Providio, PRIUM partner to deliver Medicare Set Aside Clinical Review service

PRIUM and Providio MediSolutions, LLC have joined forces to deliver an innovative Medicare Set Aside Clinical Review (MSA-CR) service that not only calculates future medical and pharmacy costs of workers' compensation claims, but also reduces medical costs by recommending changes to treatment plans and drug regimens while overseeing their implementation.

"Providio chose to partner with PRIUM to deliver additional value to clients in situations where the initial MSA calculations are high and we feel PRIUM's physician-to-physician intervention will reduce the overall MSA cost and enhance claimant care," said Ginger Susman, chief marketing officer for Providio.

With MSA-CR, PRIUM's physicians review a case and, using evidence-based medicine and treatment guidelines, discuss alternate treatment options with the treating physician. "Treating physicians tend to give more credence to other physicians," said Mark Pew, PRIUM's senior vice president of business development. "In 62 percent of our cases, our physicians obtain the treating physician's agreement on a new treatment plan."

Key to the program's success is the ongoing case management of the new treatment plan and medications. "Peer review reports can languish in the system," Pew noted. "PRIUM assigns a nurse case manager to ensure that the revised treatment plan is implemented. The nurse case manager also monitors the new plan's progress and reports on outcomes. Our experience shows that the Centers for Medicare and Medicaid Service (CMS) is more likely to accept the MSA plan once the new treatment has been established," Pew said.