Independent Medical Review and Customized Reporting

Many of our clients call upon us to provide them with customized reports at the end of each month which outline a number of different elements of the reviews that we've performed for them. From simple reports that list the clients, dates, patient names, and the outcomes through to more advanced reports that relate to reliability, returns on investments, and other elements.

An IRO needs to have advanced database management capabilities which allow them to prepare and customize reports of these natures in order to furnish them to clients on a timely basis. Clients want the IRO to be able to abstract this information and provide it to them for analysis, as opposed to asking the client to take on this burden. As medical management firms, TPAs, and health insurance plans look to outsource more of their medical decision making processes to IROs, it stands to reason that they want to outsource a lot of the analytics and reporting that would go with it. Today's IRO needs to be able to respond with advanced capabilities when it comes to database management, reporting, graphical analysis of data, and interpretation.
medical management
independent medical review

Independent Medical Review and Emerging Standards of Care

It's no secret that we're dealing with an always changing playing field with emerging medical treatments and what is accepted as being a standard of care. Indeed right now we see a shift going on as it relates to the medical necessity of beriatric surgery which, as everyone knows, is a quite complex and very costly treatment procedure for obesity. A few years ago this procedure was being denied systematically by most health plans, and today it's coming into the mainstream of treatment and being more consistently embraced by health plans as a remedial measure for treating patients who have tried but failed at diet and exercise.

An Independent Review Organization needs to stay abreast of these changes as they are happening and adapt its decision making criteria and processes in order to make sure that the decisions rendered on independent medical reviews meet those changing standards of care for medical necessity. Treatments that were once experimental or investigational are moving in the direction of being medically necessary as well. In areas such as cancer treatments we see a number of new types of medicines coming out and being moved through the FDA approval process and then into the mainstream of cancer treatments. An IRO needs to have specialist as well as tracking systems, databases, and information libraries which allow it to continuously evolve its decision making criteria to what is medically necessary in accordance with movements in modern medical thinking.

healthcare
medical management
independent medical review

Independent Review Organizations and IT Systems

Gone are the days when you can just have Microsoft Word and a couple of other applications at your company and be capable of dealing with the administrative and quality workflow that is required in order to be an IRO. Today, best in class IROs are investing in integrated web applications that provide an automated workflow between clients, their own operations, and peer specialists. In fact, AllMed Healthcare Management is in the process of rolling out it's own application called PeerPoint, which will greatly streamline and improve our ability to automate the workflow.

Companies that want to be in the business of providing independent medical reviews have to have a high degree of integration of their IT systems in order to be competitive. That includes having standardized operating systems at the network level and at the application level building customizing software applications that integrate and provide for administrative efficiency when it comes to taking in, assigning, processing, and returning independent medical reviews to its clients.

An IRO needs to have a quality IT process, standardization of operating systems, privacy and security procedures as it relates to IT information systems. These are all the kinds of things that the IRO has to maintain from an IT standpoint in today's environment.
healthcare
medical management