CASE Rx℠: Prospective Drug Review for Workers' Compensation

CASE Rx^® Clinical expertise and experience to help claims professionals address inappropriate, ineffective, or unnecessary drug therapies

About

myMatrixx developed the CASE Rx^® program, as part of our Get Ahead of the Claim™ strategy, to provide comprehensive reviews of injured patient medication usage in an effort to enhance overall treatment outcomes. Our expert workers' comp focused clinical pharmacists aid claims professionals by identifying inappropriate use of medications and providing recommendations to resolve or mitigate adverse patient outcomes as well as reduce treatment cost.

Leveraging Rx data to save lives

The treatment of injured patients may present many unique challenges and can often becoming problematic. Medication usage is a critical component of problematic claims because injured patients are frequently prescribed opioid therapy and other risky medications with high potential for serious adverse health effects from inappropriate use. Between 250,000-440,000 people die from medical errors in the U.S. every year (Sipherd, 2018).

Clinical And Safety Evaluation Rx (CASE Rx^®), is a prescriber clinical intervention program that aims to improve therapeutic outcomes by providing objective and evidence based assessments of prescription drug use by injured patients. This systematic review process ensures a comprehensive assessment. The program’s primary focus is to identify and correct potential medication errors and drug therapy problems. Additionally, CASE Rx^® identifies potentially inappropriate or inefficient use of medications. A teleconference with a treating provider and a myMatrixx clinical pharmacist may be utilized to help drive implementation of the CASE Rx^® interventions.

Lastly, specific recommendations are made for lower cost, yet equally effective alternatives when opportunities exists. The expert clinical team at myMatrixx is equipped to perform CASE Rx^® reviews for any injury or disease condition from the ubiquitous lower-back injury to more complicated and rare cases such as traumatic brain injury. On every case, the clinical team is dedicated to providing valuable clinical insight and actionable recommendations that have the potential of positively affecting the course of therapy and the patient’s overall condition.

CASE Rx^® Report

The Benefit

Expert claims analysis and intervention leads to significant reduction in drug therapy costs.

The Value

Manages and minimizes long term exposure to excessive or unnecessary drug spending.

CASE Rx Overview PDF

Advantages of CASE Rx

THE CASE Rx Report

Carefully designed and streamlined for communicating highly technical and clinical information for review, the CASE Rx^® report provides clear and concise recommendations with supporting clinical references. The report outlines recommendations for each medication along with supporting clinical rationale. Recommendations for changes are only made when it is determine that it is in the patient’s best interest. CASE Rx^® Teleconference Option Clients may request a teleconference with the treating provider and myMatrixx clinical pharmacist to drive implementation of changes and obtain clinical rational. myMatrixx pharmacist lead the discussion with the provider to obtain acceptance of change recommendations and a signed agreement is requested.

Clinical Analytics Results Engine (CARE)

myMatrixx myDataSense^SM CARE platform is an innovative business intelligence program that identifies and measures clinical utilization patterns. CARE^SM is a highly effective tool for identifying potentially at risk patients that are ideal candidates for a CASE Rx^® review thereby transforming clinical analytics into actionable intelligence. CARE Analytics can also monitor outcomes post intervention.

Expert Pharmacists Focused on Workers' Compensation

myMatrixx pharmacists are laser-focused on the field of workers’ compensation. They understand the intricacies of the system, the unique treatment environment, the mindset of providers and underlying incentives that too often protract the claim. They are up-to-date with state workers’ compensation guidelines and leverage that knowledge to strengthen assessments and recommendations. myMatrixx pharmacists are available for consultation at any time.