Alice* is a 50-year-old woman experiencing leg pain from a pinched nerve in her back.
Alice's primary care physician submits a prior authorization (PA) request for an MRI and refers her to a pain specialist for an epidural steroid injection.
Diagnosing Alice
The EviCore medical director initiates a proactive peer-to-peer discussion with the pain specialist to discuss Alice’s MRI results suggestive of a spinal malignancy.
Making the Right Call
Achieving Better Outcomes
As part of the review for the epidural steroid injection, the EviCore medical director reviews Alice’s MRI results and notices a possible malignancy in her spine.
Avoiding Complications
EviCore approves the PA request for the MRI, as it meets evidence-based guidelines for advanced imaging of the spine. The request for an epidural steroid injection requires further review once the MRI results are available.
Epidural steroid injections in patients with spinal malignancies can have catastrophic consequences, including paralysis and loss of bowel and bladder control.
Alice returns to the pain specialist who refers her to an oncologist because of the possible malignancy in her spine.
For patients with a painful MSK condition, EviCore’s data shows that more conservative care services reduce elective spinal surgeries. EviCore leverages evidence-based guidelines and innovative technologies to inform and expedite the most effective care decisions for each patient’s needs.
What happens next?
Will an injection help or harm?
Clnical Review
EviCore ensures procedures are in accordance with the most up-to-date literature and national guidelines to promote the most clinically appropriate and cost-effective care for each patient.
In 2022, EviCore saved more than 7,800 patients from enduring serious complications, including infections, due to unnecessary musculoskeletal (MSK) procedures.
A peer-to-peer discussion enables a patient’s physician to discuss a complex case with an EviCore medical director with experience in the same specialty. During a P2P, the doctors discuss how the clinical guidelines apply in these particular circumstances.
Peer-to-Peer (P2P) Discussion
*Not patient’s real name. Images are for illustration purposes only.
are both necessary?
The result: Better health outcomes, and lower costs for patients and payers alike.
To learn more about our solutions, visit
evicore.com
or email us at
MSK@evicore.com.
Meet Alice
