Monday, January 16, 2012

How Concerned? Very, Very Concerned.

Like a lot of other people in our industry, I’m a regular reader of Joe Paduda’s blog, Managed Care Matters.  Like him or not (and I acknowledge that opinions vary), Joe is an informed guy, a smart consultant, and an entertaining read.    
A post on MCM from the middle of last week caught my eye.  In the midst of compiling the results from the most recent survey of pharmacy management in workers’ comp, Joe felt compelled to stop and share one specific data point.
The survey question: “How much of an issue are opioids in worker’s comp?”
The average response was a 4.8 on a 1 to 5 scale with 5 meaning “extremely significant.”  Joe noted that this is the highest score for any question in the eight year history of the survey.
He closed the post by noting, “next step is to put solutions in place.”
From his lips to God’s ears.  Some have interpreted my post regarding the need for our industry to move away from the diagnosis of an obvious issue (over-utilization of prescription narcotics in work comp) and toward a meaningful and efficacious solution as overly ambitious and lacking in the patience required to mitigate such an intractable problem. 
To that I say… nonsense. 
To even begin to fix this problem, our industry needs levels of commitment, transparency, communication, and fortitude that don’t exist today.  We need to identify solutions that work and then have the courage to implement them, even if it creates some noise and awkwardness as we do so. 
An example:  Occasionally, PRIUM’s services rendered on an individual claim file lead to the point that another vendor should be involved – perhaps a utilization review vendor.  PRIUM happens to provide those services, but contracts sometimes don’t allow for PRIUM’s UR services to be utilized.  In essence, we’re handing business to a competitor.  And you know what?  That's ok.  We care more about fixing the claim than we do about getting our hands on one more UR case.   
Those of us who want to see the right care delivered to the right patient at the right time and for the right reasons… well, we’re on the right side of this fight.  Let’s work together, do the right thing… and not apologize for it. 

On Twitter @PRIUM1

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