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.