How URAC Specialty Pharmacy Accreditation Improves Pharmacy Outcomes

An interview with Heather Bonome, PharmD, Director of Pharmacy at URAC.

What is new for the 2018 specialty pharmacy accreditation process? Have there been any changes to the measures?

In July of 2018, URAC is scheduled to release the Specialty Pharmacy Program, Version 3.1.  This will not include a revision of the specialty pharmacy program standards, but will incorporate a revision of the URAC Core standard module into the specialty pharmacy program. The Core module is a set of standards that establishes the foundational quality and compliance requirements for URAC’s accreditation programs and is included within most of URAC’s programs. 

The new version of Core standards advances concepts already established in the current module, such as risk management, and also addresses the newest concepts to keep pace with and anticipate changes in the health care industry, such as leadership, health care ethics, and business ethics. URAC has already offered a live workshop to educate applicants on the new Core standards. This workshop explaining the new “Core version, 4.0” standards was recorded and will soon be available to view on urac.org.  

The measures that specialty pharmacies will report for the 2018 URAC measure submission have been finalized and published. There are no material changes to the measures that will be reported in 2018. Similar to 2017, pharmacies will need to partner with a URAC-approved data validator prior to submitting their measure data to URAC to ensure compliance with the technical specifications of the reporting requirements. 

What major factors are driving notable changes in specialty pharmacy right now? 

There are so many moving pieces in health care that are directly or indirectly impacting specialty pharmacy, it would be hard to list them all. The move to value-based payments, controversy of high drug prices, health care market consolidation, increase in number of drugs available to treat rare diseases, and potential changes in the 340B program are just a few.  

Another trend we frequently run into at URAC are the many technology platforms that are being used to support specialty pharmacy practice. From patient management portals, to online satisfaction surveys, text message reminders, and communication through telehealth, pharmacies are exploring options beyond face-to-face and telephonic communication to promote the clinical outcomes of their patients. 

URAC accredits so many different kinds of pharmacies, so we constantly get to see new and innovative ways of providing patient care.  

Can URAC specialty pharmacy accreditation help stakeholders with the transition to an outcomes-based/value-based health care system?

In a value-based health care system, it is all about being able to document your outcomes. URAC’s Specialty Pharmacy Program requires reporting of outcomes in two ways. 

First, the standards require that organizations have mechanisms to demonstrate the value of their Patient Management services to external stakeholders. To achieve accreditation, pharmacies must demonstrate how the clinical services they provide are impacting clinical, financial, quality-of-life, and patient satisfaction measures. They need to report on this and make the information available to external stakeholders when requested. 

Second, once pharmacies achieve accreditation, there is an ongoing annual requirement to report measures to URAC that are specific to the specialty pharmacy accreditation program. URAC’s goal here is to utilize measures that are meaningful and relevant to key stakeholders to promote quality improvement, efficiency, and the effectiveness of the health care delivery system.

Does accreditation help with adherence and patient satisfaction?

The URAC Specialty Pharmacy Program has standards that directly speak to the importance of focusing on medication adherence and measuring patient satisfaction.  Our standards require that the pharmacy have the ability to monitor and promote adherence to drug therapy. The pharmacy must be able to identify when patients are struggling with adherence to their medication and have targeted interventions that will help promote compliance with their regimen. Evaluation of how pharmacies are tracking and documenting individual patient adherence is something that we review in individual patient files when conducting an accreditation review. Similarly, patient satisfaction is directly addressed in the standards. Pharmacies must demonstrate how they are tracking patient satisfaction with the clinical services that the pharmacy provides. They then need to be able to share that information with external stakeholders when requested.

Are there any data or anecdotal evidence to show that URAC accreditation helps improve outcomes?

We consistently hear from our clients that URAC accreditation has helped them provide better service to their patients. URAC accreditation requires compliance with the industry’s most comprehensive and rigorous standards.  The framework provided by the standards requires that organizations constantly measure, monitor, and evaluate the services they are providing their patients. If there is an issue, they should know about it because there is now a mechanism to make sure issues are reported to their Quality Management Committee for evaluation, analysis, and corrective action. Pharmacies know that URAC will hold them accountable to the standards and their patients directly benefit from this accountability.