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2013 Innovation Awards: Rx Intelligence

2013 Innovation Awards: Rx Intelligence



Recognizing that workers compensation claimants with chronic pain can sometimes become addicted to the medication used to treat their symptoms, Rising Medical Solutions Inc. developed a software program that flags at-risk cases earlier by tracking all prescription activity.

By spotting questionable prescription drug usage earlier, this Web-based dashboard, when combined with physician pharmacy review, enables earlier intervention to prevent drug misuse and abuse by injured employees.

Previously, employers and their claims adjusters would have to manually pore over workers comp files to determine which claimants were taking potentially addictive painkillers for extended periods of time, said Anne Kirby, chief compliance officer and vice president of medical review services at Rising Medical Solutions in Chicago.

But such cases are identified almost immediately with Rising Medical Solutions' Rx Intelligence technology, which has been recognized for its ingenuity in this year's Business Insurance Innovation Awards.

Besides opioids, Rx Intelligence technology also tracks other prescribed drugs that have the potential for abuse or could lead to negative drug interactions.

“If an injured worker is taking one drug, they are likely taking 10,” Ms. Kirby said. “You cannot just deal with opioids in a vacuum because other drugs impact how they're used and what the impact is on their use. It's an interdisciplinary approach to managing the total pharmacy costs related to opioids.”

Risk managers also can log into the password-protected Rx Intelligence dashboard to track prescription drug usage by workers comp claimants. Cost of the combination pharmacy dashboard, review and intervention service is $1,500 per case.

“Twenty percent of the time, we don't recommend any intervention because they may already be on a weaning schedule or may still be in acute pain,” Ms. Kirby said. However, in cases when the physicians reviewing the files suspect abuse, they will contact the treating physician directly, she said.

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