Our Nation’s Healthcare Costs are Spiraling Out of Control

December 14, 2016

Almost every day we read in the newspapers how healthcare costs continue to rise at a double digit pace. As employers each year we are chagrined to hear from our health insurance carriers that they’re passing on 12 to 15 to 17 percent increases in health care premiums. We respond by shifting costs over to our employees by increasing the deductibles and co-pays hoping to stem the tide of uncontrollable healthcare costs. Yet, they continue to rise.

We want to do something about this. Clearly one of the things that we can be done is to make sure that in the healthcare system today, the resources are allocated only to those people who deserve and qualify for the treatment that they’re seeking on the basis of medical fact. AHIP commonly estimates that 30% of all healthcare treatments are unnecessary. We believe this to be the case because it mirrors our own statistical denials of healthcare benefits on the cases that we review for major health insurance carriers, Third Party Administrators and other clients.

The point is allocating health care resources an important part of medical cost containment equation and something that we should all be concerned about? Certainly our company is not at the forefront of this. Our role is to simply provide independent medical review services that help payers allocate their resources more effectively. We believe there are many other ways o to solve this problem, and Independent Review Organizations are adding increasing value by helping to contain medical costs.

As a member of the National Association of Independent Review Organizations (NAiro), we’ve banded together to press for changes in legislative and regulatory areas at the state level and to seek to unify the bureaucratic regulations that are tangling up our healthcare system at the state level and leading to increasing costs. We also are pushing for better ways to improve the overall healthcare system by advocating standards for credentialing Independent Review Organizations.

All of the NAiro members are accredited by URAC which has helped us to improve our overall quality and to insure our clients that we meet high standards of performance when it comes to medical review quality, turn around time, objectivity and evidence based decision-making. NAiro is pursuing an aggressive agenda among its members to improve the overall responsiveness of the industry to changing healthcare trends, as it relates to emerging treatments. We’re also working actively as members of the URAC board to push forward an agenda that will make it easier for healthcare organizations to select credentialed organizations as their healthcare vendors.

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