Best Payment Integrity Results at The Most Optimized Cost

Integrative Audit and Recovery Solution Offers Top Value for Healthcare Payers

Many of the healthcare companies we speak with often express concern when reconciling the concept of comprehensive payment integrity with day-to-day operational stressors, such as lowering administrative costs. In fact, much debate has been had over data, released by the ACA in late 2016, that shows administrative costs have not gone down despite healthcare reform promises that they would.

How does a health plan justify the investment in technological solutions to manage audit inventory when the strain is on them to continually lower overhead costs in a drive for value-based care?

Rising Use of Technology for Cost Containment

Insight into this matter reveals that despite financial pressures, the number of health industry professionals turning to technology-based solutions for cost containment has risen. This article by Becker’s Hospital Review states, “Sixty percent of providers and 86 percent of hospitals plan to automate time-intensive, error-prone manual backend processes by the third quarter of 2017.”

The ability of technology to reduce repetitive and manual procedures is at an all-time high – and not just for healthcare providers and hospitals. This increased efficiency is to a health plan’s benefit and encourages the adoption of automated solutions for your own initiatives.

Improving recoveries hinges upon on the ability of a health plan to eliminate systemic inefficiencies. It remains imperative for cost containment departments to consider leveraging technology for Total Payment Integrity™. Resolving workflow problems, gaps in avoidance/recovery opportunity, and identifying potential areas for automation can only be had when a health plan is able realize the value of these efforts.

In our last post, we discussed strategies for resolving inefficiencies among departments tackling different aspects of payment integrity. These same strategies – which include a focus on providing interdepartmentally accessible information streams – also extend benefits to cost control.

Experts Fear Payment Integrity Issues Could Worsen

Payment integrity remains a top-tier issue as industry changes continue to complicate matters. In 2016, the MITRE Corporation – a nonprofit that conducts federally-funded research – issued a technical report titled “Government-wide Payment Integrity: New Approaches and Solutions Needed” that highlights some of these challenges.

According to the report, “Healthcare issues and demographic changes are expected to continue straining existing healthcare and age-related means-tested benefits programs. Healthcare fraud, in particular, has been increasing in recent years.”

Integrative Technology Solutions Offer Real ROI

ClarisHealth approaches comprehensive payment integrity through an integrative platform. Data indicates that users of Pareo™, our 360-degree technology solution, realize a 10x return on investment. The value that health plans find in the resulting 2-4% reduction in administrative costs and 3-5% decrease in medical expenses is unprecedented.

To answer the question posed at the beginning of this article, commercial health plans and government payers can see optimal costs from payment integrity solutions by evaluating ROI. With a 10x return on investment seen on average, a platform like Pareo™ is a solution that brings top value to health plans and allows departments to focus their efforts on other areas.