URAC Core Tales Installment 2: Core isn’t as “core” as we thought

As I wrote in my last post, URAC’s Core module was intended from its birth in 2001 to capture universal and basic administrative requirements that could be expected of any healthcare organization. It did not take long for URAC to encounter a couple of exceptions to this.

PHARM Core

Up until the middle of the last decade, one URAC Standards Committee wrote and revised all the accreditation programs. Certainly, the committee had task forces organized around specific topic areas that helped the committee understand a new area it was entering, but the basic decision making was still done by the same standing committee.

This changed when URAC first entered the world of pharmacy-related accreditation with its Pharmacy Benefit Management (“PBM”) standards a decade ago. An entirely new Standards Committee was created for pharmacy. When encountering the Core standards, that committee decided that it couldn’t really work with the Core module that applied to most of the rest of the URAC programs. Rather, it created its own, very slightly different version, which it named “PHARM Core.”

PHARM Core differed (and still differs) from Core in only two material respects:

• Core 40, which deals with Health Literacy, was deemed not to be necessary in PHARM Core because the PBM standards had a CSCD standard which dealt with the same topic. So, there is no PHARM Core 40.
• PHARM Core 41 was added, dealing with background checks and drug tests for employees. Presumably, it was included in PHARM Core because it would be applicable to all subsequent pharmacy-related programs.

IRO Core

A similar story lies behind the IRO Core module. When the original Core came out, one of the programs to incorporate the new Core module was the Independent Review Organization (“IRO”) Accreditation Program, v. 2.0, released in late 2001. This remained true throughout IRO vs. 4.0, released in 2008, which included Core v. 3.0, the current version.

However, in 2011, URAC’s IRO world got funky. First of all, URAC split IRO into three separate programs:

• Independent Review Organization: Comprehensive Review (Internal & External Review)
• Independent Review Organization: Internal Review
• Independent Review Organization: External Review

The second quirk of these three new programs is that they had a new Core, “IRO Core 3.0”. (Even though it’s numbers 3.0, that’s simply to keep it consistent with regular Core and PHARM Core. In reality, it was the first IRO Core.)

IRO Core 3.0 was, unlike PHARM Core 3.0, significantly different than Core 3.0. Most notably, it omitted a bucketful of standards, leaving only the following behind: IRO Core 1, 3–4, 6–9, 11–16, 25–28, 31–33, 38. Only 21 of the original 40 standards remain for IROs.

In the next post, I’ll talk about another variation on the Core module — designating some standards as not applicable to certain types of organizations.