Technology’s role in improving claims recovery and optimizing revenue

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Cutting-edge work by Discovery Health Partners, a division of LaunchPoint, on display in Fierce Health Payer interview


At a time when health care companies are under more financial scrutiny than ever, health care payers should be looking at all angles to maximize efficiency, reduce costs, and optimize revenue. Cost containment and claims recovery is one area in which payers can make simple, yet highly effective improvements that yield surprising, positive financial impact.

Recently, FierceHealthPayer featured an interview with Karen Eskridge, chief operating officer at Lovelace Health Plan, a client of Discovery Health Partners. Eskridge reported that her organization recovered $16 million in just two years by improving cost containment and recovery operations, using technology as a key enabler.

Improvements that Eskridge points to include data mining, automated case management, and reporting and analytics. These capabilities have been deployed across her organization’s coordination of benefits, subrogation, and Medicare Secondary Payer (MSP) programs. But they also can be powerful tools in other payment integrity areas, including claims review; audit; and fraud, waste, and abuse.

Many healthcare payer organizations like Lovelace are starting to realize the value of information-driven, analytic approaches to recovery and pre-payment integrity efforts. They streamline complicated processes, improve efficiency of payment integrity activities, and provide new levels of insight and transparency. The payoff can be huge:

  • Identify more workable cases quickly and accurately. Data mining, sophisticated algorithms, and built-in business rules help identify opportunities to recover or avoid costs quickly and more accurately.
  • Streamline the recovery process. Online case management and workflow automation greatly simplifies recovery efforts. Recovery teams can manage cases with all the required documentation and information at their fingertips in one easily accessible location, drastically reducing the time required to manage each case. Centralized case management increases the productivity of existing staff.
  • Accelerate and increase recoveries. By giving your recovery teams the power to identify cases faster, pursue more workable cases, eliminate false positives, and consolidate and automate workflow/case management, you enable them to speed up the recovery process and collect more money sooner.
  • Achieve visibility and flexible reporting. Interactive analytics can quantify recovery efforts and provide detailed insight across case inventory. The increased insight helps forecast future recoveries, plan more accurately, and manage and improve metrics such as medical loss ratio.
  • Simplify compliance and audits. Information-driven solutions give health care payers ready access to a complete history of information about their payment integrity programs. This allows business stakeholders to gather required data for audits much more quickly and easily than they can collect it today.
  • Enhance provider and member relations. With standardized communications and more information readily available through a web-based platform, your recovery staff will require fewer calls and interruptions to your providers and members.

Additional information can also be found on the Medicare Secondary Payer and Eligibility Management resource pages. To read the full interview with Lovelace chief operating offer, Karen Eskridge, click here. To learn more about technology innovations in cost containment for health care payers, click here.


Rey VillarTechnology’s role in improving claims recovery and optimizing revenue
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Vulnerability of Transparency (Subrogator)

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wp-transpBy Paul Vosters

While on a U.S. tour earlier this year, the Dalai Lama addressed the topic of the pursuit of happiness. He was quoted in our local business journal as saying, “Happiness begins with honesty, which creates trust, which leads to friendship, which means happiness.” He most certain ly wasn ’t thin king of the subrogation industry when he spoke those words. But they could easily translate into an analogous statement: “Success in subrogation begins with transparency, which creates trust, which leads to closer relationships, which means more opportunity and success.” Let me explain…

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The Changing Face of Audits (Employee Benefit Advisor)

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wp-kalishBy Brian M. Kalish

A dependent eligibility audit can provide a typical ROI of nearly 15% and millions of dollars in cost savings. In this new age of health care under the Patient Protection and Affordable Care Act, most industry experts say audits will continue – and all say they will remain an important way to reduce overall health care spend….

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Four Trends Revitalizing Business Intelligence (Information-Management)

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Information Management

By John Bair

Business intelligence first emerged as a technology specialization in the mid-90s and, since then, it has evolved nonstop. But not since its early days has BI undergone such a dramatic period of innovation. Now, a series of technology advancements are converging to change how we think about BI, the ways we use data and analytics, and the role that BI plays in the enterprise. While each is important in its own right, each trend also acts as an enabler and driver, forming a virtual cycle of innovation that’s already transforming BI as we know it…

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Emerging Cloud Appliances for Business Intelligence and Data Warehousing (B-Eye Network)

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beyeBy John Bair

Could you put your enterprise data warehouse (DW) in the cloud? If you think you can’t, you’re not alone. Many businesses remain wary due to the perceived increased security risk for cloud-based data warehousing and the intensive data transfer process that it would require.

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The Unique Challenges of Cloud Data Security

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Recently the news media have covered security breaches at a number of high profile corporate networks, web services and public cloud services. In some of the events, sensitive government and customer data has been exposed by organized groups of hackers. Vulnerabilities like this don’t discriminate – they plague legacy data infrastructures as well as clouds. Nevertheless, cloud computing does present unique challenges to data security.

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On the Reliability of Cloud Computing

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Last week’s outage in AWS (Amazon Web Services) EC2 service continues to make headlines. The high visibility outage impacted many companies that depend on Amazon for either primary or overflow computing and storage services. Impacting a large number of databases, applications and sites across the web, the outage shows just how pervasive use of cloud computing has become.

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Analytics: Cloud Computing as an Equalizer

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In the past, the high cost of building enterprise analytic systems has meant that only large enterprises could afford to build sustainable enterprise analytics capabilities. In effect, this put world-class analytics out of reach for small and mid-sized enterprises that would have benefitted from the competitive edge these capabilities can provide.

Now, as cloud computing gains traction, it has become an equalizer – one that is providing vast opportunity for smaller enterprises to benefit dramatically from a caliber of analytics that previously were available only to the largest of enterprises. As cloud adoption becomes more widespread, analytics will assume an even more important role in understanding what’s happening in the business.

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Chicago Tribune: Daily deal sites’ new frontier: business customers

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Customer-vendor relationships may be of greater value than sales at this stage of trend

by Wailin Wong.

The employees at information technology consultancy Ajilitee like to keep ahead of trends and be known as pioneers. That’s why the Rolling Meadows firm conducted an experiment on deals site Groupon, offering $25,000 worth of services for $12,500.

The three-week offer was the priciest deal ever run on Groupon and marked one of the first times a merchant used the Chicago-based daily deal site to market services to businesses rather than consumers. And while the company saw a spike in traffic on its Web site, no buyers stepped forward.

“We felt like we were testing the waters, using the discount platform, which was Groupon, to get the most mileage from our experiment,” said Diann Bilderback, Ajilitee’s chief marketing officer. “But we jumped into a pool that’s still filling with water. In time, it will be possible to swim.”

Ajilitee’s foray into group-buying illustrates the challenges for an emerging group of entrepreneurs hoping to translate Groupon’s lucrative model in the business-to-business space, already populated by the likes of OfficeArrow, BizGrouper and B2Bucks.

All of them hope the same zeal for deals that has sold millions of discounted manicures and restaurant meals also can work for printer cartridges or legal services.

Gary Slack, co-founder of BizyDeal, a Chicago-based deals platform for businesses that launches Monday, said he wants his site to be an additional channel that small- and medium-size firms use to reach new customers. Slack said his platform is tailored to the specific needs of small-business owners. For example, some of the offers on his site will be open for a week or even a month because buying decisions at companies typically require more time, especially if multiple people have to sign off on big-ticket purchases.

This is a major difference from the consumer space, where the prevailing model is to offer a deal for 24 hours. But by running longer offers, providers of B2B discounts risk losing the sense of impulse that is a key factor in getting consumers to open their wallets.

“I think the basic psychological premise that has fueled Groupon in the consumer space (will) largely be there as well in the small-business space,” said Slack, who is also CEO of Slack and Co., a local B2B marketing services agency. “We do believe that for the deals to be compelling and to emotionally connect with people … discounts of 50 percent will really contribute significantly to their interest level in doing something sooner rather than later.”

For some business owners, a 50 percent discount might not be tempting enough if the overall scale of the deal is too small. This is one lesson Jordan Stewart learned when he started BIZcounts, a deals site for businesses, in August 2010. The site is on hiatus while Stewart and his team work on building more features. He plans to relaunch the platform in a few months.

“Offering a small business owner $25 off on a stack of paper is not going to get that job done,” said Stewart, who is based in Huntington Beach, Calif., and previously ran a social media consulting firm. “Is a $50 deal even worth a business owner’s time? They need more expensive products or services … a reason to go through the process. If I can save you $500 or $5,000, you’re looking at a totally different conversation.”

Slack said he wants BizyDeal to be a wide-ranging platform, offering discounts on reams of paper and rates for events at hotels or retreat facilities. He said he’s been talking to Ford Motor Co. about a deal for the Transit Connect, a compact commercial van, although nothing has been finalized.

For Desks Inc., a Chicago-based office furniture dealer, the appeal of partnering with BizyDeal was the ability to reach small businesses. Jim Ford, the company’s managing principal, said he had been mulling the idea of hiring dedicated salespeople to address that segment when he bumped into Slack at New York’s LaGuardia Airport. The two men later met up in Chicago and agreed to work together.

“As a vendor … you’re not going to make a lot of money on any one individual sale,” Ford said. “But you’re building a relationship database with companies that will hopefully grow, and you can grow with them.”

Ford said the products his company offers through BizyDeal will be items that can be sent via UPS and assembled by the buyer, such as office chairs. These restrictions cut down on shipping and labor costs that would otherwise eat into the value of the deal.

The new B2B group-buying platforms have the potential to help companies such as Desks Inc. by attracting small businesses. The big question mark is whether those buyers will become long-term customers, or whether they’re simply chasing discounts and will hop from one site to the next, as many consumers are doing with Groupon and its competitors.

Attracting the right kind of customer is a concern for John Duzansky, an account executive at Midwest Promotional Group, a Summit-based company that makes promotional products. After attending a Christmas party where many of the guests talked about buying Groupons, Duzansky started exploring the group-buying model as a possibility for his company. But he is still watching the industry and thinking about how to structure a deal.

“We sell (to) a wide variety of clients,” Duzansky said. “What you’re trying to do is reach the most-qualified, solid ones. We’ve got relationships — we’ve been dealing with people for 20 years here. That’s what we’re trying to build. I look at the (group-buying sites) as being a way to get your foot in the door. But you want to get your foot through the right doors.”

Meanwhile, Bilderback said Ajilitee remains optimistic about group-buying deals as a marketing tool.

“We’ve learned a great deal and we feel there’s a groundswell building,” she said. “This model has legs, and it’s going to become a tool of the small business and eventually the enterprise. I’m sure we’ll be participating again.”

Read the full article here>>

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Fast Company: The Mysterious Case of the $12,500 Groupon

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by David Zax.

By now you’re familiar with Groupon deals. You get a wacky, manically written email each day offering you $30 of tapas for $15 or half off a full Brazilian. Dollars saved here and there; small-time stuff for the average consumer. But what if you got an offer for a $25,000 product for $12,500?  

That’s exactly what happened last week. Rather than a local barbershop or cafe offering a deal to neighborhood customers, an IT tech consulting firm, Ajilitee, offered $25,000 worth of consulting services for $12,500.

No amount of lively copy-writing from low-paid freelancers (how Groupon fuels its daily deals copy) could make this IT deal seem sexy. Ajilitee offers either a “BI Best Practices Audit” (“choose among Data Architecture, Process Architecture, or BI Architecture”) or a “Cloud Opportunity Map” (“a five-day workshop that brings together key stakeholders to assess opportunities, potential benefits, and strategies for cloud computing adoption.”) But that, in a way, is the point. This isn’t a business-to-consumer offer; it’s a business-to-business offer, and a bold new experiment in whether Groupon’s social buying model works in the B2B world. If you understand what the offer even means, then maybe it’s for you: You can save $12,500 up until March 21, when the offer closes. Most Groupons just run for a day, but a several-week period is “still a relatively short timeframe for IT purchase decisions,” Ajilitee’s Michelle Smyth tells Fast Company. Only 10 such Groupons are available; no buys yet, says Smyth.

Even so, she adds, “Even without a single ‘buy’ via Groupon, we would feel successful if one or more organizations called to vet our offerings.” Though Ajilitee hasn’t gotten any phone calls yet from potential buyers, the company’s Diann Bilderback tells Fast Company: “We have seen an awful lot of interest from the media, which is asking the same question we are: whether these kinds of channels can be adapted to a B2B buying cycle. We’ve all seen how things begin in a consumer model, then migrate to a small business model, then eventually reach the enterprise level. We were just testing to see if we could accelerate that process.”

Groupon didn’t send out the Ajilitee offer via email. Rather, Ajilitee used Groupon Stores, a relatively new feature of the Groupon website where businesses can run deals whenever they want, online, via Groupon, without having to wait for an email to go out on their behalf (or, presumably, undergo some sort of vetting by Groupon). Groupon Stores deals only run for a week, which is why the offer is no longer available through Groupon (though is still valid directly through Ajilitee’s site; Groupon simply won’t get a cut if buyers still go for it). Groupon has become such a big name that simply having a deal affiliated in some way with the site is a potential way to earn attention for your brand. Whether that actually translates into money for either Groupon or businesses yet remains to be seen.

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