University Hospitals CompCare News

University Hospitals CompCare Receives URAC Case Management Accreditation

University Hospitals CompCare has been awarded Case Management Organization full accreditation by URAC/American Accreditation HealthCare Commission, the premier organization for accreditation of case management services. The two-year accreditation is effective immediately.

University Hospitals CompCare is one of about a dozen Ohio workers' compensation managed care organizations (MCOs) to receive this accreditation, which is based on compliance with more than 30 national consensus standards. The accreditation was received after a "desktop review" of University CompCare's application and a site visit that included a comprehensive evaluation of the organization's case management policies, procedures and staff.

"All of our case managers are registered nurses," said Clairmonte Cappelle, vice president of University Hospitals CompCare. "We have always prided ourselves on the depth and quality of case management services that we bring to every case we handle. Now, we have a third party confirming that we have the policies and procedures in place, that they are applied consistently, and that we manage the process diligently. We are meeting and sustaining a high level of performance."

Case management services are one of the fastest-growing areas in health care, according to URAC. URAC specifically designed the Case Management Organization Standards for organizations that provide telephonic or on-site case management services in conjunction with a privately or publicly funded benefits program such as Ohio's workers' compensation MCO program. The standards cover categories such as:

• Scope of services, including an organizational mission statement, an organizational framework, and oversight and reporting requirements.

• Case management personnel, which must include guidelines for reasonable caseload and case manager qualifications.

• The case management process, including the requirement that injured workers give consent to have their case managed and that there be a case management plan for every client that sets short- and long-term goals.

• Quality improvement, including regular reviews of the case management process and timely improvements as necessary.

• Delegation of responsibilities to ensure that any subcontractors adhere to applicable URAC standards.

• Confidentiality of client-specific information.

• Grievances and complaints, including specifying the rights and responsibilities of all parties, time frames for action, and how notification of complaint process actions will take place.

URAC is a non-profit organization that has issued over 1,200 accreditation certificates to over 300 managed care organizations doing business in all 50 states. URAC-accredited companies provide health care to more than 120 million Americans. URAC accreditation standards are recognized nationally as providing the benchmarks for quality in managed care organizations.

Garry Carneal, URAC president and CEO, said, "By applying for and receiving URAC accreditation for case management, University Hospitals CompCare has demonstrated a commitment to quality health care. Quality health care is crucial to our nation's welfare and it is important to have organizations that are willing to measure themselves against national standards."

"URAC accreditation means there is a system in place that will prevent cases from falling between the cracks," Cappelle said. "All cases are carefully managed to ensure that necessary medical services are performed in a timely manner. The accreditation process was a very positive experience for us because it validated the quality of service we have been delivering."