Payment integrity emerging as a top cost reduction opportunity for health plans

As cost reduction continues to take center stage in healthcare, payment integrity is in the spotlight. Increasingly, health plan executives are recognizing the power of payment integrity functions to add significant value to a health plan’s bottom line by improving the plan’s ability to recover or avoid improper claims payments and improve accuracy of premium revenue.

But, payment integrity is not always an easy landscape to navigate. Discovery Health Partners has had hundreds of conversations with health plans of every size and membership type across the country and a common theme that emerges is that while improving payment integrity is a priority, it is often one that is difficult to understand, manage, and achieve.

Over the last few months, Discovery has made a dedicated effort to understand what trends are shaping that complex payment integrity landscape. Our team of payment integrity professionals is experienced in not only identifying these trends, but also in understanding how they will impact health plans and shape financial performance and the member experience.

In a series of upcoming blog posts, Discovery will be exploring each of 2017’s payment integrity trends including:

  • Amplified focus on prepayment cost avoidance
  • Continued need for postpayment recovery
  • Heightened visibility around the importance of payment integrity with plan executives
  • Uncertainty about payment integrity performance by internal and vendor teams
  • Increased market consolidation and the impact on vendor selection
  • Growing interest in outsourcing the entire payment integrity function to a single vendor
  • Prioritization of business process outsourcing above software solutions

We also recently partnered with RISE to host a webinar on these trends. RISE, the Resource Initiative and Society for Education, is dedicated to ongoing outreach and education for health plans and providers. RISE offers complimentary webinars, white papers, a newsletter, peer user groups, and ongoing updates for plans and providers seeking the cutting-edge of healthcare information. To join RISE and stay engaged with latest information on payment integrity, please visit the RISE membership page.

The webinar, now available on demand, features Discovery President, Paul Vosters, and VP of Strategic Development, David Grice, discussing each of our trends and answering the following questions:

  • Why should your plan increase the focus on payment integrity results?
  • How can your plan be on the cutting edge of these trends?
  • How can your plan mitigate some of the risks these trends present?
  • How is the latest technology changing the way plans approach data and security?
  • How should your vendors support you as you navigate the payment integrity landscape?

Check back often as we post more information about each of these trends. You can also download our 2017 Payment Integrity Trends white paper to read more.

Paul VostersPayment integrity emerging as a top cost reduction opportunity for health plans