Grow Your Payment Integrity Efforts with Outsourced Vendor Management

An ideal vendor solution for growing PI departments

Building and running a payment integrity department isn’t easy – or inexpensive. There will likely be hurdles along the way, and it isn’t as if the rules around improper payments and claims management are standing still. Your new department will be handling a variety of activities involved with the payment integrity process, such as claims and denial management, recruiting qualified internal staff, regulatory compliance, and managing third-party vendors.

Outsourcing vendor management is a great strategy for a growing PI department. It frees up time, resources, and provides crucial insights into vendor performance. But often, the ability to manage vendors is overlooked when health plans consider a total payment integrity solution.

Why You Should (Probably) Outsource Vendor Management

Now more than ever, health plans are tasked with providing more value while receiving less money and fewer people to make that happen. Your organization has a lot of important work to do, and managing vendors internally sponges off already-constrained resources. To effectively manage your third-party vendors, you’ll need to track their concepts, quarterly goals, and performance. You also want to look for vendor overlap, or ways in which vendors may duplicate efforts.

Young or transitioning health plans may not have the manpower to devote to vendor management. Furthermore, health plans of all sizes that still rely on siloed, manual processes for management and analytics will find it overwhelming to effectively manage their vendors. That’s why for most health plans, it’s a good idea at some point to consider outsourcing vendor management.

Boost Your Department

Have you considered the other ways that outsourced vendor management services may benefit you? These benefits include:

1. Mitigate staffing gaps: Get coverage while you recruit and hire payment integrity experts.
2. Work around a lack of IT resources: Health plan IT departments are often consumed with enhancements to internally-developed systems or customizations for off-the-shelf on-premise claims editor solutions. It’s hard to convince them to prioritize vendor management.
3. Gain expertise: It’s difficult to justify the DIY approach when specialized expertise exists outside of the organization.
4. Access to tools: Managing vendors is difficult enough with piecemeal solutions. Outsourcing vendor management will give you access to powerful analytical and automated tools, while letting you focus on core competencies.

It doesn’t make sense to skip over the value of payment integrity initiatives because you’re caught up in staffing, training, and IT lag times. Especially not when there’s a solution for vendor management at your disposal. When you look outside of your organization for vendor management, you also access expertise. With these payment integrity experts on your side, you can make the most of your limited resources by testing out what is working with vendors and what isn’t. Once best practices and concepts have been proven, it may make sense at that point to insource target activities.

For Outsourcing to Work, Establish a Partnership

Not every outsourcing vendor solution will operate how you envision. Its success and yours depends on the level of partnership the company you work with provides. While working with the right vendor management provider does require managing your relationship with them, that process is much simpler than managing separate relationships with 10-15 third-party health plan services providers.

At ClarisHealth, we establish a partnership with our clients based on the following principles:

• Define goals and check in frequently to make sure these goals are being met.
• Act as a strategic partner, not just a company that does “stuff”. We help our clients figure out how to improve recoveries throughout their system, not just within vendors.
• Provide clear two-way communication. We establish communication expectations during project kickoff and we stick to that schedule.