Risk Management

There are essentially two practical ways to reduce risk for Physicians and Hospitals treating patients, in addition to routine patient consent; (1) verifying all information collected by the treating provider including medical history and diagnostic outcomes and; (2) insure proper protocol and pathways are being followed prior to treatment decision. This includes a second opinion by Onicol Medical Experts. Onicol's sophisticated systems and operations center perform both of these critical goals.

Onicol uses Prior Authorization Services for each Risk Management Program. The majority of requested services are processed through Onicol's automated Medical and Pharmacy Management System. All of Onicol's proprietary Protocols and Pathways have sophisticated algorithms that serve as the nerve center for prior authorization. As a result, the majority of requests can be processed in real time, while other requests may be pended for additional review. This allows Providers to work efficiently and not have to wait to perform basic routinely approved services. Rather they can focus energies on treatments that need additional information. As changes are made to the Protocols and Pathways the Risk Management Systems are updated simultaneously to reflect the changes made. Thus there is continuity of care from the Malpractice Policy and Procedures to the daily Prior Authorization process. At the same time Peer to Peer consultations have a significant impact on changing adverse physician behavior, improving outcomes and reducing risk.

Throughout the risk management process, Onicol utilizes explicit clinical review criteria based on sound clinical principles and processes that are reviewed and revised on a periodic basis. The company employs qualified risk management staff supported by written clinical review criteria. Non-clinical staff may perform limited data collection, intake and scripted clinical screening.

Risk Assessment plays a critical role in the appropriate management of patient care. Onicol develops and maintains proprietary algorithms that determine risk stratification for each patient based all data collected through Patient Intervention (web risk assessments or care manager consultations), Medical and Pharmaceutical Authorizations, Medical History, Outcomes and Claims. Risk Assessment is a continual process that can change based on single data point. Once a patient has met the criteria for a particular risk stratification the patient will be immediately transferred to the next step in the pathway. Determining appropriate risk factors also affects authorization of requested services. Some services or medications may not be appropriate for some patients with particular risk factors. Onicol's system will automatically determine a potential adverse effect based on risk factors and requested services and will alert the staff or provider. Some highlights of the program include but are not limited to:

  • Significantly reduce cost with comprehensive risk management program
  • Strengthen market position by providing benefits in terms of brand recognition, resources and efficiencies
  • Provider oriented risk management
  • Extensive algorithms, protocols and pathways for each specialty
  • Option for second opinion
  • Additional review of diagnostics and prognosis
  • Patient Education
  • Reduced risk is not solely about proper consent