Independent Review Organizations Gain Popularity Among Health Insurance Entities

By Sujata Garud
TMCnet Contributor

A recent webinar, organized by AllMed Healthcare Management, highlighted that health insurance entities are increasingly turning to specialty BPO organizations. Such payer organizations are increasingly selecting independent review organizations (IROs) and delegating medical decision making functions that used to be performed by internal medical staff. Health plans can serve their members effectively if they select IRO partner wisely and embrace BPO.

Due to this change in thought process of healthcare payer organizations, leading IROs have grown and can now work as full service business process outsourcing partners for a health plan as it relates to medical decision making. High-performance IROs have worked on an integrated portfolio of services that are delivered via web-based technology platforms.

In a press release, Andrew G. Rowe, CEO of AllMed, said, “Health plan medical directors are often called upon to review pre-authorization and appeals requests, which reduces the time they can devote to the oversight of quality, compliance and clinical operations functions. Given the compensation levels of these professionals, it makes more sense to outsource routine medical review tasks and redeploy medical directors where their higher-level expertise is of most value to the organization.”

Physicians believe that business process outsourcing allows health plans to reduce costs, scale their resources up and down with variable volumes, and allocate their medical directors to higher value-added tasks. This is the main reason why these organizations are heading into this direction. 

It is crucial that the IRO partner bring together all the cross-functional disciplines and expertise in physician recruiting, credentialing, training, quality assurance and compliance. Hence, it is crucial to select the right IRO partner with due-diligence. Also, the full-service IRO should provide a solution that is highly optimized and integrated into the health plan’s clinical decision-making workflows. Along with their involvement in providing reviews of external appeals, many of the health plans see BPO as a new model by which to engage with IROs.

AllMed is a medical review outsourcing partner to leading health insurance payers, third-party administrators, medical management and claims organizations, nationwide. Recently, the company was in news when it announced the launch of its online external peer review services for hospitals and ASCs through PeerPoint.

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