Maintaining Compliance: 5 Essential Steps to Developing a Work Plan

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You’ve identified the person or department at your organization in charge of ongoing compliance. They’ve helped you note which processes are currently in place. Now we’re ready to move on to a crucial next step to get you back on track to maintaining compliance with URAC standards.

The first question I asked about ongoing compliance last week was:

1) Do you know who in your organization is responsible for ongoing compliance with URAC Standards?

This week, you should ask:

2) Does your organization have a work plan?

Does the work plan provide a ‘snap-shot’ of Key Performance Indicators, metrics/measurements, reporting and serve an annual evaluation?

If you answered ‘no’ to any of these questions, continue reading...

The key to maintaining ongoing compliance starts with a plan. As with anything in our personal lives or business pursuits, without a plan we seldom reach our goals.

The URAC standards have specific requirements as to what must be tracked and measured in in between accreditation cycles. The work plan is a blueprint for what needs to occur each quarter and annually in order to maintain compliance with URAC standards.

If you don’t have a work plan or aren’t sure what should be in your current one, no worries. We have outlined the 5 essential steps to help you develop your own work plan. Work plans are easy if you follow the guide and use the template we at Arete Healthcare Solutions have developed.

During this module, we will work through each of the 5 Steps and I will provide examples as we go.

5 Essential Steps to Developing a Work Plan

First, get your free work plan template in Excel here. It's helpful to look at it as we go through the five steps. 

#1: Who

Identify who is responsible to obtain the data and who will be reporting the findings. Identify which department is responsible, the name of the person, and their title (i.e. Quality Management Dept./Jennifer Wester, Quality Manager).

#2: What

Identify what needs to be reported.

Here are a few examples:

●     Reporting on Performance Indicator Measurements

●     Quality Improvement Projects

●     Key Tasks (complaint handling, satisfaction results)

●     Action Items (corrective action planning)

You’ll derive what needs to be reported from the URAC Standards and use the Why to develop the metric (as described below in step #5). Most organizations have established regular reporting for their core business functions, but for the purpose of this work plan, our focus is maintaining compliance with URAC’s CORE Standards.

NOTE: Keep an eye on this space; for the next steps in this series, we will review each CORE Standard and define the reporting requirements to help you develop the work plan fully.

[BONUS TIP] The standards define the reporting requirements in a number of ways. The reporting requirement may be part of the standard itself, but most often the reporting requirements are defined in the Desk Top Review Requirements (DTR), Onsite Review Activities and sometimes they are buried in the Interpretive Information. This can be a little tricky.

Here’s an example. In Core 20(b), the reporting requirements are defined in the Standard itself; Core 20 (b) states that the organization’s Quality Management Committee “Provides ‘ongoing reporting’ to the organization’s oversight authority.”

Although the reporting is defined, you are left to interpret what ongoing reporting means. Let me help you out here: Ongoing reporting is data that is continuously monitored and tracked. Ongoing reporting is usually reported on a Quarterly basis in aggregate.Here are a few examples of reporting requirements (this is not inclusive and reporting varies by the type of business/accreditation type) :●     Quality Metrics/Key Performance Metrics

●     Quality improvement project updates
●     Quality of Care Issues
●     Abandonment rates
●     Turn-around-times
●     Complaints
●     Satisfaction
●     Regulatory Compliance updates

#3. When

Identify when the reporting will occur by frequency. For example:

●      Monthly

●      Quarterly

●      Annually

●      Biannually

[BONUS TIP]  Most often the frequency is based on the organization’s need, but there are some standards that have specific reporting frequencies requirements.

For example, Core 20 (c) defines the meeting frequency as quarterly. Not all standards are quite so prescriptive. For example, if the standard says the organization reports on an “ongoing basis,” then my recommendation would be to report this on a quarterly basis. If the standard says “periodic reporting,” my recommendation is to report biannually and on as “as-needed” basis. The reporting frequency needs to be determined based on importance and need.

#4. Where

It is important to identify the appropriate committee for where the data will be reported to (i.e. Quality Management Committee, Board of Directors, Regulatory Compliance Committee, etc.). Not all committees need to receive the same information, and too much information becomes useless and inefficient.

[BONUS TIP] Want to boost compliance with reporting requirements and minimize your work effort? Develop a standing Agenda in a fill-in-the-blanks format based off the work plan for each committee. This may seem like unnecessary work now. But, when you’re being pulled in ten different directions and you are trying to pull all of this information together for your quarterly meetings, you will thank me.

#5. Why

Did you download this free example Work Plan in Excel yet? This will help clarify all the information about the metrics I’m about to talk about below.

Below you will find a few examples to help define and build on the Why to develop a metric. The metric clearly defines the What (as noted above in step #2).

We will use two examples from URAC’s CORE standards:

1) CORE 35, Consumer Complaint Process; and

2) CORE 12, Client Satisfaction

EXAMPLE ONE

CORE 35 (a): Consumer Complaint Process 

The organization maintains a formal process to address consumer complaints that includes:
(a) A process to receive and respond in a timely manner to complaints (Mandatory). 

a) Define the Why. The Why is the objective for collecting, analyzing and reporting the data. This is often a key performance indicator.

Simply ask:

“Why is measuring consumer complaint turn-around time important for the organization?”

Example Answer: “We must maintain compliance with specific client (SLA) timeframes for resolution and response and maintain compliance with internal and regulatory requirements.”

b) Use the Why to develop a metric. This will be the What.

Example METRIC:

In order to maintain compliance with TAT’s, 95% of Complaints are resolved within 30 calendar days.

NOTE:  This will all come together when you review the work plan template I have provided for you to use. Download it for free here.

EXAMPLE TWO

CORE 12: Client Satisfaction

URAC Standards state that the organization implements a mechanism to collect or obtain information about client satisfaction with services provided by the organization.

a) Define the Why. The Why is the objective for collecting, analyzing and reporting the data and it is most often tied to a key performance indicator.

Simply ask:

“Why is measuring client satisfaction important for your organization?”

Example Answer: “Providing the highest quality of service to our clients is key to maintaining and building new business relationships.”

b) Use the Why to develop a metric. This will be the What.

Example METRIC:

In order to deliver the highest quality of service to our clients, the organization maintains a <95% client satisfaction rate.

[BONUS TIP] Why is including ‘satisfaction reporting’ in the work plan so important?

During the onsite review, the reviewer will look in the Quality Management meeting minutes [Core 20 (d)] for evidence that the quality management committee received and discussed information related to client satisfaction with program services. Missing one non-mandatory reporting requirement will not result in a failed accreditation, but if the reviewer finds a trend, your organization may fail or end up under formal corrective action. 

To continue building your Work Plan, download our free template here.

You’ll see examples of what is monitored and tracked in most work plans. Keep in mind this is not a complete example, but provides a general format for these two example standards for you to get started on your organization’s work plan.

Is your work plan working for your organization? Let Arete Healthcare Solutions go through your work plan with a fine-tooth comb. With a 100% success rate and over 25 years’ experience in the healthcare industry, we specialize in guiding organizations through URAC or NCQA accreditation and can help you develop the proper documentation to meet those standards.

Visit our website or give us a call to learn more about what we can do for your organization.

Website: http://www.aretehealthcaresolutions.com/

Call: 951-970-2573

Email: AreteHCSolutions@gmail.com