URAC Core Tales Installment 5: The New Scoring System

In my previous stories about the upcoming release of version 4.0 of URAC’s Core module, I’ve given a bit of history about the Core module itself, as well as a peek at the new structure of this wide-reaching module.

Wide-reaching? What’s so important about this module? Well, actually, it’s quite a big deal. My best guess, based on historical data and recent trends is that

over 150 million Americans receive some aspect of their healthcare through URAC-accredited companies that have Core as a component of their accreditation.

The number could actually be much higher than this, given the fact that all the major pharmacy benefit management companies, most of the major utilization management organizations, most of the accredited specialty and mail service pharmacies, and a significant number of other major managed healthcare organizations are URAC-accredited.

So, now that I’ve got your attention with these big numbers, let’s talk about small numbers — those involved in URAC’s scoring system.

Under URAC’s existing scoring system, scoring happens at the element level. Each scored element could be one of three types:

• Mandatory — meaning it must be passed for the organization to receive a Full Accreditation;
• A point value of 1 to 4 points — not quite so mandatory, but still important in order to gain accreditation; and
• Leading indicator — not required for accreditation but a useful tool for URAC to find out whether a new standard is useful and appropriate for the industry.

Not much is changing about scoring in version 4.0. In fact, as I discussed in the previous article, we got a preview of Core 4.0 in the Telehealth 1.0 standards. The new scoring will be at the level of the 4.0 equivalent of elements, that is, elements of performance. The new system is very much like the existing one:

• Mandatory — meaning it must be passed for the organization to receive a Full Accreditation;
• A point value of 2 or 4 points — not quite so mandatory, but still important in order to gain accreditation; and
• Leading indicator — not required for accreditation but a useful tool for URAC to find out whether a new standard is useful and appropriate for the industry.

One of the questions some may ask is “what will be the scoring of the standards that will be new to version 4.0?” URAC issued a public statement a few months ago on this subject:

The following features of the “introductory phase” of Core v4.0 will remain in place over the initial three-year period:

· Most of the new standard elements of performance will be weighted [2] or identified as Leading Indicators [L]; only a few will be weighted [4] and none will be Mandatory [M].

So, as I read it, we’ll all be eased into the new requirements over the next three years.

So, what’s next, both for this series of posts and for the Core 4.0 module itself?

As for this series of articles about Core 4.0, next I hope to be able to report on the actual schedule under which various modules (Case Management, Health Utilization Management, Health Plan/Network, and the Pharmacy suite of programs, in particular) will be phased in over the coming year. URAC expects to release that schedule later this month.

Once we have that behind us, I’ll start writing in some detail about the standards themselves, which, while approved in April, will be released in official form sometime later this quarter.