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Health Plan Performance Standards Open for Comment

Margaret Dick Tocknell, for HealthLeaders Media, April 12, 2011

The measures are designated as either mandatory or leading. Mandatory measures must be met in the accreditation process; leading measures are state-of-the-art or cutting edge and don't have an established industry standard to meet.

For the efficiency domain assessing the number of low birth weight infants per 100 births is a mandatory measure while assessing the number of hospital admissions for long-term diabetic complications per 100,000 population is a leading measure.

Consumers, employers, healthcare management organizations, health plans, purchasers, policy makers and others are asked to comment here. The deadline for public comment is May 20, 2011 at 6:00pm.

Comments should focus on the measure classification (leading vs. mandatory), measure specification and whether the measure should be used to evaluate the performance of health plans, health networks  or health insurance exchanges.

URAC accredits almost 70 health plans with 120 million lives across the U.S. Its accreditation standards include quality benchmarks for network management, provider credentialing, utilization management, quality management and improvement, and consumer protection.


Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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