State Regulations Make Healthcare More Expensive

 


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Healthcare is regulated to a large degree at the state level, not the federal level. This adds incredible levels of cost to the healthcare delivery system. In particular, it makes health plans, Third Party Administrators and other types of healthcare payers and delivery organizations spend more on administration in order to credential meet state licensing and regulations for each state where their patients and member reside. One way for organizations to circumvent some of this and become more responsive and provide medical decision making support that their case managers need is by outsourcing some medical decision making to an Independent Review Organization. An Independent Review Organization easily provides medical decision support across state lines for a host of different constituents. This way organizations can quickly and efficiently allocate healthcare resources according to need and plan language without being encumbered by state regulatory processes. An Independent Review Organization plays a fundamental role in speeding up and overcoming some of the state regulatory requirements that we’re facing today.

Health plans, health insurance carriers, Third Party Administrators and other managed care organizations and medical management firms encounter a myriad of regulations when they are managing members who reside in multiple states. We believe that with respect to health core organizations, the state regulatory environment amounts to nothing more than state-mandated protectionism and simply adds additional layers of cost and bureaucratic difficulty for most health care organizations doing business in several states.

Often state regulations require that care decisions be made by physicians and specialists licensed in that state. In our opinion, this is wasteful and unnecessary. In fact, national standards do exist about the education of physicians and specialists. So why don't national credentialing standards also exist? These are the questions we ask ourselves as an Independent Review Organization that is trying to deliver value across multiple states and across multiple client constituencies.

About AllMed Healthcare Management
Founded in 1995, AllMed is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base for its independent medical review and hospital peer review services includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers. Read the AllMed Medical News Blog and the Independent Review Organization Blog .

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