High Risk Patient Profiles & Opioid Abuse

Predictive models in our industry show that specific risk factors correlate to the potential for long term opioid use -most notably, patients that smoke and/or have a history of substance abuse.   With increased opioid prescribing linked to trends of misuse and abuse and opioid related overdoses contributing to more deaths annually than vehicular crashes, it begs the question, are risk factors truly being taken into account with the treatment of chronic pain?

Improving Opioid Painkiller Practices

Physicians considering opioid therapy for an injured worker with chronic pain should use a structured approach. There should be a comprehensive evaluation for the cause of pain, assessment for risk of opioid abuse or addiction, detailed treatment history including a review of medical records and routine assessment for safety and effectiveness of the opioid therapy program once in place. A dedicated focus on the patient will allow treating physicians to:

• Get ahead of the warning signs of drug abuse and addiction.
• Modify a treatment program based on patient’s recovery.
• Modify treatment based on the availability of alternative treatments and therapies that may be more effective, and have fewer side effects.
• Avoid unnecessary or inappropriate pharmaceutical and medical treatments in the event there are multiple treating physicians in the picture.

Risks should be acknowledged openly and managed, whenever possible, before prescribing opioids. When continuous opioid therapy for as little as two weeks can produce drug tolerance in some patients, the bottom line is, we need to start thinking more about the injured worker.

ANS Drug Utilization Review

Interventions with prescribers can be instrumental in not only preventing long term opioid use but also improving the quality of life and treatment for patients while also driving down medical costs. At ANS, our approach to drug utilization review includes an extensive review of a patient’s medical history allowing our experts to pinpoint risk factors and other considerations that are all too often overlooked by other medical cost management programs in the industry.

For more information about our medical cost containment strategies contact us today or visit www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/high-risk-patient-profiles-opioid-abuse/

Ineffective Intervention Results in Less Than Optimal Outcomes

Workers’ compensation payers industry-wide have relied on pharmaceutical cost containment measures in one form or another as a means to manage escalating costs. But as everyone has learned, not all strategies are created equal. In fact, most are limited in scope and effectiveness.

A Holistic Approach to Medical Cost Management

At ANS, we take a holistic, collaborative approach to managing medical costs. When a comprehensive analysis is conducted on a pharmaceutical regimen, it reveals the bigger picture, thus uncovering points of concern that may impact the pharmacy plan. Quite often we uncover opportunities for modifications that improves patient efficacy while decreasing costs. Conducting an extensive review of a patient’s medical history can avoid missing crucial factors that are all too often overlooked by other programs.

Nurse Experts Apply Advanced Pharmaceutical and Jurisdictional Knowledge

ANS’ advanced program includes a national network of highly credentialed legal nurse consultants. Utilizing experts to employ a collaborative environment with the physician and integrating a holistic approach to medical cost containment results in successful, optimal outcomes for both the injured worker and the carrier:

ANS Solutions

We offer an industry-leading suite of Workers’ Compensation Medical Cost Containment Services designed to lower costs, improve loss ratios, and enhance the claimant’s quality of care. For more information contact us today or visit www.ans-solutions.com

This content was originally posted at http://ans-solutions.com/ineffective-intervention-results-in-less-than-optimal-outcomes-2/

3 Elements of Successful Medical Cost Containment Strategies

Medical cost containment is a complex game as there is a level of responsibility that needs to be acknowledged. These strategies need to do more than just address the obvious financial costs of large loss claims as often factors driving financial costs also correlate to effects on an injured workers quality of life. In short, medical cost containment strategies need to take into account the injured workers course of treatment and quality of life including the following:

• Physicians are sometimes employing treatment regimens that prescribe expensive pharmaceuticals and medical treatments when lower cost alternatives may be available that would maintain or improve patient efficacy.
• Pain management via highly addictive opioids runs increases the risk of patient addiction or increased tolerance and subsequent need for refills or a stronger dose at a higher cost.
• Lack of compliance to a treatment regime lengthens potential recovery time for injured workers and increases associated treatment costs.
• Lack of coordination between multiple treating physicians can drive up costs with duplicate and/or inappropriate pharmaceutical and medical treatments while leaving the patient open to dangerous drug interactions, addiction, or even death.

Medical Cost Containment Strategies

ANS’ medical cost containment solutions have been honed to perfection for the past decade. Our strategies consistently yield hard dollar savings while also ensuring optimal outcomes for the injured worker. In our experience, there are three parts to our approach that ensure the success of our cost reducing strategies:

• Comprehensive and holistic review of a patient’s entire medical history – with a clear understanding of the bigger picture ANS often uncovers issues and concerns that can impact the medical treatment plan and the patient’s chances of recovery.
• Harnessing expert knowledge – ANS legal nurse consultants boast extensive medical and legal experience and expert knowledge of catastrophic injury, cutting edge medical and pharmaceutical therapies, and jurisdictional nuances.
• Collaboration - Multiple parties must be engaged from managing patient adherence to our legal nurse consultants and the treating physician(s) for optimizing medication therapy, determining a modified course of treatment, and ensuring compliance to the new course of treatment.

ANS Solutions

Our approach to cost containment was uniquely developed to simultaneously ensure a medically appropriate and cost effective treatment program and enhanced quality of life and care for the injured worker. For more information on our industry leading cost containment strategies visit us at www.ans-solutions.com.

This content was originally published at http://ans-solutions.com/3-elements-of-successful-medical-cost-containment-strategies/

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.

The Human Side of Medical Cost Management

When we talk about the costly nature of large loss Workers’ Comp claims, it is sometimes hard to think beyond the financial impact.  Further to this point, when medical cost containment strategies are discussed they are often geared toward addressing the clinical and pharmaceutical treatment programs for injured workers from a financial perspective. What about the less tangible side of medical cost containment-the human costs which are equally as significant and damaging?

Addressing Human Costs in Medical Cost Containment

When we talk about the human cost of large loss claims, we are really talking about the effect a case has on the quality of life for an injured worker and their family. While all medical cost containment strategies focus on financial cost drivers, not all strategies address human costs. There are many drivers that can contribute to compromising an injured worker’s quality of life. These human cost drivers include, but are not limited to:

·         Pain treatment through highly addictive opioids, coupled with a lack of patient education on the risks and dangers of these drugs, subjects injured workers to a path of drug addiction which may hinder or prevent their recovery.

·         Lack of appropriate physician monitoring and/or patient compliance to a prescribed medical treatment regimen can contribute to a longer recovery period.

·         Lack of monitoring patient’s treatment program and progress results in missing the warning signs of drug abuse and addiction, missed opportunities to modify a treatment program based on patient’s recovery, lost opportunities to modify treatment based on the availability of alternative treatments and therapies that may be more effective, and have fewer side effects.

·         Lack of coordination between multiple treating physicians can attribute to greater increase for drug abuse or unnecessary or inappropriate pharmaceutical and medical treatments.

ANS Cost Containment Strategies

The ANS PharmacotherpyReview Program is the most advanced and results-oriented cost containment strategy in the industry. At the first of three stages, we assess the existing treatment program using evidence based reviews to assess medical necessity. We also identify duplicate therapies, excessive dosages and alternate medication regimens. Our experts then make actionable treatment modification recommendations that ensure optimal outcomes for the patient. This includes consolidating and coordinating drug therapies between multiple prescribers.  In the second stage, our nurse experts work with treating physicians to obtain commitment on a modified future course of treatment. For a positive therapeutic outcome, we move to stage three where an ANS Clinical Liaison Officer proactively manages each case to ensure physician and patient compliance with the revised course of treatment.

ANS Solutions

Our approach to cost containment was uniquely developed to simultaneously ensure a medically appropriate and cost effective treatment program and enhanced quality of life and care for the injured worker. For more information on our industry leading cost containment strategies visit us at www.ans-solutions.com. 

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