1. The Hemophilia Alliance
Accreditation
&
Reaccreditation
The Hemophilia Alliance
Members Meeting
San Diego, CA
September 2017
Paul Limberis, RPh – Hemophilia & Thrombosis Center, University of Colorado
Dan Dalton, RPh – UNC Hemophilia Treatment Center Pharmacy

2. Key Questions to Consider
Does our organization need accreditation?
Which accreditation organization is best for our program?
Which accreditation best represents my payer mix?
Can we afford accreditation?

3. Choosing an Accrediting Agency
Organization type
Your organization’s experience
Your organization’s support
Time commitment
Payer requirements
Supplier requirements
Cost
JCAHO
ACHC
CHAP
URAC
CPPA

4. ACHC Accreditation Programs
Home Health Care
Hospice
Private Duty
DMEPOS
Pharmacy
Sleep
Behavioral Health
Hospital Accreditation
Infusion Pharmacy
Ambulatory Infusion Center
Infusion Nursing
Specialty Pharmacy
Community Retail Pharmacy
Non-sterile Compounding
Sterile Compounding

5. ACHC Standards Organization and Administration
Program/Service Operations
Fiscal Management
Human Resource Management
Provision of Care and Record Management
Quality Outcomes/Performance Improvement

6. ACCREDITATION PROGRAMS
Accountable Care Accreditation
Case Management
Claims Processing
Clinical Integration Accreditation
Community Pharmacy
Comprehensive Wellness
Consumer Education & Support
Credentials Verification Organization
Dental Network
Disease Management
Drug Therapy Management
Health Call Center
Health Content Provider
Health Network
Health Plan
Health Plan with Health Insurance Marketplace
Health Plan Quality Measures
Health Web Site
Health Utilization Management
HIPAA Privacy & Security
Independent Review Organization
Mail Service Pharmacy
Medicare Advantage
Patient Centered Medical Home
Pharmacy Benefit Management
Provider Credentialing
Specialty Pharmacy
Transitions of Care Designation
Workers Compensation Property & Casualty PBM

7. SPECIALTY PHARMACY Pharmacy Core Standards Organization 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 & Disclosures
Specialty Drug Management
Pharmacy Operations
Patient Management
Measures Reporting

8. URAC Accreditation Process
Submit Application – Pay Fee $$
Obtain access to Accreditnet through URAC Account Manager
Review Accredinet application with URAC Account Manager and submission date timeframes
Submit Self- Assessment in Accreditnet portal
Correct or submit additional evidence as required by URAC
Work with Consultants (if applicable) on standards for submission
Submit Desktop Review – documents, policies and procedures, QI information through Accreditnet portal

9. URAC Accreditation Process (cont.)
URAC notifies applicant that Desktop review is complete and in the Accreditnet portal
Review URAC comments and RFI’s – again work with consultant if applicable.
Telephone conference with assigned URAC Surveyor to review timeline and process.
Submit RFI work through the Accreditnet portal
URAC review and RFI’s as applicable – may take several times.
On-site verification review scheduled – completed.
URAC – accreditation determination – sent to Pharmacy

10. Several Challenging Standards Cold Chain Distribution: Process Controls and Monitoring System
The organization has implemented a documented program to manage its cold chain distribution process including:
Criteria for the selection of packaging products.
Criteria for the selection of modes of transit
A validated distribution process with process controls that address:
Initial testing procedures for new packaging products designed for cold chain distribution
Using the correct packaging
Following with correct packing instructions
Maintaining temperature within drug manufacturer’s guidelines through the entire shipping process (not too cold and not to hot)

11. Several Challenging Standards Cold Chain Distribution: Process Controls and Monitoring System
Methods to determine if shipments should be held due to extreme weather or expected delivery delays.
Decision process for product handling in the case of a breakdown in the distribution process
Periodic Monitoring – at least annually and when the packaging product is modified of each packaging product under different temperature profiles and length of time in the shipping distribution system, and
Annual review by the quality management committee

12. Several Challenging Standards Cold Chain Distribution: Process Controls and Monitoring System
A validated distribution process means that the accuracy of the results can be proven or demonstrated – can be validated by others.
Packing process should ensure that an adequate barrier is placed between the drug product and ice packs.
Data loggers are not required for every package shipped.
A validated distribution process means that the accuracy of the results can be proven or demonstrated – can be validated by others.
Packing process should ensure that an adequate barrier is placed between the drug product and ice packs.
Data loggers are not required for every package shipped.

13. Several Challenging Standards Quality and Error Management in the Facility
The organization has a mechanism to identify and address concerns related to the
Quality and safety of Medication inventory and distribution
Quality of service
Monitor dispensing of products for accuracy to include
Proactive risk assessment
Tracking of errors
Reporting of errors to internal and external entities as appropriate Analysis of error data
Annual review of published safety literature for prevention recommendations and best practices

14. Proactive Risk Assessment Tool

15. Patient Management Program Services
Access to patient-specific and individualized services or sets of services to the patient based on medical or scientific evidence and/or demonstrated clinical practice guidelines/protocols.
Process to document patient management information such as a patient care management plan
Processes or protocols to effectively communicate with prescribers and providers involved in the management of the patient
Strategies and interventions to optimize appropriate therapeutic outcomes for patients through improved medication use

16. Patient Management Program Services
Developed under the supervision of the clinical oversight body
Provided in accordance with the third party payer’s policies
Include identification of the following:
Lack of adherence to medication therapy
Inappropriate use of medications
Adverse Events
Identify when medication reconciliation is needed.
Include a care management plan for providing and coordinating services
Minimize incidence of adverse events

17. Patient Management Program Services
Patient Care Management Systems

18. Patient Management Program Services

19. Quality Improvement Quality Management Committee (QMC)
Monthly meetings

20. Quality Improvement Quality Management Committee (QMC)

21. Specialty Pharmacy Measures At A Glance
Disclaimer: URAC reserves the right to update its measures and measure sets to maintain measure relevancy and to remedy any unintended consequences that may arise during implementation. Further, URAC may add and/or align its measures with regulatory requirements of federal, state, and local governments.
Specialty Pharmacy
Measures At A Glance

22. Specialty Pharmacy Mandatory Measures (5)
Disclaimer: URAC reserves the right to update its measures and measure sets to maintain measure relevancy and to remedy any unintended consequences that may arise during implementation. Further, URAC may add and/or align its measures with regulatory requirements of federal, state, and local governments.
Specialty Pharmacy
Mandatory Measures (5)
Note: Mandatory measures are those measures that are a requirement of accreditation and must be reported to URAC on an annual basis.
Measure #
Measure Name
Measure Steward
URAC
Domain
Measure Description
Numerator
Denominator
Data Source DM
Drug-Drug Interactions
Pharmacy Quality Alliance (PQA)
Safe Care
This measure assesses the percentage of patients who received a prescription for a target medication during the measurement period and who were dispensed a concurrent prescription for a precipitant medication. Stratify by Commercial, Medicaid, and Medicare (i.e., report each product line separately).
The number of patients in the denominator who were dispensed a concurrent precipitant medication during the measurement period.
Patients who received a target medication.
Enrollment Data; Pharmacy Data
DTM
Call Center Performance
Health Care Mgmt.
Part A: The percentage of calls during normal business hours to the organization’s call service center(s) during the measurement period that were answered by a live voice within 30 seconds.
Part B: The percentage of calls made during normal business hours to the organization’s call service center(s) during the reporting year that were abandoned by callers before being answered by a live customer service representative.
Part A: The number of calls answered by a live customer service representative within 30 seconds of being placed in the organization's ACD call queue.
Part B: The number of calls abandoned by callers after being placed in the ACD call
queue and before being answered by a live customer
service representative.
Total number of calls received by the organization's call service center during normal business hours during the measurement period.
Automatic Call Distribution (ACD) Data

23. Specialty Pharmacy MP2012-06 Dispensing Accuracy Safe Care
Measure #
Measure Name
Measure Steward
URAC
Domain
Measure Description
Numerator
Denominator
Data Source MP
Dispensing Accuracy
Safe Care
This six-part measure and composite roll-up assesses the percentage of prescriptions that the organization dispensed inaccurately.
Measure parts include: (A) Incorrect Drug and/or Product Dispensed; (B) Incorrect Recipient; (C) Incorrect Strength; (D) Incorrect Dosage Form; (E) Incorrect Instructions; (F) Incorrect Quantity.
Part A: The number of drugs and products in the denominator in which an incorrect drug and/or product was dispensed.
Part B: The number of drugs and products in the denominator that were dispensed to an incorrect recipient.
Part C: The number of prescriptions in the denominator that were dispensed at an incorrect strength.
Part D: The number of prescriptions in the
denominator that were dispensed in an incorrect
dosage form.
Part E: The number of drugs and products in the denominator that were dispensed with incorrect patient instructions.
Part F: The number of drugs and products in the denominator that were
dispensed as an incorrect quantity.
Roll up Methodology: Sum numerator parts A - F.
All drugs and products dispensed by the organization to or on behalf of a specific patient during the measurement period.
Pharmacy Data

24. Disclaimer: URAC reserves the right to update its measures and measure sets to maintain measure relevancy and to remedy any unintended consequences that may arise during implementation. Further, URAC may add and/or align its measures with regulatory requirements of federal, state, and local governments.
Specialty Pharmacy
Measure #
Measure Name
Measure Steward
URAC
Domain
Measure Description
Numerator
Denominator
Data Source MP
Distribution Accuracy
Safe Care
Assesses the percentage of prescriptions delivered to the wrong recipient. Part A measures the percentage of prescriptions mailed with an incorrect address; Part B measures the percentage of prescriptions mailed with a correct address that were not delivered to the correct location.
Part A: The number of drugs and products dispensed with an incorrect address.
Part B: The number of drugs and products delivered to
the wrong location despite having the correct address on the package.
Total number of drugs and products dispensed by the organization to or on behalf of a specific patient during the measurement period.
Pharmacy Data MP
Turnaround Time for Prescriptions
Health Care Mgmt.
This 3-part measure assesses the average speed with which the organization fills prescriptions, once the prescription is “clean”. Part A measures prescription turnaround time for clean prescriptions, Part B measures prescription turnaround time for prescriptions that required intervention, and Part C measures prescription turnaround time for all prescriptions.
Part A, B, C: n1 + n2 + … nx , where n1 = the number of business days to schedule delivery of prescription 1, n2
= the number of business
days to schedule delivery of prescription 2 … nx = the number of business days to schedule delivery of prescription x.
Part A: Total number of drugs and products that arrived clean and that the organization filled during the measurement period. Part B: Total number of prescriptions that initially required intervention and that the organization filled during the measurement period.
Part C: Total number of prescriptions the organization filled during the measurement period.

25. Exploratory Measures (4)
Specialty Pharmacy
Exploratory Measures (4)
Note: Exploratory measures are measures “on the cutting edge”, meaning that either the industry has not come to consensus on how to measure a particular concept or the measure is experimental or in development. In the case of exploratory measure, the organization has the option to report.
Measure #
Measure Name
Measure Steward
URAC
Domain
Measure Description
Numerator
Denominator
Data Source DM
Proportion of Days Covered (PDC) --
Specialty
Pharmacy Quality Alliance (PQA)
Engagement
& Experience of Care
Measures percentage of participants 18 years and older who met the proportion of days covered (PDC) threshold of 90% during the measurement year. A separate rate is calculated for the following medications: Antiretroviral (this measure has a threshold of 90% for at least 2 medications). Stratify by Commercial, Medicaid, and Medicare (i.e., report each product line separately).
The number of patients who met the PDC threshold during the measurement year.
Members 18 years and older as of the last day of the measurement year who filled two or more prescriptions with 150 days between the first fill and the last fill, over a 12 month period.
Pharmacy Claims; Enrollment Data SP
Fulfillment of Promise to Deliver
Process
Assesses the percentage of prescriptions that the organization delivered on time, i.e., the percentage of prescriptions that reached patients on the date scheduled for delivery.
Number of prescriptions in the denominator that patients received on the date scheduled for delivery.
Total number of prescriptions that the organization filled during the measurement period.
Administrative Data; Pharmacy Data

26. Disclaimer: URAC reserves the right to update its measures and measure sets to maintain measure relevancy and to remedy any unintended consequences that may arise during implementation. Further, URAC may add and/or align its measures with regulatory requirements of federal, state, and local governments.
Specialty Pharmacy
Measure #
Measure Name
Measure Steward
URAC
Domain
Measure Description
Numerator
Denominator
Data Source PH
Primary Medication Non- Adherence
Pharmacy Quality Alliance (PQA)
Engagement
& Experience of Care
Percentage of prescriptions for chronic medications e- prescribed by a prescriber and not obtained by the patient in the following 30 days.
The number of e-prescribing transactions in the denominator where there was no pharmacy dispensing event that matched the patient and the prescribed drug or appropriate alternative during within 30 days following the e- prescribing event.
The number of e- prescriptions for newly initiated during therapy for chronic medications during the measurement period for those 18 years and older as of the last day of the measurement period.
Enrollment Data; Electronic Clinical Data: Pharmacy PH
Consumer Experience w/ Pharmacy Services
Assesses consumer experience based survey responses within the following domains: Pharmacy Staff Communication, Information about Medicine, Written Information, New Prescriptions, and About You.
N/A
PQA Survey Data