By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    improving patient experience
    6 Ways to Improve Patient Satisfaction Within Hospitals
    December 1, 2021
    degree for healthcare job
    What Are The Health Benefits Of Having A Degree?
    March 9, 2022
    custom software development is changing healthcare
    Digital Customer Journey Mapping and its Importance for Healthcare
    July 21, 2022
    Latest News
    Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
    May 16, 2025
    Learn how to Renew your Medical Card in West Virginia
    May 16, 2025
    Choosing the Right Supplement Manufacturer for Your Brand
    May 1, 2025
    Engineering Temporary Hospitals for Extreme Weather
    April 24, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Can Thinking Younger Make You Live Longer?
    April 20, 2011
    Image
    Obesity’s Outlook Unchanged
    June 13, 2011
    When It’s An Emergency Elderly Not Treated As Well in Hospitals
    July 16, 2011
    Latest News
    Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
    May 18, 2025
    The Critical Role of Healthcare in Personal Injury Recovery: A Comprehensive Guide for Victims
    May 14, 2025
    The Backbone of Successful Trials: Clinical Data Management
    April 28, 2025
    Advancing Your Healthcare Career through Education and Specialization
    April 16, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Making The Decision To Outsource And Choosing The Right IRO Partner
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Health Reform > Making The Decision To Outsource And Choosing The Right IRO Partner
BusinesseBookHealth ReformHospital AdministrationMedical EducationMedical EthicsPolicy & LawPublic Health

Making The Decision To Outsource And Choosing The Right IRO Partner

Josh Nelson Blogging
Last updated: October 19, 2015 5:17 pm
Josh Nelson Blogging
Share
4 Min Read
SHARE

Outsourcing first-level physician review has become essential as health plans continue to face increased pressure to handle larger volumes while controlling cost. When making the decision to outsource, health plan executives must weigh both the advantages and disadvantages of moving their medical reviews to an external partner. Let’s take a look at the pros and cons of outsourcing medical reviews for payer organizations.

Outsourcing first-level physician review has become essential as health plans continue to face increased pressure to handle larger volumes while controlling cost. When making the decision to outsource, health plan executives must weigh both the advantages and disadvantages of moving their medical reviews to an external partner. Let’s take a look at the pros and cons of outsourcing medical reviews for payer organizations.

Outsourcing pros and cons to consider:

Pros

  • Reduces high medial Director payroll costs
  • Shifts costs from fixed to variable
  • Improves ability to adjust costs to review volumes
  • Frees up in-house Medical Directors to work on higher strategic and value-added tasks (first-level physician reviews are stressful and mundane)
  • Leverages web-based medical review portal technology
  • IROs have optimized / streamlined physician review processes at low costs
  • Outsourcing is straighforward and can be set up at a low cost

Cons

  • Loss of in-house Medical Director expertise is not enough other work to justify keeping them on staff
  • Need to set up a new business process and train utilization review nurses on new referral procedures
  • Nurse / doctor communications via phone instead of face-to-face

Selecting the Right Medical Director-Review Outsourcing Partner

Once the decision to outsource has been made, it is vital that health plans carefully choose the right partner to handle their first-level physician reviews. Independent review organizations are particularly well suited to take on these tasks and already provide BPO services for major health plans.
 
Health plans interviewed in a study by the American Association of Health Plan (AAHP), the trade association of health insurers, attributed partnering with IROs with increasing member satisfaction, enhancement of health plan credibility with its members, and diminishing the perception that administrators rather than physicians are making coverage decisions.

Criteria to look for when selecting an IRO Partner

  • A large pool of board-certified physicians in active practice who have been credentialed and trained to provide utilization review support to nursing teams
  • A telephone hotline for client nurses to be able to discuss specific reviews and to get answers to their questions from physician reviewers with Medical Director oversight
  • The ability to meet same-day or 24-hour turnaround times
  • A web portal that allows clients to send and receive case requests, as well as to monitor status and to provide reporting functions
  • A quality management system that meets the NCQA and URAC delegation standards and fully complies with all regulatory requirements
  • A streamlined and optimized workflow that keeps costs down, along with commitment to continuous improvement and cost reduction

Larger volume fluctuation, increased legislation, and the necessity to control costs have all driven the growth in outsourcing of medical reviews. More and more health plans will have to consider advantages and disadvantages of outsourcing for their companies. Independent review organizations are well-equipped to handle these fluctuations in review volume and offer high-quality defensible reviews while helping companies reduce high payroll costs. By choosing the right IRO partner, health plans can achieve these benefits, maintain their high standards, and meet optimal security requirements, all in a quick turnaround time.

You can find the original blog post here.

Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Clinical Expertise
Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
Health care
May 18, 2025
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Health
May 15, 2025
Learn how to Renew your Medical Card in West Virginia
Learn how to Renew your Medical Card in West Virginia
Health
May 15, 2025
Dr. Klaus Rentrop Shares Acute Myocardial Infarction heart treatment
Dr. Klaus Rentrop Shares Acute Myocardial Infarction
Cardiology
May 13, 2025

You Might also Like

BusinessMarketing

Which Content Strategy Works Best For Your Healthcare Business?

January 10, 2019
Image
Health ReformPublic Health

Caring For Chronic Illnesses Should Be Different

May 26, 2013
Screen Shot 2016-09-09 at 3.35.04 PM
BusinessHospital AdministrationMedical InnovationsTechnology

Marketing Automation, Oh My! Lessons from a Leading Health System

September 14, 2016
Image
Home HealthPolicy & Law

Transitional Care Management: Reimbursement of Non-Face-To-Face Services

March 5, 2013
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?