How Equality Health’s Commitment to Excellence is Disrupting the Healthcare Ecosystem – in a Good Way
Equality Health® knows that in order to be a “good disrupter” of the healthcare ecosystem they must be committed to excellence. This year the organization was recently recognized for this commitment. URAC® accredited Equality Health for Case Management, certified it for Transitions of Care Designation and renewed its accreditation as a Credentials Verification Organization for Patient Care.
URAC is the independent leader in promoting healthcare quality through leadership, accreditation, measurement and innovation. The nonprofit organization uses evidence-based measures and develops standards through inclusive engagement with a range of stakeholders committed to improving the quality of healthcare. Achieving accreditation means that Equality Health has developed operations and infrastructure according to national healthcare industry-recognized standards of excellence.
Earned by the Best
“As a young, organization,” said Lisa Stevens Anderson, Arizona Market President, “it’s not an insignificant undertaking. It’s a significant lift for an organization of our size and stage of maturity to undertake these types of accreditation. It’s a testament to the organization and the team that we understand the importance of excellence and the additional work required to be an excellent organization.”
Anyone who has ventured into the world of URAC accreditation knows getting accredited is no easy feat. While URAC keeps the process transparent and provides a wealth of information on how to navigate the undertaking, the organization calls its accreditation “an achievement earned by the best.”
URAC’s accreditation process enables learning and compliance with nationally recognized healthcare standards and supports improvements and innovation in healthcare management and delivery. URAC accreditation requires applicants to submit policies, procedures and other organizational information that is followed by a review. Once an application is received by URAC, a primary reviewer is assigned and coordinates all aspects of the review until a decision on accreditation has been determined. The reviewer also conducts an on-site visit and interviews key leaders and staff to ensure policies and procedures have been implemented and are being followed, and necessary safeguards are in place to ensure data security.
As a Credentials Verification Organization for Patient Care, Equality Health has the responsibility to make sure providers meet certain quality standards. They must pass all of the criminal background checks, have the right education and be a good fit for value-based care.
“Once we have the best providers,” said Troy Garland, Vice President of Clinical and Quality Operations. “We know they are going to take care of our members in the best way. For our members, that means a good, high-quality and consistent standard of care.”
The Transition of Care designation assures that Equality Health maintains best practices in helping members transition from a hospital to their home and that no one falls through the cracks of the complicated healthcare system. This includes making sure members have the right medications, follow-up appointments and the tools and resources they need to avoid going back to the hospital.
“Case Management accreditation goes much deeper,” Garland explained. “Instead of reacting to a patient in the hospital, we’re a little more proactive. It’s us learning what’s important to the member and helping them succeed in the healthcare system.”
This type of case management requires standardizing how Equality Health’s clinical team interacts with members and what they do to help the member realize their health goals. The URAC accreditation ensures Equality Health consistently applies its rules to that process in a timely way. Everything goes through the organization’s Quality Committee to maintain oversight and make sure policies remain in place.
Keeping Core Values
Standardization and compliance are not insignificant requirements for an organization that thrives on challenging the status quo. Equality Health believes doing things differently brings different results and that, to some extent, it’s not always the best to do what everyone else is doing.
For Garland, who works with a diverse, multidisciplinary clinical team of individuals that includes chaplains and community workers, conformity has its challenges. Equality Health modified its protocol so that the registered nurse leads but the unlicensed staff, which bring so much to the member’s experience, remain heavily involved.
“URAC does set a framework for standards,” Garland said, “but it doesn’t necessarily tell you how to do what you need to do. Our guiding principles have been: Stay true to your organization, stay true to your goals, stay true to your people. Don’t let the standards change the value of the organization. Adapt. Make sure you adapt to the standards, but don’t lose sight of the core values of your organization. We want to hold on to the uniqueness of Equality Health, the innovation of Equality Health, and still meet URAC requirements.”
A Way of Life
URAC accreditation recognizes Equality Health’s ongoing dedication to excellence.
“It’s not enough to say we’ve done this one time,” Stevens Anderson said. “We have to keep doing it. When URAC comes and takes a look at us again they don’t just ask, ‘Are you compliant this year?’ It’s, ‘Did you keep doing what you said you were going to do every single year?’”
URAC first accredited Equality Health in July 2018 with 100% compliance. Since then, Equality Health has consistently maintained its systemic and process-driven reliability, and its attitude of excellence. Equality Health will next be looking at obtaining accreditation from the National Committee for Quality Assurance (NCQA), another regulatory body similar to URAC.
“Generally, there are two accrediting organizations,” Stevens Anderson said, “URAC and NCQA, and we went down the URAC track first. Arizona’s Medicaid agency has decided that they’re setting the standard for URAC. That requirement is for the providers. But again, because of our standard of excellence, we are looking to take on NCQA accreditation as well to ensure we are meeting the preferred accreditation status regardless of which markets we enter in the future.”
In the long run, Stevens Anderson believes these areas that require Equality Health’s conformity will bring confidence. The policies, procedures and infrastructure will take care of the day-to-day, which means the organization can focus more on long-term strategic growth.
“What this process is establishing is long-term sustainability,” Stevens Anderson said. “We have standards, policies and procedures, which is a solid operating model that we can build on as we grow.”