The Basics

This standard requires that the DM program have a mechanism for stratifying eligible patients.  URAC defines “stratification” as a “process for sorting a population of eligible consumers into groups relating to the need for disease management interventions.”  In other words, through your assessment process, you must divide eligible consumers into various groups.  Your process must:

• Specify the criteria by which consumers are placed in each group, including an identification of levels at which the consumer will receive an individual assessment;
• Define the data sources for stratification and assessment;
• Stratify the participants at the beginning of their participation in the program;
• Contain time restrictions for completing the stratification and assessment;
• Identify and document comorbidities so they can be considered when assigning interventions;
• Include periodic restratification/re-assessment (no less frequently than annually); and
• Be based on scientific evidence, if possible.

Management Tips

Your P&Ps or program description must describe each level in your stratification system, along with a description of the relationship between each level and the program’s various interventions.  Differences between the various levels could relate to different interventions, different frequencies of contact, or different assessments. 

Your documentation should also be clear about the sources of data used in the program to place individuals in various levels.  It also should explain the reasoning underlying the stratification.

Finally, make sure that participants in our program are periodically reassessed with a possibility of that assessment placing them in a different level in the stratification system.

URAC Accreditation Tips

All seven elements of this standard are weighted 4.

For the desktop review, submit P&Ps, a flow chart of the stratification process, and perhaps screen shots of the online tools used in the assessment and stratification process.

The onsite review will involve both a demonstration of the assessment/stratification process and interviews with the staff.   Questions may include:

• What tools do you use to assess a program participant?
• How do those tools help you to identify to what level a participant should be assigned?
• What are some of the differences in your program’s interventions from one level to the next? 

The onsite reviewer, during the examination of individual case files, will look for evidence that the assessment addresses co-morbidities, results in assignment to a particular level, and assigns interventions consistent with the program’s stratification P&Ps.