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MRIoA Held Its First Executive Client Council

Medical Review Institute of America (MRIoA) held its first Executive Client Council (ECC). The ECC tackled innovative strategies that health plans, third-party administrators (TPAs) and pharmacy benefit managers (PBMs) are using to solve healthcare’s most challenging utilization management (UM) issues.

2nd opinions and data analytics shine as key solutions that improve member/patient care and drive down costs for the industry

Medical Review Institute of America (MRIoA) hosted an Executive Client Council on July 23, 2020. The invitation-only Council is comprised of healthcare’s most influential executives and collectively represents over 34% of all insured persons in the United States. Council members were selected from the nation’s leading health plans, TPAs and PBMs to discuss the challenges and solutions within utilization management (UM). As the insightful discussions unfolded, two key solutions rose to the top to combat UM challenges: 2nd opinions and data analytics. These discussions were led by two prominent keynote speakers. Jay Keese, CEO of Capitol Advocates, a Washington, DC-based policy and government relations firm specializing in healthcare, presented key health policies and the legislative landscape as it relates to UM and certainty in the midst of COVID-19. Jerry Frank, MD, former SVP and CMO of EmblemHealth, shared trends and UM innovations to watch in 2020 and beyond.

Medical Review Institute of America (MRIoA) is helping to transform the member experience with simplified virtual access for patients that enables the best treatment options from prominent MD specialists. Comprehensive data analytics supported by MRIoA’s Appropriate Utilization™ platform fuel this transformation. By creating deeper insights into prior authorizations (PA) and appeals relative to peers, MRIoA helps payers, providers, TPAs and PBMs provide patient-centered care in a more cost-effective way.

In the current environment, MRIoA is helping clients meet two challenges in particular:

  • Effectively treating pain and proactively fighting addiction to opioids. MRIoA enables fast access to expert 2nd opinions on opioids, helping clients drive appropriate access and reduce overutilization and costs. MRIoA’s behavioral health experts are meeting with patients virtually to provide behavioral health interventions.
  • Transforming the administration of PA criteria. MRIoA is providing 2nd opinions supported by data on approval and denial rates at the initial and appeal level to benchmark against the industry, enabling clients to make informed decisions on the need for PA on specific services. Fewer PA requirements translate into a better, more streamlined member/patient experience and increased plan efficiency.
  • Reducing specialty and opioid drug spend through retrospective review. MRIoA’s innovative retrospective review identifies member utilization of high-cost specialty drugs or opioid regimens which allows the Health Plan or PBM to take a more active approach in drug utilization management.

Learn more about the power of partnership with MRIoA to create new, transformative opportunities for your organization and get in touch with us at and call 1-800-654-2422.