URAC Specialty Pharmacy Accreditation: Advice from the Review Team
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URAC Director of Pharmacy Heather Bonome, PharmD and URAC Reviewer Jennifer Richards, PharmD, JD, co-presented at the 2018 Asembia Specialty Pharmacy Summit at the Wynn & Encore Las Vegas. URAC is the premier accrediting organization in the U.S. pharmacy industry. Bonome and Richards offered insights into the URAC accreditation review process, as well as lessons learned from pharmacies they have reviewed. Richards shared results of a survey completed by URAC Review staff identifying the challenges and opportunities faced by URAC specialty pharmacy clients. “We believe one of the reasons URAC is considered the ‘Gold Standard’ in pharmacy accreditation is because we leverage our full-time clinicians to conduct validation reviews,” says Bonome. “Pharmacies that pursue URAC Specialty Pharmacy Accreditation benefit from the Reviewers’ years of training and experience through ongoing interaction with this team throughout the review process. URAC’s Pharmacy Reviewers have experience with all models of practice settings – from local community practices to large national organizations – giving URAC the unique opportunity to share best practices.”
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URAC Specialty Pharmacy Accreditation: Advice from the Review Team
- 1. URAC Specialty Pharmacy Accreditation: Advice from the Review Team Heather Bonome, PharmD Director of Pharmacy, URAC Jennifer Richards, PharmD, JD Pharmacy Accreditation Reviewer, URAC
- 2. Agenda • URAC Overview • Our Approach to Accreditation • Accreditation Process • Specialty Pharmacy Standards • Advice from the Review Team • Questions
- 3. URAC was founded in 1990 as an independent, third party validator of the quality in healthcare using best practices
- 5. URAC’S Unique Approach to Accreditation Unifies Diverse Stakeholders Balance views of stakeholders from across healthcare Utilize the best practices of market leaders in quality
- 6. URAC Volunteer Peer Committees • Advise URAC staff on quality best practices • Support standard updates and periodic reviews • Draft standards released for public comment • Submit final standards to URAC’s Board of Directors for approval Standards Advisory Committees • Volunteer peers review Applicant scores • Render accreditation and certification decisions Accreditation Committee
- 7. URAC Accreditation Offers • Rigorous, evidence-based standards • Thought leadership • Independent validation of quality • Platform for continuous quality improvement Industry stakeholders have recognized URAC Specialty Pharmacy accreditation as a key differentiator and an independent validation of quality
- 8. Locations With URAC Specialty Pharmacy Accreditation, 2008 to 2018 8
- 9. Five Phases of Accreditation Submit Application Desktop Review Validation Review Accreditation Committee Review Ongoing Compliance The accreditation process takes approximately 10-12 months.
- 10. Specialty Pharmacy Accreditation, Version 3.0 • Pharmacy Core, Version 3.1 • Organizational Structure • Policies and Procedures • Regulatory Compliance • Inter-departmental Coordination • Oversight of Delegated Functions • Marketing and Sales Communications • Business Relationships • Information Management • Quality Management • Staff Qualifications • Staff Management • Clinical Staff Credentialing and Oversight Role • Health Care System Coordination • Consumer Protection and Empowerment • Customer Service, Communications, and Disclosure • Specialty Drug Management • Pharmacy Operations • Patient Management • Measures Reporting Learn more: https://www.urac.org/standards- and-measures-glance
- 11. Survey: Advice from the Review Team Where are pharmacies most successful? Where do pharmacies struggle the most during the DTR? Where do pharmacies struggle the most during the VR? What are the attributes of the most successful Applicants? What are the biggest differences btw new and reaccreditation Applicants? What advice would you offer Applicants working with consultants? What advice would you offer consultants working with Applicants? What do you most want Applicants to know about the review process?
- 12. • Dispensing Practices +++ • Policy and Procedure Management • Quality Management Committee • Business Continuity Most Successful OverallSurvey Categories PnP Management Quality Management Committee Quality Improvement Projects Business Continuity HR Documentation Telephone Metrics Dispensing Practices Cold Chain Management PM for All Patients PM Assessment Documentation PM by Clinician Care Plan Documentation
- 13. • Quality Improvement Projects • Telephone Metrics • Cold Chain Management • PM by Clinician Struggle on DesktopSurvey Categories PnP Management Quality Management Committee Quality Improvement Projects Business Continuity HR Documentation Telephone Metrics Dispensing Practices Cold Chain Management PM for All Patients PM Assessment Documentation PM by Clinician Care Plan Documentation
- 14. • HR Documentation • PM Assessment Documentation • PM by Clinician • Care Plan Documentation Struggle on Validation ReviewSurvey Categories PnP Management Quality Management Committee Quality Improvement Projects Business Continuity HR Documentation Telephone Metrics Dispensing Practices Cold Chain Management PM for All Patients PM Assessment Documentation PM by Clinician Care Plan Documentation
- 15. Rank the Attributes that Lead to Success Clear Overall PnP URAC Workshop/Webinar Clear Process for Clinical Doc Sr Leadership Support Engage Reviewers Structured QMC
- 16. New vs. Reaccreditation Applicants New Applicants generally need more guidance and education. New Applicants tend to struggle more with the process of Patient Management assessments. When clinical assessments are completed, they don’t always document everything they do. Reaccreditation Applicants sometimes struggle with maintaining compliance throughout the 3-year cycle and adapting to new standards. Reaccreditation Applicants tend to struggle more with the documentation of Core elements (HR File review, QMC meeting minutes, QIPs, etc.) Reaccreditation Applicants must maintain documentation for the 3-year cycle – such as QMC meeting minutes and evidence of Primary Source Verification. Reaccreditation Applicants are more aware of the process, and typically adapt easier to Request-For- Information requests and recommendations. However, the overall success rate is not significantly higher.
- 17. Applicants Working with Accreditation Consultants Consultants can be a great resource, but it is important to own your policies and to ensure that the policies and procedures you write are reasonable and attainable. Review any template policies and procedures provided by the consultant and modify to match your practice while maintaining compliance with the standards. Not all consultants offer the same services or have the same success rate. Consider the different services offered. Consultants can be very helpful if used as a resource. Applicants who work with their consultants to help them create their own policies and procedures or refine their processes to meet the intent of the standards tend to be the most successful. Those who rely on their consultant to provide policies and procedures without working through their processes and ensuring their practices meet those policies tend to struggle significantly throughout all Accreditation phases.
- 18. Accreditation Consultants Working with Applicants Consult with your clients, but do not write policies for them. Encourage the applicant to create policies and procedures that mean something to the organization, and are attainable for the staff. Simply providing Applicants all the policies and procedures sometimes leaves them unprepared for the review. Make sure the applicant, and not just the consultant, are familiar with the standards and requirements of the accreditation process. Conduct mock reviews to identify gaps in standard compliance so action plans can be implemented prior to the validation review. Also work with applicants to customize template policies and procedures to match the pharmacy practice. Provide best practices for the organization to excel in performance and not just template policies and procedures.
- 19. What do Reviewers want Applicants to know? Understand, implement, and know your policies and procedures. Be sure to clearly cite Desktop Review documentation for each standard element. Take the time to read and understand the issues and recommendations provided during Request For Information. If you need clarification, please ask. During the Validation Review, be prepared for the review of 30 case files for compliance with Patient Management standards. Maintain your HR documentation (Primary Source Verification, Background Checks, Drug Screening). Attend a workshop or webinar and review the SP Guide before submitting your application.
- 20. Coming Soon…. • Community Pharmacy Program, v2.0 will be released in May 2018 • Webinar introducing the new version on June 12, 2018 • Specialty Pharmacy Program, v3.1 will be released in July 2018 • Replaces Core v3.1 with Core v4.0 • Core v4.0 webinar on June 19, 2018 • 2-day workshop focusing on the Specialty Pharmacy and Mail Service Pharmacy programs to be held in Washington, DC in September 2018 See the Events & Webinars webpage for upcoming events and to register: https://www.urac.org/events-webinars
- 21. More Information Available on urac.org Standards and Measures at a Glance Accreditation Process Insights & Ideas Trend Watch Events & Webinars Directory of Accredited Organizations https://www.urac.org
- 22. Questions?
- 23. Please rate this session in the 2018 Summit mobile app. Thank you!