QMC must have as members:

    * a member of senior management with the authority and responsibility for the overall operation of the quality management program (Core 31(e))
    * at least one participating provider or a mechanism to receive input from participating providers (Core 32(e)), for programs that have participating providers (e.g., Health Plan, Health Network, Pharmacy Benefit Management).

Charter

The QMC must be “granted authority for quality management by the organization’s governing body” (i.e., the Board of Directors) (Core 32(a)).

Meetings

The QMC must meet at least quarterly (Core 33 (c)) and maintain minutes at all its meetings (Core 32 (d)).

Reports the QMC must receive

The QMC must receive, periodically:

    * reports on progress in meeting quality improvement goals (Core 32(h))
    * analyses of consumer complaints and appeals (Core 28)
    * reports on ongoing compliance with URAC standards (Core 33(a))
    * reports on objectives and approaches utilized in the monitoring and evaluation of QM activities (Core 33(b))
    * tracking and trending reports of key indicators relevant to the scope of the entire organization and related to consumer and health care services (Core 33(c))
    * reports on the implementation of action plans to improve or correct identified problems (Core 33(d))

Reports the QMC should receive

The QMC should receive periodic reports on:

    * the results of consumer satisfaction surveys (Core 24)
    * the organization’s performance with respect to its standards to assure that consumers or clients have access to services (Core 25)

Reports the QMC must make

The QMC must provide “on-going reporting to the organization’s governing body.” (Core 31(b))

Specific decisions it must make and actions it must take

The QMC must:

    * approve the quality improvement projects to undertake (Core 32(g))
    * annually evaluate the effectiveness of the QM program (Core 32(i))
    * annually review and update the written description of the organization’s QM program (Core 31(c))

Specific decisions it should make and actions it should take

The QMC should:
    * approve the organization’s mechanism to respond on an urgent basis to situations that pose an immediate threat to the health and safety of consumers (Core 22)

Ongoing activities of the QMC

The QMC must:

    * provide guidance to staff on quality management priorities and projects (Core 32(f));
    * monitor progress in meeting quality improvement goals (Core 32(h))