URAC Measurement-Based Care Designation — Frequently Asked Questions

Last updated: April 2026

Answers to 13 common questions about URAC's Measurement-Based Care (MBC) Designation — what it is, who qualifies, what the standards require, how it differs from URAC accreditation, and how IHS guides organizations through the process. Thomas G. Goddard, JD, PhD — former Chief Operating Officer and General Counsel of URAC — leads IHS's URAC consulting practice.

What is the URAC Measurement-Based Care Designation?

URAC's Measurement-Based Care (MBC) Designation is an elective add-on to existing URAC accreditation or certification. It consists of a focused set of standards that recognize organizations demonstrating systematic use of validated patient self-assessment tools to track symptom severity and inform treatment decisions for mental health and substance use disorder (MH/SUD) populations.

The Designation does not replace accreditation — it sits on top of it, adding a specific clinical quality signal for payers, purchasers, and regulators evaluating behavioral health network quality. URAC designed the MBC Designation as part of its Path Forward agenda — aligning accreditation recognition with measurable patient outcomes rather than process compliance alone.

What does measurement-based care mean?

Measurement-Based Care (MBC) is the systematic practice of administering validated patient self-assessment instruments at every clinical encounter, scoring results, tracking symptom severity over time, and using that data to drive treatment decisions. This is the clinical discipline behind the Designation's standards.

In a functioning MBC program, a patient with depression completes the PHQ-9 before or at the start of every visit. The score is recorded, compared to prior scores, and classified against defined thresholds. If the score shows inadequate response after a reasonable trial, the clinician and patient have a documented basis for evaluating whether to change the treatment plan — adjust medication, shift therapeutic modality, or escalate to a higher level of care. If the score reaches a remission threshold, that milestone is documented and incorporated into ongoing care planning.

The evidence base is strong: research consistently shows 20–60% better outcomes in programs implementing MBC compared to care delivered without structured symptom tracking (URAC). Despite this, fewer than 20% of behavioral health practitioners implement MBC consistently — making organizational MBC infrastructure a meaningful quality differentiator.

Who is eligible for the URAC MBC Designation?

Any organization that currently holds a URAC accreditation or certification is eligible to apply. The Designation cannot be pursued as a standalone credential. The most common eligible organizations are:

  • Managed behavioral health organizations (MBHOs) accredited under URAC's Behavioral Health Accreditation program
  • Health plans with behavioral benefit carve-ins, accredited under URAC Health Plan Accreditation
  • Integrated behavioral health delivery systems operating collaborative care models
  • Outpatient mental health and SUD providers holding URAC accreditation
  • Employee Assistance Programs (EAPs) accredited under URAC's EAP program
  • Telehealth behavioral health platforms holding URAC Telehealth Accreditation

Does my organization need URAC accreditation before applying for the MBC Designation?

Yes. URAC Designations are elective add-ons to URAC accreditation or certification programs. Your organization must hold a current URAC accreditation or certification before applying for the MBC Designation. If your organization is simultaneously pursuing URAC accreditation and the MBC Designation, IHS can coordinate both engagements to reduce documentation redundancy and compress the overall timeline.

What are the URAC MBC Designation standards?

URAC's MBC Designation standards evaluate five areas of organizational infrastructure:

  • Assessment tool deployment: Standardized, validated symptom rating scales administered at each clinical encounter, producing reliable symptom severity data
  • Symptom severity classification: Classification of symptom severity changes into clinically meaningful categories — response, partial response, non-response, and remission — using defined thresholds for each instrument
  • Care plan integration: Use of assessment data to develop individualized care plans and to identify patients achieving remission or requiring treatment escalation
  • Quality improvement integration: Incorporation of MBC data into performance process measures, outcomes evaluation, and quality improvement programs
  • Exploratory measures reporting: Reporting on any of the exploratory measures included in URAC's MBC Designation framework

All standards require documented operational evidence — not just written policy. URAC reviewers evaluate whether clinical records, QI reports, and training documentation demonstrate that MBC practices are embedded in day-to-day operations.

What assessment tools are used in measurement-based care?

Validated instruments commonly used in MBC programs include:

  • PHQ-9 — Patient Health Questionnaire-9 (depression)
  • GAD-7 — Generalized Anxiety Disorder 7-item scale (anxiety)
  • AUDIT-C — Alcohol Use Disorders Identification Test-Concise (alcohol use)
  • DAST-10 — Drug Abuse Screening Test (drug use)
  • PCL-5 — PTSD Checklist for DSM-5 (PTSD)
  • C-SSRS — Columbia Suicide Severity Rating Scale (suicide risk)
  • MDQ — Mood Disorder Questionnaire (bipolar spectrum)
  • WHO-5 — World Health Organization Well-Being Index (general wellbeing)

URAC requires validated, reliable instruments — the organization selects tools appropriate to its patient population and service lines. Freely available instruments such as the PHQ-9 and GAD-7 are generally preferable: they eliminate licensing cost, are widely integrated into commercial EHR platforms, and are supported by extensive psychometric literature for threshold classification. IHS advises on tool selection during the gap assessment phase.

How does the URAC MBC Designation differ from URAC Behavioral Health Accreditation?

URAC Behavioral Health Accreditation is a full-scope accreditation program evaluating the breadth of a behavioral health organization's operations: governance, network management, access and availability, care coordination, utilization management, quality improvement, and member rights. It is a comprehensive review of organizational structure and processes.

The MBC Designation is a focused add-on that evaluates a single dimension: whether the organization systematically uses validated outcome measures at the patient-encounter level to inform clinical decisions. The two programs are complementary — an organization with URAC Behavioral Health Accreditation can add the MBC Designation to signal that its accredited operations also include systematic outcomes tracking.

The Designation does not substitute for accreditation in payer contracting situations that require URAC Behavioral Health Accreditation. It augments the accreditation, it does not replace it.

Why is measurement-based care adoption so low despite the evidence?

Fewer than 20% of behavioral health practitioners implement MBC consistently, despite robust evidence of outcomes improvement. Research identifies several converging barriers:

  • Perceived time burden: Clinicians associate patient-reported outcome measures with intake screening rather than ongoing clinical tracking, and experience encounter-level administration as added friction without perceived clinical value
  • EHR fragmentation: Most clinical EHR platforms do not natively prompt assessment administration at each encounter or automatically score and trend results, requiring manual workarounds
  • Training gaps: While knowledge of instruments like the PHQ-9 and GAD-7 is high (97.9% of physicians in one study), willingness to use them as ongoing tracking tools is significantly lower — only 73.1% for PHQ-9, 62.7% for GAD-7 (Waheed et al., 2024)
  • Absence of organizational protocol: Without a policy requiring encounter-level assessment as a standard workflow step, adoption is dependent on individual clinician preference rather than organizational infrastructure
  • Annual reassessment norms: Many organizations conduct PHQ-9 assessments annually for quality reporting purposes — a frequency that satisfies payer HEDIS requirements but is insufficient for MBC-level clinical tracking

The URAC MBC Designation addresses these barriers at the organizational level. The standards require infrastructure — protocols, classification frameworks, EHR integration, and QI reporting — that makes encounter-level assessment routine.

What outcomes does measurement-based care actually produce?

The MBC outcomes literature is consistent across study designs and populations:

  • A 2025 large-scale implementation study found approximately 23.5% relative improvement on combined PHQ-9 and GAD-7 measures, with 95% of clinicians demonstrating improved documentation behaviors (Frontiers in Health Services, 2025)
  • Two pilot studies found MBC clients had statistically significantly greater symptom improvement at discharge across PHQ-9, GAD-7, and WHO-5 measures (JMIR Formative Research, 2024)
  • Discharge rates (routine treatment completion) improved 22–29% in MBC groups compared to non-MBC groups — a measure directly relevant to behavioral health program quality reporting
  • URAC cites a 20–60% improvement range based on the broader MBC outcomes literature

These outcomes reflect the mechanism: MBC prevents clinical inertia — the continuation of an ineffective treatment plan in the absence of objective data — by creating a structured prompt to evaluate and adjust when assessment scores indicate non-response.

How long does the URAC MBC Designation process take?

The MBC Designation process is narrower in scope than a full URAC accreditation. IHS structures the engagement in four phases:

  • Phase 1 — Gap assessment: Weeks 1–4
  • Phase 2 — Standards documentation and policy development: Weeks 4–12
  • Phase 3 — Mock review: Weeks 12–16
  • Phase 4 — Application submission and URAC review: Weeks 16 onward

Total elapsed time from gap assessment to Designation decision is typically 4–6 months, depending on the depth of your organization's existing MBC infrastructure. Organizations that already administer validated tools routinely but lack documentation infrastructure typically move faster than organizations building MBC programs from scratch.

What does URAC look for when reviewing an MBC Designation application?

URAC reviewers evaluate whether documentation demonstrates that MBC practices are embedded in clinical operations — not just described in policy. Key evidence points include:

  • Clinical assessment records showing validated tool administration at each encounter (not just intake or annually)
  • Score classification documentation showing symptom severity categorized against defined thresholds — response, non-response, remission
  • Care plan documentation tracing assessment data to specific treatment decisions
  • Staff training records demonstrating clinical staff competence in tool administration, scoring, and interpretation
  • QI program reports incorporating aggregate MBC outcome data — response rates, remission rates, treatment completion rates

Policy documents alone are insufficient. URAC reviews operational evidence that policies are implemented. IHS's mock review phase specifically tests the gap between written policy and documented operational compliance before the application is submitted.

How does the MBC Designation benefit payer contracting?

Payers and employer purchaser coalitions are increasingly evaluating behavioral health network quality on outcomes evidence rather than process compliance alone. The National Alliance of Healthcare Purchaser Coalitions has specifically cited URAC's MBC Designation as a mechanism for purchasers to evaluate behavioral health contractor quality (National Alliance).

In practical contracting terms, the Designation provides: a formal third-party-validated credential that your organization systematically tracks patient outcomes; a standardized basis for the outcomes data payers increasingly require from behavioral health networks; and differentiation in network adequacy evaluations where payers are beginning to distinguish between MBC-implementing and non-implementing providers.

In some payer relationships — particularly collaborative care models and carve-in behavioral health contracts — MBC documentation is moving from differentiator to contractual requirement. The Designation provides a credentialed basis for that documentation rather than requiring payer-by-payer evidence submission.

What does an IHS MBC Designation consultant do?

IHS structures the MBC Designation engagement in four phases:

  • Gap assessment: Structured review of your current clinical operations against each MBC Designation standard, producing a remediation roadmap with findings ranked by severity and implementation complexity
  • Standards documentation: Policy and procedure templates for each standard area, adapted to your patient population, service lines, and EHR infrastructure. Includes clinical assessment protocols, symptom severity classification frameworks, care plan integration policies, escalation protocols, and MBC QI reporting frameworks
  • Mock review: Review of your completed documentation against each Designation standard, simulating URAC's evidence evaluation. Gaps identified here are corrected before formal application
  • Application support: Preparation and submission of the formal Designation application, and direct response support if URAC issues requests for additional information during review

IHS does not replace your internal clinical and quality improvement team — we ensure your team builds and documents against the correct evidentiary standard. Thomas G. Goddard, JD, PhD — former Chief Operating Officer and General Counsel of URAC — leads the engagement.

Related Resources

Ready to Get Started?

Schedule a no-obligation consultation with IHS. We will assess your current MBC infrastructure, confirm your eligibility for the Designation, and give you a clear roadmap to application.

Schedule a Free Discovery Session