UPMC Health Plan
Accreditations & Awards
Community Care Establishes In-Process Status for Health Utilization Management Accreditation from URAC
Community Care is currently seeking Health Utilization Management Accreditation from URAC, an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, education, and measurement.
URAC's Health Utilization Management Accreditation ensures that all types of organizations conducting utilization review follow a process that is clinically sound and respects patients' and providers' rights while giving payers reasonable guidelines to follow. URAC's standards address the use of evidence-based guidelines, outline specific reviewer requirements for each level of review, and require a policy preventing financial incentives to doctors and other providers based on consumers' use of health services; thus, the standards meet the demands of a changing health care system. URAC's accreditation ensures the adequacy of health utilization management programs through evaluation against broadly recognized standards and measures.
"Community Care Behavioral Health Organization should be commended for its decision to be reviewed under URAC's strict quality standards," said URAC President and CEO Kylanne Green. "It is critically important for health care organizations to make a commitment to quality and accountability."
The URAC standards development process is consensus driven, with industry experts serving as volunteers to establish and revise appropriate industry benchmarks.
Starting with standards development, select representatives from URAC's volunteer network gather to establish and revise appropriate benchmarks. These volunteers represent the interests of a wide variety of stakeholders including purchasers, regulators, consumers, providers, and health care organizations. As a result, URAC standards are relevant and suitable for the health care sector they address. This sets the stage for establishing accreditation as an opportunity for companies to improve and enhance their operations, as well as prove to others that they can meet national standards.
URAC, an independent, nonprofit organization, is a well-known leader in promoting health care quality through its accreditation, education, and measurement programs. URAC offers a wide range of quality benchmarking programs and services that model the rapid changes in the health care system and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit www.urac.org.
Community Care has been awarded three-year Full Accreditation – the highest possible level – from the National Committee for Quality Assurance (NCQA) for Managed Behavioral Healthcare Organization. NCQA Accreditation is a voluntary review process.
NCQA is an independent, non-profit organization that assesses and reports on the quality of the nation’s managed care plans. NCQA Accreditation is nationally recognized as a seal of approval.
“We are an organization that is committed to continuous quality improvement and I believe that has been validated by the NCQA accreditation,” said James Gavin, president and CEO of Community Care Behavioral Health Organization. “The fact that each of our employees, and providers, as well as our management team, contributed to the accreditation process in some way, makes us even more proud of this achievement,” Gavin said.
Managed Behavioral Healthcare Organization
The NCQA Accreditation survey process includes on- and off-site evaluations of over 60 standards conducted by a team of physicians and managed care experts. A committee of physicians analyzes the team’s finding and assigns an accreditation level based on the performance level of the plan being evaluated to NCQA’s standards. NCQA MBHO Accreditation standards are purposely set high to encourage MBHOs to continuously enhance their quality.
Gold Achievement Award
Community Care Behavioral Health Organization received a 2013 Gold Achievement Award from the American Psychiatric Association (APA). APA recognized Community Care for its support of shared decision making in mental health and substance use disorder programs. Advancement in shared decision making for improving the quality of health care is a focus in the Affordable Care Act. Community Care has supported the implementation and operation of CommonGround, a unique software program designed by Patricia Deegan, Ph.D., that provides for shared decision making in psychiatric medication clinics. Its use is facilitated by peer-run decision support centers (DSCs) in, primarily, outpatient mental health centers. Read the press release for more information.
Distinguished Advocate Award
The Pennsylvania Association of Psychosocial Rehabilitation Services (PAPSRS) presented Community Care with the 2012 Distinguished Advocate award in April 2012. PAPSRS recognized Community Care for its efforts on behalf of people with behavioral health disorders, in collaboration with county, state, and community leaders and other behavioral health stakeholders, to promote effective, accessible mental health and substance abuse services that support recovery. Community Care supports the mission of PAPSRS - to promote and improve the range of services and approaches that facilitate the recovery of persons with psychiatric disabilities.
The Tree of Life Award
The 2008 Tree of Life Award for service to people recovering from addiction, was presented to Community Care and its President, James Gavin, by Message Carriers of Pennsylvania.
The American Association of Community Psychiatrists (AACP) and H. Steven Moffic, M.D, presented Community Care with the 2003 Moffic Award for Ethical Practice in Public Sector Managed Behavioral Healthcare in October 2003. The AACP recognized Community Care for its ethical practices in patient care, as evidenced by its accomplishments in Western Pennsylvania, partnership with providers, and academic alliances. The award was presented to Community Care for uniquely attending to the needs of persons receiving behavioral health services and providers; and for assertively advocating accessible behavioral health services, quality care, best practice models, and improved outcomes. Community Care is the only managed care organization ever to have been nominated.
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