ANS Medical Cost Management - the Human Side of medical cost containment through drug utilization reviewWhen 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 Pharmacotherpy Review 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 medical 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 contact us today!