URAC Wellness Standard 4 -- Health Risk Assessment Tool

This standard lays out what URAC describes as the "critical first step" in understanding the health risk in the target population, a health risk assessment tool.  That tool needs to address all the risk-types, be based in peer-reviewed scientific literature, relate risk factors to risk-types that are identified in th target population, and provide a report to the individual using the tool his/her score on the assessment.  Like the overall assessment process, the tool needs senior level clinical approval, and should use biometric screening.

Taken as a whole, this standard highlights the importance that URAC places upon a documented correspondence among all the elements of the wellness program.  In otherwords, the health risk assessment must be inclusive of all the risk-types in the program.  As URAC's interpretive notes state, "the assessment should be tailored to the program’s purpose and risk-type(s)."

While URAC won't second-guess the research upon which the program's assessments and interventions are based, it will require documentation of the evidence-based nature of the program design, including the selection and design of the assessment tool.  URAC also will require clear documentation that either the senior clinical officer or a committee sign-off on the risk assessment methodology.  No committee is required, but is an option.  That review must document that the clinician or committee has validated the tool as being clinically up-to-date and evidence-based.

This standard has two "Leading Indicators" in subsections (e) and (f).  (Click here for more information on leading indicators).  They acknowledge that it is an indication of a wellness program's superior design if the assessment tool can provide the participant with an overall score.  Further, it recognizes the utility of using biometric screenings in stratifying the target population into meaningful segments.

The onsite review will establish compliance based both on interviews with program staff members and file reviews that show that program participants are completing URAC-compliant HRA tools.  In addition, the reviewer will look for documentation of the senior clinical approval of the tool(s) used by the program.