When is a Medical Cost Projection Recommended?

Medical Cost Projections are recommended to establish accurate reserves for the future medical costs of complex, large loss claims, often associated with catastrophic injuries. Catastrophic claims can extend over decades, racking up millions of dollars in medical costs. For this reason, setting an accurate reserve is absolutely critical to the financial well-being and security of the carrier and/or the employer.

Medical Cost Projections and the Complex Large Loss Claims

Oftentimes, large loss claims are highly complicated with multiple factors driving exposure and complex information needing to be weighed. The complex nature of large loss claims can stem from several elements:

• Multiple co-morbidities such as diabetes, multiple infections, respiratory ailments, heart disease.
• Injuries may include fractures that do not heal or develop infections, traumatic brain injuries, spinal cord injuries, amputations, and multiple surgeries.
• Treatment is ongoing resulting frequent reserve increases.
  • Reserves may become exhausted prematurely as a prior review did not include new or increasing exposures.
• Pain management treatment, including high medication utilization with escalating medication costs.
  • May also include the use of pain pumps and/or spinal cord stimulators.
• Ongoing frequent physician visits with multiple providers, possibly creating polypharmacy.
• It is often helpful to develop a Medical Cost Projection when settling a claim with an undocumented worker.
  • Cost Projections can be useful in detailing anticipated future care should the worker intend to permanently relocate outside of the United States.

The volatile nature of catastrophic claims makes accurately setting a reserve no small task. It requires the highly credentialed expertise and comprehensive analysis that a Medical Cost Projection program can provide. At ANS, our national network of highly credentialed nurse experts have extensive catastrophic injury experience and are able to apply jurisdictional specific knowledge to the cases they are strategically assigned.

ANS Approach to Medical Cost Projection

The ANS approach to Medical Cost Projections combines an evaluation of potential areas of exposure with potential areas of savings to provide a complete plan of action. Our findings are independently examined using expert medical and cost data sources. The resulting evidence-based recommendations achieve the best possible outcome from a cost and quality of care perspective. For more information on ANS Solutions’ industry leading approach to Medical Cost Projections, contact us today at www.ans-solutions.com.

This content was originally posted at www.ans-solutions.com.

The Perfect Storm: Rising Pharma Costs & Part D

As we all know, injured worker treatment regimens relying heavily on costly prescriptions is the unfortunate norm. On top of that, pharma costs are continually rising, surpassing general and medical cost inflation. It seems that Payers can’t catch a break. To add insult to injury, Medicare Part D came into existence as part of the Medicare Modernization Act, which further mandated the inclusion of prescription drug coverage in Medicare Set-Asides. Accounting for prescription drug coverage in the face of inflating pharma costs and excessive prescriptions is the perfect storm for excessive MSAs, resulting in fewer settled claims.

Mitigating MSA Part D Exposure

To reach settlement quickly and with optimal results for both Payer and Claimant, a comprehensive expert approach is necessary. At ANS we mitigate Medicare Set Aside Part D exposure with a unique three step approach.

PharmReview – Pharm Ds examine the worker's current treatment and recommends modifications, often finding similar or superior results that can be achieved using less expensive drugs or alternate therapies, producing improved results for both the worker and the carrier.

PharmIntervention - To address these recommended conversions, an ANS Nurse Expert meets with the injured worker's physician to develop a new pharmaceutical regimen based on the expert review and recommendations. Significant MSA savings are often achieved by formally discontinuing previously prescribed medications, allowing their removal from the MSA.

PharmCompliance - To ensure hard dollar savings and a positive therapeutic outcome, each case requires proactive management. An ANS Clinical Liaison Officer is assigned to every case and employs protocols to ensure the new regimen is adhered to by both the treating physician and claimant.

Experience shows that ANS Solution's comprehensive Pharmacotherapy Review Program can reduce pharma costs by as much as 25%. Settlements are optimized, and achieved faster with lower costs. ANS’ program often leads to the claimant obtaining an improved quality of life.

To learn more contact us at www.ans-solutions.com.

This content was originally posted at www.ans-solutions.com.

Advanced Strategies for Pharmaceutical Cost Management

With large loss claims, the road to managing the hefty costs associated with pharmaceutical therapies can be long and winding. As more drugs become available within drug classes, there is often a large cost disparity among medications. Further, patient access to more affordable and equally (if not more) effective medications is limited. Fortunately, there are advanced pharmaceutical cost management solutions available. One such solution, Pharmacotherapy Review, is ANS’s highly evolved approach to drug utilization review. The Pharmacotherapy Review Program utilizes a three-stage approach to provide economically balanced and appropriate treatment options for injured workers.

PharmReview – Stage 1

At ANS we are not just concerned with cost-effective treatment regimes. Overall our strategies strive to improve the quality of life for the injured worker. The PharmReview program applies evidence-based medical guidelines when strategically assessing each case to identify the best possible clinical and pharmaceutical treatment plan based on the injured worker’s medical condition. The final product is an expert recommendation on a course of action to improve the living conditions of the injured worker while reducing unnecessary costs for the carrier.

PharmIntervention – Stage 2

PharmIntervention involves applying expert clinical knowledge and experience in catastrophic injures to recommend, where appropriate, alternative treatments and therapies. The goal of this strategy is to improve quality of care and overall outcomes. Achieving this goal requires a thoughtful and collaborative partnership between treating physicians to employ a modified treatment plan based on the recommendations of highly credentialed and experienced nurse experts. When done correctly it will ensure that patients receive the highest quality of care balanced with the necessary cost controls.

PharmCompliance – Stage 3

Physician and patient compliance with the new prescription plan established during the PharmIntervention stage is crucial to a successful pharmaceutical cost management strategy. First, it will help determine whether the modified treatment plan is achieving the desired result. Second, it will ensure both the physician(s) and injured worker are actively engaged in the new treatment regime. Compliance by both parties will generate hard dollar cost-savings and positive therapeutic outcomes. In this stage, ANS Clinical Liaison officers will pro-actively manage a case to ensure compliance and maximize outcomes.

ANS Solutions

Effective use of advanced pharmaceutical cost management tools such as ANS PharmReview Program can minimize overall costs, improve patient access to more affordable medications and provide an improved quality of life. Our pharmaceutical cost containment strategies have achieved proven results time and time again. To find out more about our medical cost management services visit us at www.ans-solutions.com.

Content originally posted at www.ans-solutions.com.