#FutureReadyHealthcare
Modernizing MLR: Embracing Tier-Based Review Strategies
15 May 2024
In a recent webinar by Indegene, the challenges in the MLR content review process were explored, shedding light on the need for more efficient methodologies in light of evolving content landscapes and emerging AI-generated materials. The solution presented? Tier-based review—an approach aimed at tailoring the review process to match the risk level associated with each piece of content, ultimately streamlining the MLR process.
Jeremy Richter, Senior Director, MLR and Content Strategy, Indegene, moderated the panel. Jeremy was joined by a panel of industry experts—
Chett Bhatt, Executive Director, Global Medical Operations & Strategy Amarin Pharma Inc
Joel Goffinet, Director, Head of Global Clearance Standards and System UCB, and
Mohit Jain, AVP - Client Partnership and Advisory, Enterprise Medical Solutions Indegene
The experts shared their organizations' experiences with implementing tier-based review, offering unique insights into how tier-based review can transform MLR processes.
Chett Bhatt delved into how Amarin shifted its focus from volume and velocity to value and fit-for-review, aligning the MLR process with the core objective of approving materials in a timely and compliant manner. Joel Goffinet emphasized the importance of prioritizing content intent over mere risk assessment, stressing the need for aligning stakeholder perspectives and fostering accountability.
The panelists discussed the implementation journey, highlighting the critical steps of stakeholder alignment, defining tier criteria, and nurturing a culture of collaboration and accountability. Throughout the discussion, the benefits of tier-based review became evident—improved workload management, increased transparency, collaboration, and ultimately, more efficient MLR cycles.
The importance of continuous learning and adaptation was underscored as crucial for the success of the implementation process, with a focus on future-proofing the MLR process. Automation and taxonomy were recognized as key enablers, ensuring that the system operates smoothly and aligns with stakeholder expectations.
Here are some of the key takeaways from the webinar:
Tailoring Review Processes: Tier-based review offers a customized approach to content review, aligning the intensity of review with the risk level associated with each material. This ensures that resources are allocated efficiently, focusing efforts where they are most needed.
Shift in Focus to Value and Fit-for-review: Organizations like Amarin have shifted their focus from sheer volume and velocity to value and fit-for-review. By aligning the MLR process with the core objective of approving materials in a timely and compliant manner, they have streamlined their operations and enhanced efficiency.
Content Intent over Risk Assessment: Joel Goffinet emphasized the importance of prioritizing content intent over simplistic risk assessment. By understanding the purpose and context of each piece of content, stakeholders can make more informed decisions, leading to improved outcomes and greater accountability.
Stakeholder alignment and effective communication: Successful implementation of tier-based review requires thorough stakeholder alignment, clear criteria definition for tier determination, and the cultivation of a culture of collaboration and accountability. Change management and effective communication are also essential for driving adoption and ensuring success.
Augmenting with Technology: The benefits of tier-based review are manifold, including improved workload management, increased transparency, collaboration, and ultimately, more efficient MLR cycles. By leveraging technology and automation, organizations can further enhance the effectiveness of tier-based review while retaining the value of human expertise.
Continuous Learning and Adaptation: Continuous learning and adaptation are critical for the success of tier-based review implementation. By remaining agile and responsive to evolving needs and industry trends, organizations can future-proof their MLR processes and stay ahead of the curve.
Overall, the webinar showcased the transformative potential of tier-based review in revolutionizing MLR processes. Tier-based review represents a transformative approach to MLR content review, offering organizations the flexibility, efficiency, and agility needed to navigate the complex and rapidly evolving regulatory landscape. By embracing tier-based review and its core principles, organizations can optimize their MLR processes, enhance compliance, and drive greater value across the board.
Have questions or need assistance with implementing tier-based review in your organization? Contact us today!
Do not miss the full webinar here! https://www.indegene.com/what-we-think/videos/on-demand-webinar-adapting-for-success-customizing-mlr-approval-processes