This weekend I worked on a presentation that I will present at the URAC Quality Summit in October. In preparing the program, I reviewed a large amount of literature that helped me better understand the quality process. I studied the work of several theorists who’ve laid the groundwork for the processes we’re following today, and I reviewed a list of the resources available to organizations to help them analyze variances in quality. I learned how, by collecting and analyzing data, projects can be developed that allow for improvements in systems and processes. I also discovered how these tools can help healthcare organizations standardize processes and decrease variation in reports, so providers and consumers alike can make side-by-side comparisons that will assist them in deciding where to put their healthcare dollars and trust.

As we all know, there is a great deal of work to do in the area of healthcare quality and consumer safety. The good news is that the quality movement is taking firm hold across the country. Payers as well as providers have embraced it, and the industry is making progress. The movement has been led by the Institute of Medicine (IOM), which in 2001 published the report Crossing the Quality Chasm. The study brought to light serious shortcomings in our healthcare system, and issued a clarion call for healthcare organizations to begin to examine themselves and launch efforts to address areas of compromised quality. As a result, organizations are beginning to take steps to proactively identify variances in safety and quality, and work together to set up systems to make improvements.

One of the organizations working to provide a linkage between accreditation outcomes and the IOM’s six aims of healthcare quality is URAC. In an attempt to provide organizations with a way to improve quality and share that information, URAC has developed healthcare management service measures. The measures, released today, will be applied across nine of URAC’s 16 accreditation programs. The goal is to create and maintain healthcare management service measures to promote consumer protection and quality improvement. During the public comment period, URAC is seeking input on the measures from professionals who work in healthcare management organizations and health plans. The deadline for public comment is October 6, 2006. To participate, go to www.urac.org.

Lastly, a few weeks ago, in the August 15th Across My Desk, I wrote about a clinic in Mendota, Virginia, and described the value the nurse-run clinic provides to the members of that rural community. In spite of the quality work it does, the clinic was slated to close due to cutbacks. This week, I received some very wonderful news from someone close to the situation. The person informed me that the Vice President of Strategic Development for the organization responsible for the clinic was able to use my column to support the clinic’s positive effects in his search for an organization that could take it over and keep it open. Last week, it was announced that the Clinic is being acquired by Stone Mountain Health Services, a network of rural health providers in Virginia. This will allow the staff to continue to provide their valuable services to the people of Mendota. I am sure many of you will be as glad as I was to hear this great news. I received a good number of emails from readers letting me know that they enjoyed the article, and expressing a wish that something could be done to save the clinic. This example shows how we case managers can utilize our skills to seek out opportunities, ask critical questions and raise red flags when we see opportunities for improvement.

I hope you will take advantage of the opportunity offered by URAC to share your expertise in the field of medical management. Take a few minutes go to the URAC website during the public comment period, and express your views on the proposed measurements organizations can use to ensure quality improvement in managed care organizations.

Let your voice be heard!

Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN
Editor-in-Chief of Across My Desk, Case in Point magazine, and the Case Management Resource Guide
allewellyn@dorlandhealth.com