April 18, 2019
How can you use metrics to evaluate your MSP compliance and MSA programs? And, what metrics apply? Tower CEO Rita Wilson shares key performance indicators, ways payers can use them in the settlement process and apply settlement strategies to on-going claims management in this week’s WorkCompWire Leaders Speak.
Here’s a brief excerpt:
“When issues are detected, the same clinical interventions (pharmacist-to-physician contact or physician peer review) used in the MSA process can be used to ensure the injured worker receives appropriate treatment and reduce costs to the claim. Payers can mitigate their eventual MSA exposure by managing the claim for settlement, and the PBM can help, but only if they know what will happen downstream.
Some payers tend to isolate MSP compliance, but it’s actually a continuation of claims management and critical to pre-settlement analysis. If payers have a high drug spend throughout the life of the claim, they are accepting a lifetime of spend at settlement. If they implement clinical interventions to reduce pharmacy usage early in the claim, they reduce its overall costs.”
Read the full article:Rita Wilson: Applying Settlement Strategies to Improve Ongoing Claims Management