Effective Medical Cost Containment Strategies that Reduces the Overall Costs

Medical cost containment is a complex game and has certain strategies that address the financial costs of large loss claims. Employers and insurers should not limit these cost containment strategies to one or few areas, if they want it to be truly effective. The employers and insurers should utilize as many cost containment strategies as they can to save more money. In this article, we can discuss about the different cost containment strategies that are solely dedicated to reducing the overall medical costs.

Effective Cost Containment Strategies

Medical Cost Projection

Medical cost projection strategy is used to evaluate medical bills, medical savings and other comprehensive medical plans. The type of injury, prior medical treatment, co-morbidities, age health status, life expectancy and other pertinent factors are taken into account by medical cost projection professionals for an accurate analysis of the medical needs of the injured worker.

Legal Nurse Expert

A Professional Legal Nurse Consultant is destined to review medical records and gives advice and suggestions on the standard of nursing care. They are allowed to meet the doctor in person and negotiate any evidence supported pharmacy regime in a non-threatening way with the patient. They also assist with depositions and trial preparation and serve as an expert witness support for the compensation claim.

Medical Management

This is the process of having experienced legal nurse consultants to co-ordinate and to manage the medical care received by an employee. A legal nurse consultant would be dedicated to handle the accounts and medical claims for that company. They will review all the medical reports of the injured employees and recommend additional tests to get the employee back to full recovery.

Medical Bill Review

Medical bill reviewing is only done by the companies that are pioneers in performing accurate medical bill diagnosis and charges. Generally, the medical bill charges are compared with the reasonable and customary charges for the medical services provided.

Medical Examinations

These independent medical examinations are done when the patient is sent to another medical practitioner for an alternate opinion. These examinations are conducted in cases where the employee’s medical recovery process is slower than the normal.

Utilization Review

This review includes precertification review done before the medical care, concurrent reviews while the treatment is on progress and retrospective reviews for the medical services that is already provided.

Tactics Involved in Medical Cost Containment

•    Evidence based medical record review for prescription drugs

•    Co-ordination of drug therapies

•    Suggesting alternate medical regimes

•    Deep analysis and monitoring of prolonged duration of therapies

•    Examination and identification of duplicate drugs and therapies

•    Identification of excessive dosages of drugs

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