Inside Network Accreditation
UnitedHealthcare Community Plan of Tennessee (TN UHC), is taking steps to become the first managed care organization to achieve CQL Network Accreditation. The pursuit of this prestigious designation demonstrates a strong commitment to improving the quality of services and the quality of people’s lives across the State.
UnitedHealthcare Community Plan of Tennessee
UnitedHealthcare is dedicated to helping people live healthier lives and making the health system work better for everyone by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. In the United States, UnitedHealthcare offers the full spectrum of health benefit programs for individuals, employers, and Medicare and Medicaid beneficiaries, and contracts directly with more than 1.3 million physicians and care professionals, and 6,500 hospitals and other care facilities nationwide. The company also provides health benefits and delivers care to people through owned and operated health care facilities in South America. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified health care company. For more information, visit UnitedHealthcare at www.uhc.com or follow @UHC on Twitter.
CQL Network Accreditation offers states, provider organizations, people receiving services, and other stakeholders guidance, support, and partnership in improving quality through proprietary tools and internationally-recognized person-centered approaches. It encompasses training, workshops, planning meetings, agency assessments, on-site visits, individual interviews, policy reviews, focus groups, and more. Network Accreditation provides TN UHC with a consistent framework for defining, measuring, and evaluating quality from the perspective of the person receiving services. TN UHC can then better assist its members in designing and implementing responsive, person-centered supports so that people can achieve their personally-defined outcomes. The components, tools, and approaches of accreditation expand beyond policies and procedures to exploring how they are actually put into practice and impact lives.
1. Network Foundation
The first phase involves activities to build capacity across TN to learn about and begin utilizing CQL tools, including the Personal Outcome Measures® and Basic Assurances®. TN UHC will also begin enacting cultural change across all of its staff and partners. This process is not only essential to achieve buy in from all key stakeholders, but to promote sustainability and ensure effective and lasting impact.
2. Network Transformation
The second phase involves evaluation of the current state of quality across the UHC network. TN UHC staff will collect data using the Basic Assurances® and Personal Outcome Measures® tools. Taken together, these tools help to determine the overall effectiveness of supports provided by organizations contracted through TN UHC, resulting in meaningful outcomes for people receiving support through the network.
3. Network Accreditation
The third phase involves CQL facilitating TN UHC’s What Really Matters plan. This model is characterized by excellence in person-centered supports which ultimately promote personal quality of life outcomes. It facilitates person-centered supports throughout the network. After analysis of data, TN UHC and stakeholders will select a few factors to target in their journey toward person- centered excellence.
Network Accreditation is different from traditional CQL Accreditation, as TN UHC carries out the processes. While the application will differ, the components will remain similar.
- Pre-Accreditation Planning Meetings
Conference calls covering the accreditation process
- Organizational Self-Assessments
Organization evaluates its operations, validated by CQL (TN UHC)
- On-Site Visits
CQL (TN UCH) visits and reviews sites where you provide supports
- Personal Outcome Measures® Interviews
Conversations with people supported and staff
- Basic Assurances® Reviews
Evaluation of fundamental requirements for agencies
- Focus Groups
Separate discussions with staff and people supported
- Data Collection & Analysis
Collection and analysis of outcomes and supports data
- Ongoing Support
Continual collaboration between CQL and organization
Basic Assurances® evaluate the essential, fundamental, and non-negotiable requirements involving issues of health, safety, and human security, looking at the provision of safeguards from the person’s perspective. These are not statements of intent but demonstrations of successful operations, where the effectiveness of systems or policies are determined in practice, person by person.
Personal Outcome Measures® (POM) are a powerful tool to explore quality of life areas involving choices, relationships, rights, goals, dreams, employment, and more. In a Personal Outcome Measures® interview, people receiving services share information about the presence, importance, and achievement of outcomes. Their support providers then discuss the services that the organization has in place for those outcomes.
Shared Values represent an alignment in culture and philosophies between CQL’s and the organization’s values. These values influence management decisions, organizational priorities, and the character of the workforce. Most organizational decisions related to budget, human resources, or regulatory matters are ultimately decisions about values – what people and organizations believe are important.
Person-Centered Excellence® assesses quality improvement initiatives, including how the managed care organization can implement or enhance those associated practices. The findings from this process can then facilitate strategic discussions about aligning the organization’s mission to make an organizational transformation.