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

Visit http://ans-solutions.com/ to know more about the new medical cost containment approach.

Alabama Doctor Arrested In Connection with Matt Roberts of 3 Doors Down Overdose Death

In mid-August of this year, fans were stunned by the death of 38-year-old Matt Roberts, former guitarist of 3 Doors Down. Alabama physician Dr. Richard Snellgrove was arrested November 16th for allegedly providing the rocker with drugs outside the course of his professional practice. Snellgrove prescribed some five different medications, including methadone, hydrocodone, lorazepam and fentanyl — all prescribed in the names of different individuals, but intended for Roberts.

Slated to perform at a charity event for veterans, the rocker’s father, Darrell Roberts, who often traveled alongside the star, learned of his son’s death the morning following rehearsals. The elder Roberts was informed his son was “either asleep or passed out in the hallway of his hotel” by authorities. Roberts’ father indicated that his son had been fighting a prescription medication addiction to combat his anxiety since joining the band.

A Serious Issue Beyond Over-Prescription
While Roberts’ father noted that he didn’t have any bitterness or anger toward the doctor, he drew attention to the seriousness of the issue in the medical community across the U.S. Prescription drug abuse causes the largest percentage of deaths from drug overdosing, with opioid painkillers the most common culprit. Roberts is among a string of stars over the past decade, including Prince, Whitney Houston, Michael Jackson, Brittany Murphy, Heath Ledger, and Anna Nicole Smith – alongside thousands of other unnamed “average” Americans – sons, fathers, mothers, daughters, brothers, sisters, and friends – all lost to the prescription drug abuse epidemic sweeping the nation, unheeded by age, race, gender, or income level.

Re-Thinking “the Norm”
In chronic pain treatment, particularly where opioids are concerned, there seems to be a disconnect between a drug’s approval for use and its potential for harm, leading to over-prescription and deadly drug interactions. This is why ANS developed its unique pharmacotherapy review program, the only drug utilization review system in the industry with a hands-on, state by state jurisdictional approach. Sometimes to help an injured worker, “it takes a village”, and the ANS face-to-face collaborative process uses locally based legal nurse experts to bring doctors, patients, insurers, and legal representatives all onto the same page. Other drug utilization processes act superficially and fail to follow up, but the ANS process consistently achieves the most impactful patient outcomes while producing the lowest MSA’s and most improved loss ratio’s in the industry. All this while offering a risk free “No Fee Assurance” guarantee for WC payers who wish to try the program.

To truly improve patient treatment outcomes and stop the opioid epidemic try http://ans-solutions.com/ scientifically-based, cost-effective pharmacotherapy review programs. Contact us today.

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The Impact of Workers Compensation Compounding

As custom-made compound prescriptions concoctions continue to rack-up higher workers’ compensation costs, insurers are scrambling to find alternatives and employers are looking for relief from equally inflated premiums. With little to no evidence as to the efficacy of such creations, many states have implemented treatment guidelines directing doctors to more evidentiary-based, easily reimbursable options. Despite guidelines and formularies however, loopholes in coverage continue to allow providers to sell millions of dollars of compounds, with many companies submitting inflated reimbursement bills in their attempts to get paid.

A Growing Issue in Workers Compensation

This June, the U.S. Attorney’s Office brought criminal charges against such providers across the country, accusing them of defrauding the Medicare, Medicaid, and Tricare health insurance programs that serve the military and their families. Additionally, the Inspector General of the U.S. Postal Service identified compound drugs as attributable for 34% of the postal service’s prescriptions, and 53% of prescription drug costs in 2015, a rise from 22% and 27% in 2014, respectively. State and federal prosecutors also continue to finger some pharmacies for offering doctor kickbacks in exchange for prescriptions.

Money or medicine?

Industry guidelines point to the use of such compounds as a last resort, accepted in instances where a person is allergic to an ingredient in a drug, or when a liquid version of a commercially available drug is necessary for one who cannot swallow capsules. Some doctors prescribe initially despite these guidelines. The unnecessary prescription of compounds is costing the workers’ comp industry billions annually.

Deep impact

2015 calculations indicate…

• Re-packaged drugs dispensed by physicians cost employers 60% to 300% more than those dispensed at retail pharmacies.
• The average paid per compound drug increased by more than two-thirds from $460.00 to $774.00, though non-compound drugs fell slightly from $113.00 to $108.00.
• The U.S. Postal Service alone spent a whopping $390,000.00 a day for compound drugs in 2015.

Tired of paying more for ineffective treatments?
Proven, more affordable, clinically tested and approved options to compounds do exist. It’s time to find a better way. Discover how to achieve better claims outcomes with ANS Solutions Pharmacotherapy Review. Contact http://www.ans-solutions.com today.

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New FDA Warning: Avoid Prescribing Opioids & Benzos Together

In a recent announcement by the FDA, boxed warning labels will now be required to advise against the utilization of prescription opioid pain medicines alongside benzodiazepines unless no other adequate alternative treatment method exists. Warnings about the risks of combining these two classes of drugs are nothing new. Already required on drug warning labels, additional black box warnings are an effort by the FDA to reach out to those who may have “missed the message.”

Classified as Central Nervous System (CNS) depressants, each drug alone can trigger side effects such as respiratory depression (slowed/labored breathing), coma, and death, the effects of which are enhanced in combination. For clinicians living in the dark, these risks will now be spelled out in the black boxes of 389 different pharmaceuticals. Additionally, opioid painkillers such as oxycodone and benzos like alprazolam (i.e. Xanax®) – even the combination of opioid cough medicines with benzos and other CNS depressants (like alcohol) should be avoided. If the drugs must be used together, clinicians have been advised to warn patients of these risks.

The FDA’s latest measure in battling the nationwide epidemic of prescription opioid abuse, essentially classifies this drug combination in the “last resort” genre. Rates of emergency room visits resulting from the nonmedical use of this combination of drugs has tripled from 2004-2011, with the rates of drug-related deaths following suit. According to the FDA, these rates coincide with a 41% increase in patients prescribed both an opioid and benzo between years 2002-2014. The measure is a win for public health officials from 17 states and territories and 13 cities who petitioned the agency in February to require the boxed warning in an effort to fight the routine but unproven treatment method.

Bridging the gap is possible, however, with the help of clinically proven injury and disability treatments from ANS Solutions. Our expert medical legal nurse consultation services and Pharmacotherapy Review Program get the result patients need – without side effects – protecting and enhancing the quality of life for injured workers, and guarding against the medical and financial risks of unproven treatment methods with scientifically-backed protocols. Are you ready to set out on a new path in worker’s comp injury management? Contact http://www.ans-solutions.com today!

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Prescription Drugs and the Workers’ Compensation Arena

The U.S. remains the biggest global consumer of prescription drugs, up from around 76 million in 1991 to nearly 207 million in 2013 however a recent court ruling has called into direct question the prescription practices of physicians nationwide (Volkow).

The occurrence of unnecessary or medically inappropriate prescribing of opioids in pain management is compromising the lives and well-being of injured workers.  There are a number of serious issues concerning the use of opioids in pain management:

• Not cost effective
  Evidence-based reviews are seldom consulted prior to the prescribing of opioids, and a lack of appropriate physician monitoring and/or patient compliance further contributes to longer recovery periods and increased cost.
• Increased drug-drug interactions
  Polypharmacy, the use of 4 or more medications simultaneously with opioids, can result in drug-drug interactions with severe consequences for patient health.
• Risk for Addiction and Abuse
  The highly addictive nature of opioids leads to the necessity of higher doses over time, resulting in cost increase and greater risk of overdose/addiction. .
• Lack of evidence for proven benefit
  Recovery and return to work rates are not improved by the use of opioids in pain treatment. The American Academy of Neurology and a number of states have released product guidelines advising physicians to proceed with caution when initiating opioid therapy for pain or long-term use.

• Dose dependent risks for serious harm
  Physicians and patients are not always properly educated on use and good faith prescription practices and guidelines, including risks of remaining on disability, addiction, drug-drug interactions, and dosages at which death and risk of overdose dramatically increase.

Where do we go from here?
It’s never been more obvious than now that effective pain treatment must focus on the legitimacy and efficacy of treatments, keeping in mind the quality of care and quality of life of injured workers.  At ANS Solutions our pharmacotherapy review program is focused on protecting the injured worker by:

• Better addressing the needs of pain patients with the assessment of treatment programs and help of evidence based reviews.
• Improving recovery times with the proper monitoring and modifications of treatment.

• Reducing the risks associated with common opioid treatment regimens by consolidating and coordinating drug therapies between multiple prescribers, identifying duplicate therapies and excessive dosages, and pointing out alternate medication regimens.

Positive change stems from a comprehensive and economically responsible approach in the treatment of pain in workers compensation claims settlements. To learn more about pharmacotherapy review contact ANS today.

References

Volkow, Nora D. Prescription Opioid and Heroin Abuse, House Committee on Energy and Commerce Subcommittee on Oversight and Investigations. https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/prescription-opioid-heroin-abuse;  April 29, 2014.

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What’s Trending with California Workers’ Compensation

Though workers’ comp claims frequency is declining, a recently released California hospital report indicates claim severity is on the rise. Obtaining data from 35 hospitals and individual facilities, the Milliman and Keenan Healthcare report sourced more than 3,500 claims for review.

Trends identified in the report:

• A decline in indemnity and medical-only claims, with ALAE costs playing an increasing role in overall claims costs in recent years. More specifically:
  • Higher average costs per indemnity for workers over 30.
  • Lesser average severity of indemnity claims in workers 30 and younger, with payments more likely to be incurred as age increases.
• Over the 10-year period ending in 2014, overall losses per $100 of payroll have remained flat. This cumulative effect is believed due to reform laws enacted during this time, as identified in the report:
  • 2005-2014: Severity per indemnity claim (indemnity, medical, and allocated loss adjustment) rises almost 5.5%.
  • 2003-2004: Drop in claim severity (reform laws enacted during this time).
  • 2003-2008: Indemnity claim frequency declines dramatically.
• Costs per indemnity claim for 2014 accidents has decreased approximately 10% from the previous year.
• Litigated claims showed a significantly higher average claim severity. They contributed to 20% of total claims with indemnity payment, and account for approximately 54% of total incurred losses.
• Cost projections for 2015: $2.20 loss cost per $100 of payroll.

A Balanced Approach to Medical Cost Containment

In California’s complex and ever-changing workers’ comp environment, informed decision-making is essential to safeguarding results. At ANS, we pride ourselves at staying at the forefront of (legal and technological) industry changes to ensure the best possible outcomes for both our clients and injured workers.ANS’s three-staged Pharmacotherapy Review Program ensures economically balanced and appropriate treatment options for injured workers. Our legal nurse experts excel at presenting actionable treatment modification recommendations in clear, written proposals for treating physicians, including recommendations such as:

• Consolidation and coordination of drug therapies between multiple prescribers.
• Consideration of alternate therapies.
• Specification of weaning programs for over-prescribed narcotics.
• Use of generics where applicable.

The end result? A cost effective treatment regimen that simultaneously enhances the quality of care for injured workers. Discover more about this advanced and comprehensive treatment strategy. Contact http://www.ans-solutions.com today.

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Why ANS Pharmacotherapy Review is so Effective

The prescription pain medication crisis is taking its toll across the U.S. Costs are extreme, with a broad array of collateral damage fanning out from those effected to families and industries, among the hardest hit, workman’s comp. So extreme are the effects of addictive and deadly prescription opioids, even the Federal Government has taken notice, with the CDC stepping in to release new opioid prescribing best practices earlier this year in hopes of ushering in a new era for an ailing nation. The issue is out in the open. Are you missing out on the opportunity to protect patients and break the pharmaceutical cost cycle with a lackluster pharmaceutical intervention program?

Not all drug utilization review programs are created equal

Traditional pharmaceutical intervention programs often yield poor results. Why? Insufficient “drug evaluations” yield sub-optimal analyses, neglecting to account for patient and prescriber history, co-morbidities, and other important factors. Peer-to-peer, phone-based approaches questioning treatment efficacies have the tendency to put doctors on the defensive or induce feelings of frustration over micro-management. Non-binding, verbal commitments lead to repeated calls regarding the implementation of reduced treatment protocols, and ultimately future “call-dodging.” Settlement dates are then repeatedly pushed out, with poor clinical outcomes resulting.

ANS’s proprietary Pharmacotherapy Review

Pharmacotherapy review processes built on the foundation of the intelligent and intimate collaboration of all vested parties produces superior results. How does ANS’s Pharmacotherapy Review fix what’s broken in the typical pharma intervention system?

• In-depth, in-person collaborations. 
  In-office visits with legal nurse experts featuring evidence-based, patient-centered treatment plans presented in a non-threatening manner increase openness to alternative therapies.
• Clear guidelines.
  Written, signed, collaborative agreements are established within 4-5 weeks, complete with detailed drug utilization changes curtailing costly pharma regimes, keeping all parties accountable and on the same page.
• Patient-centered care.
  Physician-directed care with the interest of the injured patient in-mind, including expert consultation, thorough review of medical history and prescription data, and clinically-proven drug alternatives reduce Payer costs and improve patient quality of life, decreasing the potential for drug related issues such as drug interactions and overdose.
• Friendly follow-ups.
  Doctors work with a dedicated CLO (Clinical Liason Officer) until settlement. Repetition of visits with an established legal nurse builds better relationships, allowing for amiable quarterly follow-ups regarding compliance and treatment evaluations, ensuring proper dosing modifications or weaning of medications.
• Quantifiable impact (& performance guarantee).
  The hard work accomplished by ANS representatives and collaborating parties is seen in post-meeting reporting, showing enhanced clinical and patient outcomes as well as reduced pharmaceutical treatment costs. In fact, ANS proprietary Pharmacotherapy Review program boasts:
  • A success ratio of 94% of all case referrals.
  • Enhanced clinical/patient outcomes.
  • Acceleration of MSA settlements.
  • Average cost reductions of over 25%.
  • Loss ratio reductions from 1-2%.
  • Average first year savings of over $7,000.
  • Average life expectancy savings of greater than $250,000.
  • An average return on investment of 20 to 1.

Tired of using the same procedures and expecting a different outcome?
You won’t get extraordinary results with the average pharmaceutical intervention programs. Redefine success with the help of ANS Solutions Pharmacotherapy Review.

Contact http://www.ans-solutions.com today.

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