The Business Case for Outsourcing First-Level Physician Review
As core business processes are re-examined in light of the new healthcare regulations, many health plans, TPAs and medical management organizations are considering outsourcing first-level physician review, as a strategy to reduce fixed costs. Making the decision to outsource first-level physician review involves many variables, which require careful consideration by executives developing a business case.
With the new federal healthcare reform laws, healthcare payer and medical management organizations expect to process about 32 million new enrollees during the next 10 years and adopt their services to a myriad of new regulations that will force them to re-examine their core business processes.
This onslaught of changes will force healthcare payers to re-evaluate their utilization of both internal and external resources. With health plans under pressure to comply with the new regulations and to reduce costs, outsourcing first-level physician review may be one of the most straightforward strategies to ease this burden.
Many larger payer organizations are already contracting out their first-level physician review. The development of web-based software and communications technologies will make it easier to do this, without compromising quality. Increased competition within the healthcare industry will also force the adoption of this practice by health plans, even if they were hesitant about it in the past. This may allow for better focus and allocation of internal resources, while reducing fixed costs.
The decision to outsource should not be done without careful consideration of the trade-offs that will occur. In order to weigh these trade-offs, health plan executives must understand how to put together a sound business case that weighs the pros and cons of such a decision.
Sign up today for AllMed’s next webinar and learn more about how to analyze the business case for outsourcing first-level physician review. You’ll also receive a companion white paper.
Topic: The
Business Case for First-Level Physician Review Outsourcing
Who Should Attend: VP and Directors of Clinical Opeations, UR, Case Management, Claims and Medical Directors
Date: September
23, 2010
Time: 11:00
PDT/2:00 EDT
Reserve Your Seat Today
