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Improving Clinical Review to Increase Member Engagement & Optimize Cost of Care

Improving Clinical Review to Increase Member Engagement & Optimize Cost of Care


By Rodney Musselman, MD, Chief Medical Officer – Commercial and Innovation, Medical Review Institute of America


How can we help our clients meet patient/member expectations, ensure appropriate care and reduce medical costs? That was the question we set out to answer through innovation in independent medical review at MRIoA. We’ve developed a technology-enabled solution that ensures patients get decisions quickly and receive a valuable second opinion. For a typical health plan, our solution also creates $6M in savings per 100,000 members over a three-year period, a 3.9x ROI.


An End-to-End Utilization Management (UM) Solution

We’ve integrated two of MRIoA’s most significant offerings, PA Optimization and MyCareChoices™, in a streamlined, end-to-end solution. Each on its own is proven to create positive impact for our clients and their patient/members:

  • PA Optimization enables health plans, PBMs, TPAs, government, and self-insureds to prior authorize what they need and stop what they don’t to ensure patients/members get the right care at the right place at the right time.
  • MyCareChoices™ – Your 2nd Opinion enables MRIoA clients to provide patients/members with fast, reliable second opinions and conservative therapy options from world-class medical specialists within 24 to 48 hours.


When we stack these in a seamless solution, they reduce unnecessary care and overutilized PAs, drive patient/member engagement, and optimize the cost of care. First, PA Optimization identifies PA gaps and removes low value PA, which reduces unnecessary medical expense. Next, eligible patients/members are identified for MyCareChoices using the MRIoA Insights™ propensity model. Evaluation includes eligible procedures, timeline until surgery, and the location of surgery. Eligible patients are auto-enrolled in MyCareChoices, and from there, begin a personalized, educational journey that includes fast, evidence-based virtual second opinions.


The Future of Healthcare with Technology-Enabled Medical Review

Our integration of PA Optimization and MyCareChoices is just one of the ways MRIoA is modernizing independent medical review. You can find out more about how technology-enabled medical review is helping payers build better businesses and a better health system that puts patients/members at the center in our latest white paper. Download it now.