Risk Stratification

This standard, which carries a weight of "4", reads:

The wellness organization includes additional interventions that focus on participants with disproportionate
risk factors. (4)

Borrowing from the world of disease management, URAC places a high value on stratification of the participants in the wellness program according to risk factors.   This standard requires an evaluation, along the spectrum of health risk factors, of the target population with an eye toward providing more intensive interventions for those at greatest risk. 

Documentation for purposes of the desktop review should include an official, approved document that describes the stratification process.  In addition, documentation should address how additional interventions for high-risk participants match the high-risk categories identified through this stratification process.  The onsite review will combine a closer examination of documents demonstrating the implementation of the stratification process, as well as an interview of senior clinicians associated with the stratification process to assure a full understanding of both the risk identification methodology and the administration of the interventions for high-risk participants.