Financial Incentives

At a recent URAC educational program, the URAC reviewer giving the presentation made it clear that this policy, which requires the organization to ensure that consumer healthcare is not compromised whenever there is compensation based on consumer utilization, includes capitation of providers.  Not all URAC reviewers over the years have interpreted this standard this way, so it is helpful to get official clarification on this sometimes controversial issue.

This becomes more critical now that the 2007 changes are moving into effect this summer: this standard is now a mandatory standard.  Mess it up and there's no Full Accreditation for your organization! 

There is no change in the language of Core 20 from v. 2.0 to v. 2.1.  The standard still reads:

If the organization has a system for reimbursement, bonuses, or incentives to staff or health care providers based directly on consumer utilization of health care services, then the organization implements mechanisms addressing how the organization will ensure that consumer health care is not compromised. (Primary)

What URAC has done, however, is to raise the weight from 4 to 5, making this a mandatory standard.  In other words, you must get a score of 2 or higher on this standard in order to receive full accreditation.  

For a more complete explanation of URAC scoring, see my earlier blog on the topic.