About Alex Shiels

This author has not yet filled in any details.
So far Alex Shiels has created 4 blog entries.

Independent Medical Review cuts costs!

Senior executives from some of the top California workers’ compensation carriers identified emerging trends that are of great importance to California employers at the 2015 California Workers’ Compensation and Risk Conference. Panelists were: Moderator: Pamela Ferrandino, national casualty practice leader at Willis North America Mike Mulray, chief underwriting officer at Everest National John Dickey, regional president at Liberty Mutual Mike Hessling, chief client officer at Gallagher Bassett Glen-Roberts Pitruzzello, vice president of workers’ compensation, group benefits claim strategy and clinical operations, at the Hartford The WCIRB projects the estimated average medical cost-per-claim will be the lowest since 2007. What do you think are the key drivers behind this improvement? The independent medical review (IMR) process. IMRs are being upheld in favor of the employer – around 90% of the time. That is showing that evidence-based protocols are being followed. Medical inflation has decreased. Effective utilization review (UR) programs have had a positive effect on controlling medical costs. Will the greater use of generic drugs in the California drug formulary materially lower workers’ compensation costs? Texas is a good example. We have not seen any major pushback from what Texas has done. Texas communicated to the providers, so they know how [...]

Independent Medical Review cuts costs!2018-09-21T17:29:44+00:00

Opioid Overdose Survivors are Prescribed more Opioids

Examining a national database of health insurance claims, researchers found that 91 percent of patients who suffered a nonfatal overdose of prescription opioid painkillers continued getting prescriptions for opioids following the overdose. The findings, published in the Annals of Internal Medicine, follow news earlier this month from the Centers for Disease Control and Prevention that drug overdoses, opioid overdoses in particular, have reached epidemic levels. Read Full Story

Opioid Overdose Survivors are Prescribed more Opioids2018-09-21T17:29:44+00:00

CWCI Examines Workers’ Comp

Following California workers’ compensation reforms enacted in 2002-2004 and 2012, the process of approving medical care for injured workers went through significant change. While a means of resolving medical necessity disputes is common to almost all other healthcare delivery systems, including group health and federal programs, workers’ compensation is not like other systems. Read Full Story

CWCI Examines Workers’ Comp2018-09-21T17:29:44+00:00

Are you ready for the California Drug Formulary? California seems to be!

A bill mandating a closed drug formulary for California's workers comp system is heading to Gov. Jerry Brown's desk. A.B. 1124 was adopted by the state legislature in the final moments of its 2015 session Friday. The bill, introduced and shepherded through the legislative process by Assemblymember Henry Perea, D-Fresno, would establish an evidence-based prescription drug formulary for California's workers comp system, the largest in the United States, by July 1, 2017. Such a formulary would be designed to curb the abuse and overprescribing of certain medications, particularly opioids. “The central purpose of our workers' comp system is to ensure injured workers regain health and get back to work,” Mr. Perea said in a statement. “When workers get addicted to dangerous medications, goals of the program are not met.” Read Full Story

Are you ready for the California Drug Formulary? California seems to be!2018-09-21T17:29:44+00:00