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Medical Dispute Resolution: Utilization Review and Independent Medical Review

Medical dispute resolution is a vital component of all healthcare delivery systems. This study examines the key linkages between utilization review (UR) and independent medical review (IMR).

Obesity as a Medical Disease: Potential Implications for WC

A new CWCI report examines the implications of the AMA’s recent reclassification of obesity as a treatable disease, and identifies and measures key differences between claims with and without obesity as a co-morbidity.

ICIS Injury Score Card: 2001-2011 Other Injury, Poisoning & Toxic Effect Claims

The latest CWCI Injury Score Card provides detailed data on claims in which the diagnosis falls in the “Other Injury, Poisoning and Toxic Effect category, which comprise 1 out of every 13 California workers’ comp claims, but 1 out of every 10 loss dollars.”

Use of Network Physicians in California WC, AY 2004-3Q2011 Claims

The latest research on network provider utilization in California workers’ compensation shows network physicians delivered nearly 80% of first-year, physician-based outpatient treatment on AY 2010 claims.

Differences in Outcomes for Injured Workers Receiving Physician-Dispensed Repackaged Drugs in the California WC System

New CWCI Research shows California workers’ comp claims that involve physician-dispensed repackaged drugs have higher average medical and indemnity payments and more days away from work than comparable claims with no physician-dispensed repackaged drugs.

Current Trends In Compound Drug Use and Costs in California WC

New CWCI research shows compound drugs accounted for a declining share of prescription medications dispensed to California injured workers last year, yet compound drug payments continued to represent a growing percentage of prescription dollars.

Estimated Savings from Enhanced Opioid Management Controls through 3rd Party Payor Access to the Controlled Substance UR and Evaluation System (CURES)

A new Institute analysis suggests that allowing workers’ comp payers access to data from the state’s prescription drug monitoring program (CURES) would help reduce inappropriate dispensing of opioids in workers’ comp, improving injured worker treatment and saving an estimated $57 million in AY 2011 claim costs.