URAC Wellness Standard 3 -- Health Risk Assessment Process

This standard, which was substantially beefed-up after the public comment period, requires that the program's health risk assessment process meet seven criteria.  It must first identify both risk types and risk factors -- at the level of the individual -- within the target population.  It must describe how individuals will be evaluated for possible inclusion in the program.  Further, the risk assessment must be closely related to the program's interventions and be inclusive of all the program's covered risk-types.  

The assessment process also needs to be designed to elicit information regarding the risk factors that relate to the corresponding risk-types.  Further, there needs to be documentation of its grounding in scientific evidence.  Finally, the assessment needs to have senior-level clinical approval, as defined by the organization's P&Ps.  

It is important to remember that URAC requires documentation of each element of every standard.  So, for example, an applicant can expect to be required to document how it identifies risk types and factors in the target population.  This documentation likely will be in the form of a program description. 

As another example of required documentation, the applicant should expect to submit documentation demonstrating a link between the health assessment process and the interventions it selects. The evidence-based requirement will not constrain a wellness program to subscribe to a particular model.  All that URAC requires is a demonstration that whatever approach is taken is based upon peer-reviewed research.

The onsite review is likely to involve an interview with those responsible for wellness program design to make sure that they understand the documentation submitted for desktop review.