Employers, claim payers and workers' compensation care management organizations continue to be challenged to provide solutions for rapidly escalating workers' compensation medical costs. According to a recent study released by the National Council of Compensation Insurers (NCCI), pharmaceuticals and related costs account for approximately 14 percent of workers' compensation medical costs. Pharmacy spending in workers' compensation is now one of the top cost drivers for lost-time claims. While technology and related services have been a significant component of medical cost-management strategies, many employers have adopted a more advanced model that is driving significant levels of additional medical and pharmaceutical cost savings.

Tight Integration Successful

One newer model centers on the tight integration of information systems, as well as the involved procedural workflows between the claim payer — TPA or insurer — and the cost management service providers — medical bill review and pharmacy benefit management providers (PBM). Such tight and detailed workflow integration allows employers and payers to proactively manage and control the PBM process. As a result, financial effectiveness, process efficiency, and information value are increased for all stakeholders.