An Epidemic

Narcotic analgesics have become a first line of defense against pain in our country.  Opioid analgesic pain relievers are now the most prescribed class of medications in the United States, with more than 289 million prescriptions written each year.1  In 2015 approximately 50% of all overdose deaths involved an prescription opioid.2  Meanwhile our healthcare providers receive inadequate training on pain management, and do not adequately perform or interpret opioid risk assessments.3,4 Together these factors have contributed to over 33,000 opioid related deaths in 2015.

While it is uncertain as to how many overdose deaths can be attributed to workers’ compensation provided prescription medications, workers’ compensation injured workers, providers, and payers are indisputably being impacted.  A 2014 NCCI research brief indicates that controlled substances accounted for 29% of total pharmacy spend for all active workers’ compensation claims.5 In addition to the risk of overdose the utilization of these medications can impact the recovery and the ability to return to work for the injured worker.

  1. Mental, Health Services Administration US, and Office of the Surgeon General (US. “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.” (2016).
  2. CDC. Wide-raning online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017.
  3. Upshur CC, Luckmann RS, Savageau JA. Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006;21:652–655.
  4. Salinas GD, Susalka D, Burton BS, et al. Risk assessment and counseling behaviors of healthcare professionals managing patients with chronic pain: a national multifaceted assessment of physicians, pharmacists, and their patients. J Opioid Manag. 2013;8(5):273-284.
  5. Lipton, Barry, and David Colón. “WORKERS COMPENSATION AND PRESCRIPTION DRUGS: 2016 Update.” (2016).

Collegial Intervention

PRIUM’s mission is to improve clinical outcomes and prevent human tragedy.  The place to start is to improve provided care and improve the patient-physician relationship through peer review.

PRIUM believes that collaborative physician engagement encompassing evidence-based medicine, clinical oversight, and jurisdictional guidelines is a primary means of facilitating optimal clinical and financial outcomes. PRIUM’s exclusive nationwide network of physician consultants enable PRIUM to fulfill all regulatory requirements related to PRIUM service offerings including specialty categories, active practice status, and state licensure. Our physician consultants are selected so as to not only have sufficient accreditation and clinical experience to appropriately assess the treatment plan underway, but to also be able to engage in difficult conversations with treating physicians about alternative avenues for improving function and reducing symptomatic pain and anxiety while reducing reliance on inappropriate and often unsafe polypharmaceutical regimens.

 

 

 

Better Process

PRIUM has created a peer review process that leads to more frequent and more valuable peer-to-peer conversation.  PRIUM ensures that the treating provider is prepared for the discussion when it takes place.  This engenders better discussion, better collaboration, and better outcomes. Because rendering evidence based clinical guidance is our singular aim, we do it better than anyone else in the industry.  This strategic focus enables a constant evolution of our products and services to achieve ever greater results for our clients and outcomes for injured workers.  

Written Agreement

We achieve peer review discussion with the treating physician in 74% of cases, and obtain Written Agreement on 80% of medication recommendations, and a 50% Written Agreement rate to recommendations that represent a change to treatment.  Following PRIUM’s peer-to-peer discussion and broader chronic pain intervention program PRIUM has seen substantial results across our book of business.

Superior Outcomes