2022/08/31 Council Agenda Packet

SCHEDULE 12 Medication Review Services Terms and Conditions I. DESCRIPTION OF SERVICES. (a) CorVel acknowledges there is a subset of patients in the system that do not improve despite extensive diagnostic testing and numerous treatments. CorVel knows these relatively fewer cases drive a disproportionate amount of costs. Interestingly, these "creeping catastrophic" claims often present as a simple strain or sprain injury or diffuse spinal pain. There is ample data to suggest that bio-psychosocial factors can amplify, sustain or mitigate a patient's perception of disability in these cases. CorVel shall use clinical modeling to identify those patients at risk for delayed recovery and apply an interdisciplinary bio-psychosocial approach to their care. (b) CorVel offers a variety of interventions that are recommended depending on the severity and chronicity of the claim. They can be utilized separately or integrated in a more comprehensive management plan again depending on claim severity and patient characteristics. II. DELIVERY OF SERVICES. Medication Review: • CorVel's contracted physician will evaluate the medical necessity of each currently used or prescribed medication. • CorVel's contracted physician will recommend elimination of duplicative medications. • CorVel's contracted physician will determine and recommend medications that may replace and be equally or more effective than one or a group of currently used/prescribed medications. • CorVel's contracted physician will recommend medications that are pharmacologically similar to currently used or prescribed medications when available at a lower cost (same or similar class, less cost, generic when available). • CorVel's contracted physician will attempt Peer to Peer contact by calling the PTP. • CorVel's contracted physician will provide the customer a written agreement from the prescribing physician (if agreement is reached) for alternate treatment plan. • On cases where agreement is not met between CorVel and the PTP a written report will be generated and sent to the customer that includes a written summary of all activity that will include recommendations, rationales and potential savings identification made by CorVel's contracted physician. • Allowances will be made for the attending physician to bill for their time spent on the teleconference at the applicable fee schedule. Wellness Program: Cases can be initially referred to a network of cognitive behavioral therapists who function to help the patient/claimant improve their pain coping skills, change their perception of disability and decrease fear -avoidance behaviors that are often a significant barrier for RTW. City of Everett, WA — CorVel EC Amendment 3 7-25-2022