PMSI Announces A Population Risk Scorecard for the Workers' Compensation Industry

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Predictive risk tool helps payors focus on high-risk and high-cost claims earlier in the claims lifecycle

PMSI, the nation’s largest provider of specialty products and services for the workers’ compensation market, announced its progressive clinical tool that provides a predictive risk assessment for identifying comparative risk across a workers’ compensation population. Built on PMSI’s many years of managing millions of pharmacy transactions, identifying risk and intervening at an injured worker level, the Population Risk Scorecard predicts risk for a population with regard to medication-related health outcomes and drug costs, and identifies clinical interventions that will drive down risk and pharmacy spend.

“Our Population Risk Scorecard applies a proprietary set of clinical criteria across a payor’s workers’ compensation prescription claims population to develop a clearer picture of the medication risks involved,” stated Jay Krueger, Chief Strategy and Client Services Officer for PMSI. “This allows clients to focus on high-risk areas sooner, thus keeping costs under tighter control and providing more appropriate care to their injured workers.”

Knowing that claim age, cost and prescription volume alone are not sufficient for determining when therapeutic issues may be present, the model was developed to identify areas within a population that may have medication utilization that is inconsistent with best-practice clinical guidelines and evidence-based medicine. Through PMSI’s MedAssess Risk Intelligence System, Risk IS™, pharmacy transactions are evaluated against PMSI’s medication-related criteria and algorithms, generating a risk score for the payor’s population. In addition, the percent of the population meeting each risk criteria is identified and reported against comparative benchmarks. The value of identifying the risk for the client population includes the ability to:
■ Quantify the severity of medication-related issues within the client’s population
■ Identify clinical programs that will assist in decreasing overall medication risk and costs
■ Help payors identify areas to focus their time and financial resources
■ Measure the degree of medication risk reduction after implementation of specific clinical
     interventions

“Once identified, the risk score is plotted on a scale to show the measured population’s risk of poor health outcomes against pharmacy spend, indicating the level of low, moderate or high risk and cost. We also include a comparative risk score to help clients understand how their risk compares with PMSI’s benchmarks,” said Dr. Maria Sciame, Executive Director of Clinical Services at PMSI. “In addition, the scorecard will allow payors to evaluate the impact of PMSI’s MedAssess™ clinical programs over time.”

PMSI’s Population Risk Scorecard also matches specific high-risk injured workers to the MedAssess clinical interventions that will deliver the best results. This way, PMSI enables clients to selectively apply additional interventions to their injured workers posing the highest level of risk, thus containing overall costs while providing appropriate care to the injured worker.

About PMSI:
Founded in 1976, PMSI is a leader in developing solutions to control the growth of medical costs in workers’ compensation. As one of the nation’s largest and most experienced companies focused on workers’ compensation and liability markets, we deliver proven solutions for cost containment across the claims lifecycle. PMSI’s solutions for Pharmacy, Medical Services and Equipment, and Settlement Solutions deliver quantifiable results and improve the quality of care for injured workers. We provide our customers with the innovation, focus, expertise, analytics and technology needed to successfully deliver workers’ compensation benefits. For more information, visit http://www.pmsionline.com or call 877.ASK.PMSI.

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Jan Luongo, APR, CPRC
PMSI, Inc.
(813) 318-6810
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