Clinical intervention is a proven and valuable tool utilized industry-wide by workers’ compensation PBMs and payers. That’s not breaking news. However, the current process embraced by the industry merely scratches the surface of success because it focuses solely on a patient’s medication therapy. Making clinical recommendations based on only one aspect of a patient’s medical history – in this case their current medication regimen – is like trying to hit a target while blindfolded.
Implementing enhanced clinical decision support removes the blindfold and brings to light the patient’s full medical history and contributing health factors. The result delivers a holistic view of the patient and helps inform the most accurate and impactful care decisions. This type of clinical innovation is only possible when clinical expertise is supported by advanced clinical analytic capabilities. The “enhanced” aspect relates to an expansion of the historical clinical intervention process through access to more medical information and advanced clinical analytics delivers more insight.
Innovation is one of the three keys to overall clinical excellence, and it unlocks the door to greater possibilities and improved patient outcomes. Transparency into clinical analytics and patient information is another key that drives improved insight into an appropriate clinical strategy. The third key, comprehensiveness, allows for an understanding that each claim, each patient, each therapy presents unique complexities and should be viewed from a holistic perspective and approached with multiple strategies. Let’s take a closer look at the three keys to clinical excellence.
In the workers’ compensation industry clinical innovation should deliver “right-time” knowledge. When advanced clinical knowledge is integrated into technology-driven tools and solutions, powerful results are achieved:
- a patient is tapered off of a dangerous dose of oxycodone;
- quality of life is improved because a medication that causes side-effects is discontinued;
- a patient adheres to therapy and their health improves.
Knowledge is powerful only if it is put into action.
Healthesystems innovates in many ways that are entirely unique to the workers’ compensation industry. A prime example is found in Healthesystems’ enhanced clinical decision support process, in which a holistic and comprehensive clinical assessment delivers informed and extremely detailed patient recommendations. A PBM may often review a patient’s medication regimen and make drug recommendations based on this narrow view of their drug therapy. A patient’s medication profile is valuable information, but just the tip of the iceberg. An analysis of full healthcare records will reveal a much larger picture, and often uncovers underlying issues that impact the medication regimen and overall treatment plan.
Is the patient showing signs of non-adherence to therapy? Did the doctor note lack of improvement based on the current treatment regimen? Was a urine drug screen conducted and what were the results?
Comprehensive clinical analysis offers critical insights that can help change the trajectory of a claim. For example, more than half of Healthesystems enhanced clinical reviews included a recommendation to discontinue or taper medication.
“Cost savings is certainly a consideration in this recommendation, but the biggest concern is the safety risk for patients,” states Dr. Robert Goldberg, chief medical officer of Healthesystems.
“When analyzing various claims populations where claims met the criteria for enhanced clinical decision support, nearly 40 percent of the prescriptions written raised real safety concerns. The patient is always our first priority and as we thoroughly analyze medical records and gain a more complete picture of a patient, we often see many opportunities for optimization of therapy that benefits the patient and the payer.”
Safety concerns most often uncovered include:
- Duplication of therapy
- Drug-Disease Interactions
- Lack of evidence for use
- High dose of medication(s)
- High incidence of side-effects
- Excessive duration of therapy
- Patient age concerns
The reality is that in today’s landscape of multiple doctors and pharmacies, shortened appointments, and conflicting priorities, not all prescribers have the time to conduct an extensive review of a patient’s medical history. Situations may be missed such as:
- lab and diagnostic results may be missed;
- additional therapies may not have been tried;
- inconsistency in diagnosis between doctors may occur and;
- high risk patient behavior could be present
Missed intervention opportunities such as those listed above result in a less than optimal treatment outcome and are often costly.
Transparency of all medical data, driven by advanced analytics complements this enhanced clinical review process. Visibility into medical detail provides more insight into the patient’s overall treatment and highlights the trajectory of the claim. Consideration should be given to patient-specific demographics such as a claimant’s age and gender. For example, analysis of Healthesystems data reveals clinical recommendations are more likely to be successful when applied to female patients, as well as other claimant age demographics. Deeper and more holistic insight into a patient’s therapy can bring to light various types of issues and concerns. For example, medical records may reveal a patient may have been receiving the same medication(s) prior to the workers’ compensation claim; therefore raising a question as to compensability as well as potential drug therapy duplication.
Enhanced clinical decision support is a patient-centric and coordinated approach involving multiple parties:
- the PBM analyzes medical information;
- expert clinicians develop recommendations and strategies that fit into the patient’s overall treatment regimen;
- the prescribing physician engages the patient and incorporates recommendations into the treatment plan;
- the payer coordinates all aspects of treatment and actively monitors the claim.
Multiple strategies are engaged from managing patient adherence, to optimizing medication therapy to managing diagnostics to physical medicine strategies.
Strategies are only a roadmap to success – true success can only be achieved by executing on those strategies. Advanced clinical analytics tools can put the power of actionable information into the hands of payers to help facilitate these strategies. Healthesystems enhanced clinical decision support provides a suite of clinical analytics tools. This includes the latest innovative offering, the Risk Management Dashboard. The intuitive dashboard combines data science with clinical analytics to identify opioid and other therapy risks and delivers evidence-based recommendations.
To learn more about how Healthesystems’ enhanced clinical decision support is changing the way clinical intervention has historically been conducted and delivered, visit www.healthesystems.com or stop by booth #1423 at the upcoming NWC&D conference in Las Vegas.
This is a sponsored post from WorkCompWire marketing partner Healthesystems.