Navigation Links
IROs Help Cut Health Plan Costs During the Recession
Date:5/12/2009

Evidence-based, Unbiased Determinations Use Latest Clinical Information

LANSDALE, Penn., May 12 /PRNewswire/ -- Health care spending today equals 17 percent of the U.S. gross domestic product (GDP). By 2017, experts project it will equal 20 percent. Most politicians and healthcare experts agree the current system is burdened by inefficiencies, inflated prices, poor management and waste that increases medical care and health insurance cost. Independent review organizations (IROs) provide a simple and immediate solution to decrease costs while delivering the right standard of care to plan enrollees says NAIRO, a trade organization of IROs.

"IROs are a smart way to help reduce costs in today's healthcare system," said Joyce Muller, president of NAIRO. "Using an evidence-based approach, they can help health plans determine the appropriateness of treatments, often saving them money in the short- and long-term."

Medical Necessity Decision-making

According to Muller, IROs can provide a broader range of credentialed, licensed and actively practicing specialists focused on medical niches than health plan providers or payers can afford to employ. Access to narrowly focused specialties helps plan providers and administrators tap the specific expertise needed for the decision making process.

Using unbiased and evidence-based determinations, IROs help health plans decrease the likelihood and cost of appeals and litigation. At the same time, they ensure plan enrollees gain coverage they deserve for complex or controversial cases, such as multiple organ transplants or medically necessary surgery.

IROs can also aid health plans with reviews of medical treatments that may be unnecessary or considered experimental. Treatments falling into these categories can increase health plan costs.

Outsourcing complex cases or appeals to an accredited IROs provides health plans with evidence-based determinations from medical specialists with up to date knowledge that help ensure plans make correct coverage decisions. In addition, evidence-based decisions assist health-plan members' understanding of the reasons for a coverage denial or approval.

"Spending money with an IRO to determine complex and controversial issues is simple way to reduce health costs during a recession," said Muller. "Recent research has shown that for each dollar spent on an IRO, a healthcare plan can save up to $15. It's sound business and creates member goodwill to pay claims correctly and on time, while avoiding a costly appeal or legal actions.

About NAIRO

NAIRO works to promote the value and integrity of the independent medical review. Its members embrace an independent, evidence-based approach to medical review for resolving coverage disputes between enrollees and their health plans. For more information, visit www.nairo.org.


'/>"/>
SOURCE NAIRO
Copyright©2009 PR Newswire.
All rights reserved

Related medicine news :

1. Penn study finds pro-death proteins required to regulate healthy immune function
2. UCLA researchers identify markers that may predict diabetes in still-healthy people
3. Air pollution linked to cardiovascular risk indices in healthy young adults
4. More proof needed of safety and quality of electronic personal health records
5. Health care incentive model offers collaborative approach
6. Loneliness is bad for your health
7. Mailman School of Public Health study examines link between racial discrimination and substance use
8. Green Tea May Brew Up Healthier Skin
9. For Health Info, Women Often Turn to the Web
10. Record Number of Americans Lack Health Insurance
11. U.S. Research Funding Continues to Flatten as U.S. Health Costs Climb - in August 31 Science
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/31/2016)... Florida (PRWEB) , ... May 31, 2016 , ... ... Jay Butch of CertainTeed Corporation, he knew it was something that contractors should ... state-of-the-art and cutting-edge as it gets,” says Butch, CertainTeed’s Director of Contractor Programs. ...
(Date:5/31/2016)... ... May 31, 2016 , ... Effective leaders not only ... the industry as a whole. On June 2, Northbound CEO Mike Neatherton and COO ... (WCSAD) and presenting the opening plenary on “Leadership: The Journey to Authenticity” with Onsite ...
(Date:5/31/2016)... ... May 31, 2016 , ... WaterField Designs, an innovative ... announces the waxed-canvas and leather Duo Dopp Kit , the ideal gift upgrade ... ballistic nylon, the Duo is smartly designed for Dad’s grooming routine. Two ...
(Date:5/31/2016)... , ... May 31, 2016 , ... Interest is on ... screening tool and as an orthogonal tool for RNAi hit validation. A key reason ... specific guide RNAs—allows rapid generation of CRISPR RNA (crRNA) collections in arrayed formats. ...
(Date:5/31/2016)... Tel Aviv (PRWEB) , ... May 31, 2016 ... ... in the May 4, 2016 Cool Vendors in Security Infrastructure Protection report by ... areas and publishes a series of research reports evaluating these innovative vendors and ...
Breaking Medicine News(10 mins):
(Date:5/27/2016)... Hutchison China MediTech (Chi-Med) ... the highly lucrative global oncology and immunology markets. ... first-in-class or best-in-class tyrosine kinase inhibitor (TKI) drugs, ... partners. HCM,s profitable Chinese healthcare business continues to ... progress of the mid-to-late-stage pipeline during 2016-17 (including ...
(Date:5/26/2016)... May 26, 2016 According to a ... Management Market - U.S. Industry Analysis, Size, Share, Growth, Trends, ... in the U.S. was valued at US$ 5.89 Bn in ... 3.4% from 2015 to 2023 to reach US$ 7.99 Bn ... current and emerging needle free drug delivery devices and the ...
(Date:5/26/2016)... , May 26, 2016 ... has matured into an essential life science tool for ... development applications. BCC Research reveals in its new report ... second growth phase, one powered by a range of ...      (Logo: http://photos.prnewswire.com/prnh/20140723/694805 ) , ...
Breaking Medicine Technology: