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View More Press Releases by URAC

Press release:

URAC Launches Consumer Education and Support Standards and Sets Stage for New Consumer-Centric Market

Issued by: URAC

Date: June 3, 2005

Washington, D.C. - Consumer-directed health care (CDH) plans are on track to become as mainstream as their PPO and HMO counterparts, and today URAC launches the first set of standards to address the quality of these programs.

URAC, the accreditation organization committed to promoting health care quality across the full spectrum of health service organizations, announced that its board of directors has approved the first ever set of accreditation standards for Consumer Education and Support (CES).  The new standards are the first step towards addressing the unique demands of CDH products, which call upon consumers to make more of their own decisions about health coverage and personal health choices.

URAC CES Accreditation is one of 17 accreditations and certifications currently offered by the organization, which has broadened its quality mission to include accreditation programs that focus on the evolving consumer-centric aspects of health care, such as Health Web Site Accreditation, HIPAA Privacy Accreditation and HIPAA Security Accreditation.

The goal of the new CES Accreditation program is to ensure that consumers may readily access information for health care decision making in a CDH environment. The URAC CES standards focus on administrative transactions, decision support tools, and access to educational support designed to arm the consumer with information on health and health care during and after selection in a CDH plan. URAC CES Accreditation enables consumers, employers and benefit consultants to easily identify health care organizations with the processes in place to provide the support needed for health care decision making in a CDH environment.

"It is vitally important that CDH plans offer consumers decision support tools that will allow them to balance cost and quality choices," said Charles W. Stellar, chair of URAC's board of directors.  "It is URAC's practice to stay out in front of current trends, and to ensure that our standards continually move quality efforts forward.  With these new plans, consumers must be supported to become better purchasers of care and to fully participate in the management of their health and their health care dollar. Through URAC CES Accreditation, we create a sustainable quality improvement model for CDH as it evolves and matures."

Recent surveys of the insurance and employer markets conclude that CDH plans can no longer be termed an "emerging" market segment.  CDH plans were first introduced as stand alone products and they are now offered by major national health insurance plans such as Aetna, UnitedHealth Care, Anthem/Wellpoint, CIGNA and Blue Cross/Blue Shield.  In 2004, 43 percent of employers responding to a Mercer Human Resources survey reported they already offered CDH plans; 73 percent of respondents said they were likely to offer the plans by 2006.

Most critics of CDH say that consumers do not yet have access to the tools and information to knowledgeably choose which plans are best for them.  Evaluation of how well a company informs consumers of health care costs and quality is an area of health plan operations that is difficult to observe directly from the outside, so URAC CES Accreditation is especially useful for those trying to compare and select CDH plans.

"During the standards development process the URAC CDH Advisory Committee recognized the importance of taking a phased approach to standards that would offer consumer protection but also allow for product innovation," said Stellar.  "URAC will continue to work with the advisory committee to create additional accreditation modules that will ultimately result in a comprehensive CDH accreditation," he added.

"This type of accreditation assures health care purchasers that their employees will know the true cost of their health plans and their own responsibilities, both financial and otherwise," said Frank D. Titus, assistant director for insurance services programs in the federal Office of Personnel Management.  "With the new CDH plans coming on the market, CES Accreditation can be a key indicator that accredited health plans have internal structures to provide consumers with information needed to manage their health and make important financial decisions."

URAC first convened a multi-stakeholder advisory committee in 2004 to explore creating a set of overall accreditation standards for CDH plans.  The committee, with representation from employer/purchasers, consumers, health plans, CDH plans and other industry experts, narrowed its scope over the course of a year to develop a rigorous but achievable set of standards  focusing on consumer education and support as the first in a planned suite of CDH accreditation standards.

"Consumers are really being asked to take more control of their own health, and it's not that easy to know how to do that. They need all the help they can get," said Sonya Schwartz, who served on URAC's Consumer Directed Health Advisory Committee and is a senior health policy analyst for Families USA.

"It's important with this new type of plan in the marketplace to set these standards for the sake of quality, and also because consumers need to be educated about how to use these new plans," Schwartz said.

According to Annette Watson, a URAC vice president, the CES Accreditation is most relevant for companies offering CDH type plans. But the accreditation is also applicable to traditional health plans and specialty health care organizations that are becoming more consumer focused in their HMO, PPO and other programs, such as case management and disease management.

"URAC sets quality standards that keep pace with the evolution of the marketplace," Watson said.  "As the movement for consumer-centered health care grows, URAC's role is to design accreditation programs to improve the quality of health care delivery within the segment."

The decision to focus on consumer education and support instead of a more global accreditation for CDH plans reflects the reality of a market segment which is still rapidly evolving, Watson said.  "There are no commonly accepted best practices for CDH, but URAC is poised to lead the way with CES Accreditation," she said.

Organizations that go through URAC CES Accreditation will be measured against the first meaningful benchmarks for CDH, and purchasers will be able to assess the quality and value these new products bring to the market.  "URAC is setting the bar for organizations to demonstrate that they can effectively disseminate information that enables plans, employers, benefit consultants and consumers to make the best choices they can about CDH offerings," Watson said.

"URAC undertook the development of these standards to address the growing role of consumers in health care decision-making, in the belief that consumers will need support if they are to perform this role effectively," said John DuMoulin, a URAC vice president.  "The standards work on two levels:  first, giving consumers the information they need to determine what health plan they should select, and second, once enrolled in the plan, giving consumers ongoing access to information to become prudent purchasers of health care while managing their health and their health care dollar more effectively."

Areas the URAC CES standards assess include consumer access to decision support tools that incorporate quality and cost information; availability of health assessment tools such as Health Risk Appraisals (HRAs) as well as prevention and wellness information to all members; availability of information in different languages and in different formats (for example, Web-based communication alone is not enough); and accommodation of individuals with cognitive or physical impairments. The URAC CES standards also require compliance with the URAC Core Organizational Quality Standards, which address key functions such as organizational structure, staff qualifications, training and management, oversight of delegated activities, regulatory compliance, quality management, and consumer protection.

URAC's CDH Advisory Committee will reconvene in the summer of 2005 to discuss the creation of additional CDH Accreditation Program enhancements.  Future modules will be incrementally phased in over the coming years.

About URAC
URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit www.urac.org.

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