Expertise from the WCRS Team
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Commonly Asked Questions
How does WCRS support health plans?
As the volume of new devices, diagnostics, and drugs continue to accelerate on an annual basis, the complexity of medical policy determinations must increase to meet the pace of innovation. This increase in volume and complexity leaves limited time to deliver quality medical policies.
WCRS delivers top-tier, cost-effective, tailored medical policy documents in a timely manner to keep pace with the needs of health plan members.
What expertise does WCRS possess to deliver complex medical policies?
WCRS created a unique combination of expertise to address the wide scope of medical policy determinations required on an annual basis. The experienced WCRS team of trained specialists include:
- Communication Experts
- Medical Coders (proficient in CPT, HCPCS, and ICD-10-CM/PCS)
- Medical Directors
- Medical Librarians
- Medical Reviewers (trained in over 70 specialties)
- Medical Writers
- Policy Writers
WCRS’ team covers over 500+ policy topics annually, represents a 99% publication rate, and has years of experience with Payers and prominent evidence-based clinical decision companies.
What services do you offer?
WCRS effectively updates clinical policy documents in real-time through three comprehensive steps:
- Assessment: WCRS’ advanced algorithm and a team of trained multidisciplinary specialists evaluate existing policies to propose a customized approach to maximize quality and efficiencies. Additionally, WCRS offers a peer coverage analysis detailing the coverage determinations for plans whose coverage decisions may affect your regional/national market.
- Determination: WCRS’ policy writers and medical reviewers review existing evidence and synthesize policy updates based on enhanced epidemiological review and the evidence-based modified Delphi approach.
Publication: WCRS polishes your updated policy documents according to evidence-based natural language process and verification practices to ensure comprehensiveness and completeness.
How does WCRS’ algorithm classify existing policies?
WCRS’ algorithm evaluates and assigns a numeric score to each policy document according to how well the policy reports updated information used to determine coverage. This approach allows WCRS to make observations to the effectiveness of existing policies relative to current literature.
What is an Epidemiological Review?
Epidemiologic information is used as a framework for decision making by health officials responsible for policy development, implementation and evaluation. Our epidemiologists use descriptive epidemiology to analyze policies as they affect member populations and, when available, analyze comparison groups to fully understand and evaluate coverage.
What makes evidence outdated or redundant?
Evidence become outdated or redundant primarily when new, more comprehensive evidence becomes available. This could occur when several randomized controlled trials are replaced with a Cochrane review that analyzes these studies as a whole and produces meta-analyses that review evidence across these trials. However, some studies, such as Pivotal trails, may not be considered outdated if they are the first-to-ground in a therapeutic or diagnostic area. Ultimately, having a team that is well-versed in the body of literature is necessary to determine which trials should stay or should be retired as outdated or redundant.
How are new sections added if they weren’t previously included in a policy?
WCRS works with each Plan to ensure their policy documents are consistent with current literature. In particular, WCRS environmental scan continuously evaluates the need for updates prior to the annual cycle. In addition, WCRS evaluates the health plan policy in comparison to other local health plans to determine differences within the same geographic market.
Do Plans have any control over the template of their policy documents?
Yes. In the first month of the working relationship, the WCRS team works with Plans to understand their template and creates a customized Style Guide according to the Plan’s policy guidelines.
Are there any deadlines I should be aware of?
There are two main deadlines to consider:
- 1st week of each month – WRCS provides updated policies with notes from the review team with potential implications to a Plan’s coverage determination. Plans are to review the updates and notes upon receipt.
- 3rd week of each month – Plans are to provide WCRS modified policy documents that have been edited over the previous year and are now different from the policies received at the beginning of the working relationship or each calendar year.
What is the payment structure?
WCRS’ competitive pricing allows Plans to access the highest quality policies and evidence. Our pricing structure is volume-based. In short, our pricing is tiered based on how many policies we update each year. We update a minimum of 100 policies per client each year.