ESIS Enhances Efforts to Control Pharmacy Costs and Utilization

ACE Group announced the expansion of ESIS Pharmacy Impact, a key component of ESIS' medical programs offering.

According to a release, ESIS Pharmacy Impact was launched in January, 2012 to help control pharmacy-related claims expenses, while ensuring best possible clinical outcomes for injured employees. The enhancement and expansion includes early and ongoing application of ESIS' risk scoring predictive model to identify claims that have the potential to incur high pharmacy costs. Once identified, aggressive strategies and tactics can be implemented to ensure appropriate clinical interventions.

"ESIS' predictive modeling approach is improving the way we manage medical costs on workers compensation claims," said David Patterson, Division President, ESIS, Inc. "Our continual investment in ESIS Medical Programs helps ensure we continue to meet the complex and evolving needs of our clients - providing aggressive strategies that give them a high level of control over their loss costs on each claim and on their risk management program overall."

"ESIS Pharmacy Impact has delivered significant savings -- 56.5 percent from 2013 original billed pharmacy charges," said Veronica Cressman, Vice President ESIS Medical Programs. "We are acutely aware of the importance of continual enhancement of our pharmacy program and continue to dedicate time and resources necessary to help ensure we continue to minimize pharmacy costs on behalf of our clients."

The program enhancement utilizes data analytics and predictive modeling to identify claims that have the potential for higher costs due to pharmacy utilization. For example, the program involves monitoring the use of narcotics and other critical pharmacological interventions in pain management. ESIS' approach uses four years of historical data that pinpoints drug utilization patterns on high cost claims, enabling ESIS clinicians to take actions needed to ensure best possible clinical outcomes for injured workers and lowest possible claim costs.

ESIS pharmacy specialists employ evidence-based medicine and recognized regional and national medical guidelines to ensure that the right drugs are prescribed at the right time and for the proper duration. Utilizing data analytics, clinical triage, pharmacy utilization review and urine drug monitoring, ESIS is able to exert an appropriate measure of control over utilization at every stage in the claim life cycle.

"From years of experience, we've learned that sharing common goals with our clients provides clear value," added Cressman. "At ESIS, we continue to improve our medical program offerings in response to the evolving needs of our clients. We are committed to delivering better results and reduced costs today and in the future."

Additional components of ESIS Medical Programs include:

-Medical Bill Review

-Case Management

-Catastrophic Claim Case Management

-Dental Services

-Diagnostic Imaging

-Durable Medical Equipment

-Physical Therapy

-PPO Networks

-Nurse Triage

-Utilization Review

ESIS Medical Programs provide the following benefits on workers compensation claims:

-Oversight of appropriate medical care

-Timely and appropriate sharing of claims and medical information

-Program quality management

-Loss cost reduction strategies

-Ongoing network enhancement

-Audits and controls

ESIS, Inc. (ESIS) is part of ACE Group, providing claim and risk management services to a variety of commercial clients.

more information:

esis.com

acegroup.com

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