Specialty Programs

For those injured workers with chronic and complex claims, we typically find that they require a holistic treatment plan that incorporates services from each of the MedAssess™ levels of care. To serve these injured workers, we have created several specialty programs to address issues such as Pain Management, Fraud and Abuse Prevention and Catastrophic Care Support.

Pain Management

Pain is a consequence of most industrial injuries and effective treatment of pain often determines the rapidity with which an injured worker returns to work. Pain is also of great concern for the majority of chronically injured workers. PMSI’s Annual Drug Trend Report reveals that 70% of total pharmacy spend is related to medications used for the treatment of pain. In order to address these complex issues, PMSI’s Pain Management program combines a variety of MedAssess services to contribute to better health outcomes for injured workers and savings for our clients.

Fraud and Abuse Prevention

Although the incidence of drug abuse and diversion is relatively infrequent, when considering the pervasive use of narcotic analgesics in the treatment of pain, misuse of pain medications is of great concern to the healthcare community, our clients and society. PMSI’s Fraud and Abuse Prevention program targets this problem with integrated solutions through our MedAssess services. The result is a program that deters fraud, prevents abuse, and manages utilization through close monitoring and follow-up.

Catastrophic Care Support

Catastrophically injured workers have unique and complex healthcare needs that require expert coordination and execution, especially for medical services and equipment. We assist claims professionals and case managers with these needs by assigning a dedicated, experienced nurse to assist with these complex cases. When engaged early in the injury lifecycle, PMSI can help ensure that appropriate products and services are available for injured workers being discharged from the acute-care setting to the home environment. Subsequent monitoring for appropriate utilization and cost effectiveness of products and services results in improved injured worker care and savings for our clients.