URAC Wellness Standard 12 -– Evidence-Based Research and Practices

This standard has two mandatory subsections and a third subsection that is a "leading indicator":

The wellness organization selects and designs defined interventions that are: (---)
(a) Consistent with and supported by evidence-based practices; (M)
(b) Approved by a committee designated by the wellness organization to have authority over the clinical aspects of the wellness program; and (M)
(c) Within three years of initial accreditation, provides level of evidence supporting interventions to health benefits purchasers proactively and to consumers upon request. (L)

Subsection (a) echoes from earlier standards URAC's insistence on basing the fundamental components of a wellness program on evidence.  So, like the health risk assessment tool, the interventions must be evidence-based. Affirmative documentation demonstrating that the intervention was based on current clinical research will be an essential part of the submission to AccreditNet.  Additionally, however, URAC is almost sure to require that the program have a policy and procedure that requires the basing of the design of interventions on clinical evidence. 

Subsection (b) is written in a curious way, particularly when read together with the Interpretive Information.  The standard is unambiguous in requiring that the interventions be approved by a committee.  The interpretive guide, however, suggests that this could be something other than a standing committee, that is, the senior clinical officer could approve it in consultation with other providers, not necessarily a standing committee.   While I find it curious that the standard itself doesn't say that a committee is not required; on the contrary, it explicitly requires committee review.  That being said, applicants can take URAC at its word, at least for the initial version of the standard, and, if they choose, may submit evidence of approval by the senior clinical officer.  However, those that take the individual approval route rather than the committee approval route almost surely will require evidence that the senior clinician, in fact, did consult with others in the design and selection of interventions.  Absent such evidence, the applicant runs the risk of violating this mandatory subsection.

The leading indicator subsection (c) places a responsibility on the organization to provide the evidence it used in designing the intervention to the employer -- without the requirement of a request by the employer for that evidence.  Additionally, the program will have to provide such evidence to participants upon request.  Again, not only will there need to be documentation that this evidence was provided, but that the program has a policy and procedure requiring that it submit such documentation to employers and participants in a manner that complies with this subsection.

The onsite review for this standard is likely to be a combination of interviews with relevant personnel and documentation to be submitted onsite upon selection of employers from a list of employers.  Furthermore, the applicant would do well to maintain a log of participant requests for such evidence, from which the reviewer will select files to determine how responsive to those requests the program has been.

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