Controlled Substance Monitoring Program (CSMP) by ICM
We understand you may have concerns regarding a controlled substance that you, or an employee, have been prescribed. ICM’s nurse case manager reviews pharmacy claims and performs medical necessity reviews of any prescription in this category to identify excessive utilization. This is different for each person and is reviewed in conjunction with the individual’s unique clinical scenario.
ICM’s program works closely with customers and plans to develop specific plan language to support the application of this type of controlled substance monitoring program. Details vary on the plan language adopted by the client but may include aspects such as Mandatory Case Management (MCM). If MCM is available, and once a patient has been identified as having concerning utilization, the case manager will work directly with the plan and may enroll the member in ICM’s Mandatory Case Management (MCM) program. This provides the opportunity to readdress the situation and is handled in a variety of ways. The program encourages proper medication usage and can coordinate with the treating physician to establish a treatment by a pain management clinic, explore alternative treatments, and coordinate among all treating providers. Moreover, if necessary, the program may establish a limit of one prescribing physician. This ensures there are no overlapping or conflicting medications that may prolong the overutilization of the controlled substance.
The Benefits of ICM’s Controlled Substance Monitoring Program
For Patients
- Prescription utilization is reviewed in conjunction with your unique clinical scenario, giving a full view of your current health situation. Many times, high utilization is clinically justified, and no further action is needed.
- Direct support for you, your health plan, and your providers in situations where there is a concern for developing a substance use disorder to ensure that you are set up for the best possible medical outcome.
- Coordination of alternative pain management treatment options, reducing the length of time that controlled substances may be required.
For Clients
- Identification of costly medication-seeking behaviors, reducing the risk of medication fraud.
- Identification and support for members most at risk for drug misuse, thereby lowering your workplace safety risk.
- Full customization based on each client’s unique plan design.
- Reduction of the economic burden of opioid misuse estimated to cost $78.5 billion per year.
Why Choose Innovative Care Management?
At ICM, we do healthcare differently. Our top priority has always been to give our patients and clients the best quality care at an affordable price because we believe every single member we work with deserves nothing less. Our compassionate care and non-adversarial approach are why we retain more than 97% of our client base every year.
According to the NIH, roughly 21-29% of patients prescribed opioids for chronic pain eventually misuse them, and 8-12% of people using an opioid for chronic pain develop an opioid use disorder. This has led to enormous public health, social, and economic concerns. The health of our patients and clients is our highest priority, and we aim to assist in any way we can. ICM has developed this program to support health plans looking to identify misuse of controlled substances and put plan limitations in place to support the individual in returning to the appropriate use of medications.
If you’re looking for medical management services for your health plan, you want to know you can trust your provider. ICM has been a reliable and independent organization for over 30 years now, doing our best to sincerely help each and every client. To find out how we can be of service to you, reach out today to speak with an ICM team member.
Learn More About the Controlled Substance Monitoring Program
We work with clients and patients across all 50 states, and our focus is on delivering a premium service with a compassionate approach.
Call us today to learn more about our CSMP.