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The Game In Claims Falls Mainly on the Pain

Sep
05

Question:

What do more people have–

a) Chronic Pain
b) Diabetes/Heart Disease/Cancer Combined?

If you guessed, a) Chronic Pain you were right!

In an August 13, 2012 article from Business Insurance authored by Deborah Gleason, she puts the “blame on pain” for claims complexity.

According to a recent study from the “Institute of Medicine’s Relieving Pain in America”, 100 million Americans suffer from chronic pain. In comp, we see that ineffective pain management coupled with long term narcotic usage is the one thread that rings true in almost every complex/catastrophic claim.

The NCCI reports that prescription medications are almost one fifth of the total medical expense in comp. Narcotics are about 1/3rd of comp drug costs compared to only 3% in the group health sector.

What’s the solution?

  • Early/Aggressive/Constant Intervention by Independent (not related to the PBM) Pharmacy UR Professionals
  • Extensive Peer to Peer contact with treating physicians
  • A willingness to dispute ineffective/dangerous prescribers with scientific medical evidence
  • Reporting rogue providers/pill mills to enforcement authorities

Call Us. We can do better.

William V. Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

Posted in Group Benefits Programs, Medical Cost Containment, Workers’ Compensation