MetaStar Makes the Difference in URAC Accreditation

On the Mission page of the Utilization Review Accreditation Commission (URAC) website, President and CEO, Shawn Griffin, MD, declares “At URAC, we seek to inspire health organizations and communities to deliver a higher level of care.” The page goes on to say that URAC knows “equity and inclusion can be improved. It’s our intention to continually define and write standards that elevate health care for each individual. Every person matters. Every person deserves the best care.” Figuring out how to get to that higher level of care can be a complex and challenging endeavor for most healthcare organizations. That’s why, in 1990, the newly incorporated URAC created standards and metrics that allow organizations to receive URAC accreditation. The accreditation shows that, through careful data collection and validation, an organization has reached an elevated level of healthcare delivery. Today, URAC offers dozens of accreditation programs to help healthcare organizations provide the best, most efficient health care at the lowest cost.

Steps to URAC Accreditation

URAC accreditation is a multi-step process of data collection and validation. In healthcare, where it’s difficult to consistently measure outcomes between and within organizations, having a third-party organization—like URAC—allows healthcare providers and administrators to see how their organizations are performing using a set of predetermined metrics. Like the shiny gold star atop a school test, the URAC accreditation gold star lets everyone who sees it know that this organization has met the high standards set by URAC’s various panels of experts.

Accreditation happens in three steps: first, the organization applies to URAC to be accredited. For the remainder of that year, the organization reviews the required metrics for their area and adjusts their workflows, data tracking, and data storage systems to ensure they are tracking and collecting the required data. Next, the organization collects data for an entire calendar year for all mandatory metrics. The final step includes data validation by a URAC-approved validating organization such as MetaStar and the submission of that data to URAC. For example: if an organization applies to URAC in 2024, they collect their first year of data in 2025, and they would have their data validated for URAC submission in 2026. Data submission is required each year the organization wishes to be URAC-accredited.

Each URAC accreditation program has mandatory metrics used to evaluate their organizations. For example, mail service pharmacies will report on their prescription dispensing accuracy, such as the number of labels with incorrect patient addresses. This will be reported as a numerator (number of prescription labels with incorrect addresses) and a denominator (total number of prescriptions) to create a percentage of prescriptions with incorrect addresses. Measurement rates can then be assessed to find areas of improvement or areas of exceptional competence.

The Data Validation Process

During the validation process, MetaStar helps “confirm that the pharmacies/organizations are collecting the appropriate data and calculating the measure rates correctly,” said Ross Gatzke, the URAC data validation lead at MetaStar, during a recent interview. This means providing the organization with documentation to help them through the validation process, confirming they are collecting the correct data, and ensuring the organization is ready to report the required information to URAC. “For most of the mandatory measures that URAC has, organizations typically already have a data collection process in place,” Gatzke continued. “A lot of times, they just have to make some updates to meet the technical specifications [set by URAC.]”

MetaStar provides top-tier data validation services for pharmacies, which are the only organizations that require data validation for URAC accreditation. MetaStar validators continuously review submitted data and measure rates through the validation process. “It helps the organization feel at ease and get confirmation that they are reporting the measures accurately to URAC,” Gatzke explained. If any issues are found, the organization has time to adjust and run more data checks to ensure the final submission to URAC accurately portrays what happens at their organization.

The MetaStar Difference

MetaStar is one of the five URAC-approved data validation vendors. When deciding which vendor to choose, consider the following:

• MetaStar’s three-year retention rate (2022-2024) is 98.73%.
• MetaStar has the experience and consistency that organizations who are serious about URAC accreditation look for:
  • Ten unique data validators. Each data validator has at least two years of experience, while most have five or more years of data validation experience. “They are subject matter experts in their own rights,” Gatzke said.
  • A consistent, reliable relationship between MetaStar data validators and organizations.
    • Year over year, the same validator will work with an organization, building a relationship on familiarity, trust, and knowledge.
    • In subsequent years, data validation becomes a familiar process as the data validator will have experience and expertise working with the specific organization.
  • MetaStar hosts three webinars twice each year that provide education and guidance regarding URAC data validation.
  • MetaStar has outstanding customer service, and their data validators are among the best in the business.

Organizations praise MetaStar’s work, data validators, and customer service. Here’s what they say:

• [MetaStar is] dependable, quick to respond and extremely helpful. Everyone has been amazing and very friendly.
• The experience with MetaStar and our current reviewer is excellent. We have been customers for 5 years, and we enjoy the bi-directional learning that comes along with these audits and reviews.
• Our overall experience with MetaStar was excellent; our validator was very easy to work with and was very helpful every step of the way.
• We have been working with MetaStar for several years and continue to appreciate the quality and efficiency shown during the validation and reporting process!
• [MetaStar is] extremely professional and diligent. Working with our validator was a very positive experience where any question or concern we had was met with professional insight and remediation.
• Overall experience was fantastic. [MetaStar data validators are] extremely knowledgeable and helpful throughout the process.

If your organization wants top-of-the-line URAC data validation from a leader in the industry with proven, positive results, MetaStar URAC data validation services is the obvious choice. Contact Manny Martin, Vice President of Commercial Services at MetaStar, at 608-441-8264 or mmartin@metastar.com for more information or to get the contracting process started today.