, Volume 8, Issue 1, pp 70-71
Date: 28 Dec 2011

Osteoarthritis: Health Insurance Perspective

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Introduction

Health care costs for members with osteoarthritis have been estimated as twice the cost of a random population, controlling for comorbid conditions. This population generates approximately 5% of the medical cost of a health plan. As such, patients with osteoarthritis provide opportunity to improve outcomes and are candidates for medical management.

The goals of medical management are improvement in the quality of health care and a reduction in its cost—preferably both simultaneously. Opportunities in osteoarthritis include assurance of a reasonable and appropriate medical plan, support, and education of the patient to promote adherence, reduction of adverse events and drug reactions, and concurrent management of comorbidities and psychosocial barriers. Several domains of effort are available.

Precertification and Concurrent Review

The goal of this effort is to assure that the most appropriate treatment is provided for the patient at the most appropriate time and setting. This