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INDEPENDENT MEDICAL REVIEW (IMR) RESEARCH STUDY
RESEARCH PROJECT: Assessing the Impact of External Review Programs IMQ conducted a two-part study funded by the California HealthCare Foundation to evaluate the performance of California’s legislatively mandated external review program. Phase I of this study reviewed the impact of legislation on the effectiveness of the external review system from 1999-2000. It reviewed outcomes and gathered opinions from patients, physicians, health plans and independent review organizations regarding the fairness and value of the process, and how well the components of the system served them. Findings from this first phase uncovered low levels of awareness of the availability of external review and consumer skepticism about the independence and rigor of the process. Phase I and II of the report, Independent Medical Review Experiences in California, Phase I and II: Cases of Investigational/Experimental Treatments are published on the California HealthCare Foundation web site. Independent medical review has continued to evolve in California. Legislation, which went into effect in 2001, expanded eligibility for independent medical review to include treatments denied by health plans as “not medically necessary.” This legislation also modified how the independent medical review occurs. The second phase of the study looked at the effectiveness of the process under the expanded parameters which went into effect in 2001. It again looked at patient, physician and health plan experience. Both phases of the study were developed with the involvement of an Advisory Panel including consumer, physician, health plan and DMHC representation. This study will help develop recommendations for improving the effectiveness of external review in California with the hope of maximizing the value of the system. FURTHER INFORMATION: For more information on this study, call (415) 882-5169
or write to: or e-mail at: jsilverman@imq.org You can also fax us at: (415) 882-5149
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