Independent Review and Mass Customization

When you have hundreds of reviews being done each day and dozens and dozens of clients who are each asking for the reviews to be prepared just slightly differently from each other you can imagine how intricate it is to manage all of those different reviews and customize them according to each client's exact needs. We call this mass customization, which is certainly what is referred to in manufacturing when companies are mass-producing lots of different variants of the same product. Dell computers is probably the best example of a mass customization company who has really mastered this concept. Similarly, IROs also have an incredible ability to mass customize their product and service. The reason this gets done is because each new client has it's own set of parameters that are recorded into the IRO's operating procedures. An IRO needs to be able to mass customize in order to meet the demanding requirements of each of it's different clients.

Why do those requirements vary so much from company to company? Well, IROs are used differently by just about every single type of business. Some companies do first level reviews. Other companies are doing second and third level appeals. Some clients are using us for preauthorizations of medical treatments. Yet again, another group of clients could be looking at us to do quality management reviews. Each of those clients has a different set of needs and the independent medical reviews that we provide for them are integrated into their operations at a different stage of the process. This is why it is so important that an IRO can customize each review to each client’s requirements in addition to meeting demanding turn around times.

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medical management

Independent Review as a Highly Optimized Work Flow

We hear about companies that are considering getting into the business of doing independent medical reviews and indeed, on the surface it looks like it's quite easy for any doctor to organize a small panel and start doing specialist reviews for a few clients. The fact is, that in today's environment, an IRO is called to build rigorous processes and standards and the investment required in order to do this correctly to meet the demands of large health plans and other healthcare organizations is very rigorous. I would like to outline in the next several blogs why it is that independent review is not a trivial, easy to organize function inside any organization, and why it requires a significant amount of investment and diligence.

The first thing to know about any IRO is that in order to be competitive they need to have a highly optimized work flow that breaks down the independent review process into a number of standard steps capable of providing a consistent level of turn around time and quality. Today's independent review organization typically has a staff of operations people, clinicians, as well as several software applications, each which have been brought together to organize a workflow that is capable of meeting the turnaround time of our customers.

When 20, 30, or 50 of our clients are calling in review requests that need to be received, dispatched, typed, proofed, edited, and finalized within a 24 hour period, you can imagine how demanding that is on your systems and procedures and how critical it is that your organization has optimized all aspects of the process. We have invested considerable sums of money into integrating our applications, databases, reporting, tracking, data entry procedures, word processing systems, and other aspects of our business including accounting, sales, and customer service in order to be able to provide the level of responsiveness the average health insurance payer or manage care organization needs. The independent review process itself requires an incredible amount of efficient organizational streamlining in order to be effectively and competitive.