Utilization Management and Leveraging the ICD-10 Solution

Specialty drug trend continues to grow at 14-25% annually and it has become the number one drug management priority for payers. Specialty trend is driven primarily by Price, Drug Mix and Utilization and the imminent availability of the ICD-10 data standard creates new opportunities for utilization management programs that can reduce trend up to 7%. With the deadline to transition to the ICD-10-CM data set looming on the horizon (October 1, 2015), many health plans and providers are mired in the thought of “am I ready?” The ICD-10-CM data set has approximately 5 times as many diagnosis codes than its predecessor and is intended to provide more specific coding of patient diagnoses. This transition has been in motion for some time and new diagnosis detail is about to become integrated into the daily flow of medical claim and medical record data. Leveraging ICD-10 for more accurate identification and application of the patient diagnosis codes to Specialty drugs will ultimately provide higher utilization control through improved clinical criteria, drug policies and prior authorizations. Join Randy Falkenrath on Wednesday, August 26th at 2 pm (EST) to learn more about Utilization Management. Randy will go in depth on how ICD-10 can be a key component for reducing drug trend. Register for the webinar here.