The not-so-secret history of URAC’s Core module

This summer, URAC will release version 4.0 of its Core module, a move that ultimately will affect nearly all of the many organizations with (or soon to seek) URAC accreditation. When that is released, we’ll spend a good bit of time helping folks understand the new standards.

In this article, however, I’ll specifically address the very concept of URAC’s Core module, going back to the module’s beginning.

When I joined URAC in late 1998 to become the Chief Operating Officer and General Counsel, URAC had a small but growing number of accreditation programs. In my tenure there, we added a few more until, by the time I left in 2001, URAC had a full dozen programs. Each of these programs had been developed completely separately from the rest, yet contained similar (but not identical) standards.

So, what’s the problem with having similar but not identical standards from one program to the next? The issue was felt most acutely by organizations seeking or maintaining multiple accreditations from URAC, organizations that had to navigate the variations in requirements on the same topics from one program to the next.

For the most part, these standards dealt with what I’d call “administration 101” type issues, that is, requirements that one could reasonably expect of all accredited organizations. These issues included:

• Organizational purpose and structure
• Staff qualifications, training, and management
• Oversight of delegated activities
• Quality management
• Consumer protection and patient safety

Core as a component of nearly all URAC programs

In August 2001, to address these inconsistencies, URAC approved the first Core module. Since then, nearly all the accreditation programs operated by URAC have contained the Core module as a part of the program. So, for example, if an organization wants to be accredited under the Health Utilization Management (“HUM”) program, it must meet the requirements of both Core and HUM in order to receive accreditation.

Core as a stand-alone module

In addition, Core has been used as a stand-alone module for those organizations for which there is no existing URAC accreditation program. For example, if your organization is a medical review company that does not qualify as an IRO for purposes of URAC accreditation, it may seek accreditation under the Core module.

While there have been a few accreditation programs that URAC has released that do not use the Core modules (e.g., Health Web Site and Telehealth), nearly all of the more than 30 programs do use the module.

The most significant deviation from this concept arose when URAC developed its Pharmacy Benefit Management (“PBM”) module in 2006–2007. For that,URAC developed the PHARM Core module, which has for the last decade been required of all the organizations under pharmacy-related accreditation programs, including PBM, Specialty Pharmacy, and Mail Service Pharmacy.

I’ll write about PHARM Core in my next article. Stay tuned! Or, write me at thomas.goddard@integralhs.com for more of the inside scoop on the new Core 4.0 standards.