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URAC is a Washington, DC–based non-profit organization [1] that provides accreditation of organizations involved in medical care services, as well as education and measurement programs. Founded under the name Utilization Review Accreditation Commission in 1990, the name was shortened to the acronym URAC in 1996. [2]
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Individual physicians are employed by the group practice, rather than by the HMO. The group practice may be established by the HMO and only serve HMO members ("captive group model"). Kaiser Permanente is an example of a captive group model HMO rather than a staff model HMO, as is commonly believed.
Additionally, there are alternative national medical boards, i.e. the National Board of Physicians and Surgeons, [10] with over 10,000 board-certified physicians, that meet national quality standards, including the Joint Commission, the National Committee on Quality Assurance, and the Utilization Review Accreditation Commission, and has gained ...
Formal utilization review and quality improvement programs including disease management and case management; An emphasis on preventive care including wellness incentives and patient education; The techniques can be applied to both network-based benefit programs and benefit programs that are not based on a provider network.
Clinical peer review, also known as medical peer review is the process by which health care professionals, including those in nursing and pharmacy, evaluate each other's clinical performance. [1] [2] A discipline-specific process may be referenced accordingly (e.g., physician peer review, nursing peer review).
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In 2014, the ACGME, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) announced an agreement to pursue a single, unified accreditation system for graduate medical education programs in the United States beginning in 2015. Plans called for the ACGME to accredit all osteopathic ...