URAC Core Tales Installment 3: “Let’s make Core flexible!”

Then, rather than make up any more new Core modules, URAC decided to build flexibility into Core itself

The challenges of the “one size fits all” vision that led URAC to create PHARM Core and IRO Core (as I discussed in my previous post) continued.

Rather than coming up with new Core modules, one for each of the types of healthcare organizations that didn’t quite fit the Core mold, URAC simply published a chart that explained that some standards didn’t apply to some modules. This novel and creative idea solve a lot of problems, and didn’t require URAC to convene new task forces or committees to go through the cumbersome process of developing new modules as URAC had done for PBMs and IROs.

Nice idea, but how does that work?

So, how does this change play out in the real world? Let’s take Health Utilization Management (“HUM”) as our first example. What if you’ve got a situation where the accredited HUM organization is prohibited by its contract from having any contact with consumers? What does that do to the Core standards that have to do with consumer interaction? Well, under URAC’s new approach, such an HUM organization does not need to meet the requirements Core 34–40, all of which have to do with consumer interactions.

Similar decisions about Core 34–40 were made with regard to Health and Dental Networks, Provider Credentialing organizations, and Credentials Verification Organizations (“CVO”). But URAC didn’t stop there. There are a couple of URAC accreditation programs, Provider Credentialing and CVO, for which it made no sense to worry about whether the organization had financial incentives that impacted consumer utilization of healthcare services. Boom — there goes Core 33, right out the window!

No quality improvement projects required!

Quality improvement projects (Core 22–24) also were deemed as not applicable to certain accreditation programs, specifically, Health and Dental Network, Provider Credentialing, and CVO. The consumer safety quality improvement project standard was deemed not applicable for HUM and WCUM, primarily because those modules had other standards that directly related to consumer safety.

For a couple of programs, the quality standards (Core 17–24) were deemed to be not applicable, not because those programs didn’t need quality management programs, but because URAC’s expectations for QM were noticeably higher than those established in the Core standards. So, for Health and Dental Plans, Core 17–24 are replaced by the Quality Management (QM) standards in the Plan modules.

Core as a freestanding module

Finally, we turn to the Core-only applicants. From the beginning, Core was thought of not only as a part of the existing accreditation programs, but also as its own freestanding program for organizations for which URAC did not have a program. For such an organization, the process of figuring out which Core standards apply to the organization is negotiated with URAC on a case-by-case basis. In other words, the organization goes to URAC, declares its desire to have Core-only accreditation, and then describes its business model to a member of the URAC staff who then helps sort out which Core standards apply and which do not.

That’s a whole lot of history. What’s next?

I’m so glad you asked. We’re building up to a rather significant event, URAC’s release, sometime later this year, of Core 4.0. There are some major changes ahead, and, because URAC goes through a public comment period in which the public got to look at earlier drafts of the new standards, we know something about what is about to unfold. We figured that giving you a bit of background about the URAC Core module would help you understand our upcoming articles about Core 4.0.

In the meantime, if you have any questions about these issues or URAC accreditation, generally, shoot us a note at info@integralhs.com.