Award-winning Discovery employee proves that small acts of accountability make a big impact

When a company sets hefty goals to deliver profound client value and create highly engaged employees, it’s not enough to communicate those goals to everyone. To be transformational, every single employee must be 100% committed to contributing to the company’s goals. 

Discovery has invested in a comprehensive accountability model based on the concept that when people take personal ownership of the company’s goals and accept responsibility for their own performance, they work at a higher level to ensure their own success AND the company’s overall success. 

Working with the culture management firm Partners in Leadership, Discovery has built a culture of accountability by sponsoring training workshops and holding weekly small-group huddles that let employees work on the four best practices of accountability—recognizing when there are gaps in execution, fully and personally owning responsibilities and aligning them to the company’s key results, creatively and collaboratively working on solutions, and actively executing on the solution while building an environment of trust.

“As I like to say, accountability is every Discovery employee’s best friend,” says Phil Garrison, VP of Human Resources at Discovery and the executive sponsor of the company’s accountability program. “For each of us at Discovery, the principles of accountability give us easy-to-use tools to improve our individual work performance, share honest feedback with each other, and contribute very directly to the company’s overall goals.  The concepts are so foundational, they can even benefit us in our personal relationships.”

Discovery has integrated the model into many aspects of the company’s processes, onboarding, and expectations, and accountability is a cornerstone of the company’s culture. The company’s new Accountability in Action award is one example.

Each quarter, this award recognizes Discovery employees who demonstrate they have a stake in the company and go above and beyond to contribute to the company’s key results by living the “what else can I do?” attitude.

The first-ever recipient of Discovery’s new Accountability in Action award is Beverly Orwig, an MSP Recovery Specialist who has been with Discovery less than a year. 

Beverly received the award—which includes a cash reward, an extra day off with pay, and other perks—for a small gesture done consistently at a challenging time for her team. When COVID-19 hit, Beverly recognized that the pandemic was causing a lot of stress for her coworkers and they were struggling to keep a positive mindset. She asked herself what else she could do to stand out, to make a difference. Beverly took it upon herself to start each morning by posting a positive message to motivate her team, help them push through the challenges, and hit their goals. Focusing on how the team was reacting to the new environment caused by COVID-19, Beverly knew that it can be very hard for people to stay engaged, stay aligned to company goals, and maintain a connection with the team. Beverly’s positive communication among the team members promoted the understanding that the team had the ability and would be able overcome obstacles.

Commenting on receiving the award, Beverly says, “I was beaming—winning made such an impact on me! It made me realize that one individual employee can make such a big difference in the company. This company empowers me every day. It’s what makes Discovery who we are—everyone pushing each other to continue the momentum, to move forward in the same direction.”

Beverly credits her supervisor Shawn Daniels with inspiring her and driving her motivation. “I never want to disappoint him,” Beverly explains. “When he sets a goal for me, well, I’m going to push to overachieve that goal. He takes a personal interest in me and my success and is consistently available to help me.”

Beverly feels she is succeeding at Discovery because of the tools and transparency that the company provides. “Discovery gives me all the tools I need and empowers me to do my job every day,” she says. If I don’t know something, there’s transparent management all the way up to the top to get questions answered. It doesn’t get better than that.” 

“I want to be here…I want to come here every day. How many people can say that? I love coming to work every day.”

When she’s not demonstrating accountability at work, Beverly is a murder-mystery bookworm; enjoys Blues, jazz, and swing music; and spends weekends baking and cooking great dishes.


Discovery has built a culture of accountability throughout the company and created a quarterly award to recognize employees that have a stake in the company and go above and beyond by living the “what else can I do?” attitude.

Congratulations to Q1 2020 Accountability in Action award runners-up!

Christine Garcia, Accountability in Action award runner-up
“Christine works to get the issues fixed rather than come up with temporary solutions. She is in constant contact and responds within minutes, often working late to make sure issues are resolved.”
Chad identified ways that Discovery’s platform could better support the business. He immediately took ownership and spearheaded the development of an app in record time—in addition to his day job.

If you’d like to learn more about the steps to accountability and building this kind of culture at your organization, we recommend the book The Oz Principle.

Discovery Health PartnersAward-winning Discovery employee proves that small acts of accountability make a big impact
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Webinar: COVID-19 roundtable | Helping you get payment integrity done

COVID-19 roundtable: Helping you get payment integrity done

What you can expect from this webinar

The COVID-19 pandemic has quickly and drastically changed the way we’re living and working these days. This webinar helps health plans solve payment integrity operational challenges associated with the COVID-19 pandemic.

  • Learn more about working from home, security infrastructure, and productivity
  • Gain insights from Discovery’s own experience transforming to a remote workforce company over a year ago

Use the quick form on the right to view the webinar on-demand.

Discovery Health PartnersWebinar: COVID-19 roundtable | Helping you get payment integrity done
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Enhancing premium restoration in four steps

Today, more than 22 million seniors and people with disabilities choose a Medicare Advantage plan, and enrollment is projected to increase to an all-time high of 24.4 million this year1. Do you have insight into how much revenue your plan might be losing in underpaid premiums?

Ensuring accurate premium payments for your Medicare Advantage members requires the right people, processes, and technology to identify your potential for premium restoration. It all starts with data. By integrating data sources and viewing eligibility data holistically, you can easily identify members with the greatest propensity for inaccuracy: those requiring Medicare Secondary Payer (MSP) validation and those diagnosed with end-stage renal disease (ESRD).

Here are four steps you can take to capture underpaid premiums:

#1: Identify members with premium restoration potential

The undisputed first step in capturing underpaid premiums is identifying those members with premium restoration potential. Our experience shows that an average of 4% of Medicare Advantage members have open MSP records, and 50% of those records have premium restoration potential. By identifying members with MSP or ESRD, your plan can ensure those members are accounted for in MMRs and in payments from CMS.

#2: Improve process efficiencies

When analyzing open MSP and ESRD occurrences, your plan needs to identify and prioritize those that require investigation. By allocating scarce resources to the activities that will have the greatest impact on the bottom line, you can ensure that dollars and staff time are spent wisely and efficiently.

#3: Monitor the financial impact

As premium restoration becomes more complex and when resources are limited, sophisticated monitoring is needed to achieve the results your plan expects. With a proactive approach to monitoring premium restorations, you will want to forecast how many dollars will be added to the premium check, uncover whether you have received every month of restored premiums, and maintain an audit trail to validate the outcomes and steps taken to correct inaccuracies.

#4: Maintain ongoing premium restoration activities

Given the impact it can have on your bottom line, the premium restoration process must be maintained on an ongoing basis. By ensuring payment accuracy throughout the year, you can capitalize on significant revenue opportunities month after month, year after year.

Discovery’s data analytics combined with our deep understanding of CMS eligibility rules can help your plan unlock the hidden value in your data and collect the full value of premiums owed.

Discovery Health PartnersEnhancing premium restoration in four steps
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eBook: Restoring millions for your Medicare Advantage plan

eBook: Restoring millions for your Medicare Advantage plan

Correctly paid Medicare Advantage premiums are a critical source of revenue for many health plans

Unlock the hidden value in your data to identify root causes of errors and collect the full value of premiums owed to your plan.

Download our eBook and find out how a Premium Restoration strategy can help you:

  • Identify members with premium restoration potential
  • Improve process efficiencies
  • Monitor the financial impact
  • Maintain ongoing premium restoration activities

Discovery Health PartnerseBook: Restoring millions for your Medicare Advantage plan
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How COVID-19 trends are impacting payment integrity

At the close of 2019, healthcare predictions echoed the challenges of years past: complex billing processes, changing regulations, and rising healthcare costs. It was no surprise that health plans would continue to tackle these long-standing issues that contribute to improper claims payments in 2020. Little did we know, though, that payers would find themselves facing these challenges in very unexpected ways amid a global pandemic.

Health plans, bracing for the full impact of COVID-19, will need to find ways to navigate the uncharted course―a course that is no longer focused primarily on cost efficiency, quality, and delivery standards. Rather, a new course is taking shape that centers on safety, performance, and demand.

Promoting safety and well-being

In response to the COVID-19 pandemic, most states have issued shelter-in-place orders, requiring non-essential businesses and staff to work from home. Health plans are now faced with either remaining open as a critical operation or moving operations to newly established remote environments. For some plans, the transition from offices to mandatory work-from-home settings can present initial challenges (e.g., operational requirements, data security). As these challenges are addressed, payers are also working with their provider partners to increase access to care while protecting providers and the community. For example, the expansion of remote care and monitoring services help support social distancing and reduce the risk of exposure to COVID-19.

Facing financial performance impacts

The total number of COVID-19 cases continues to rise, prompting healthcare associations to recommend the suspension of elective surgeries and procedures to maintain sufficient capacity to treat patients and minimize risks of exposure. As those types of claims decrease, we anticipate a spike of high-dollar inpatient claims to treat individuals affected by COVID-19. In fact, a recent analysis by S&P Global estimates a severe COVID-19 pandemic could cost U.S. health plans more than $90 billion in medical claims alone1. While several major health plans have recently pledged to waive costs associated with COVID-19 treatment, we can expect these costs will cause health plans to experience significant financial stress.

To offset these great costs, we recommend health plans with large Medicare populations to look to other areas to positively impact revenue. For example, Premium Restoration (the recovery and protection of premium revenue) is one way to maximize financial performance in 2020 while not disrupting COVID-19 initiatives.

Increasing demands on healthcare organizations

It’s no surprise that as COVID-19 cases continue to grow, so are claims for testing and treatment and, more importantly, high-dollar inpatient stays. To this end, the Centers for Medicare & Medicaid Services (CMS) has issued new guidelines that lift restrictions and offer more flexible coverage options (e.g., tele-health). The American Medical Association (AMA) has also provided special coding advice to help healthcare professionals during the COVID-19 public health emergency. And in an effort to help ease the strain the pandemic is creating for healthcare providers, health plans are suspending reviews on COVID-19 related claims

With so many rapidly changing policies and requests, the regulatory burden is mounting for both health plans and providers alike. It will be more important than ever to make sure your plan has the correct member eligibility to avoid months of catch-up. Given these uncertain times, we highly recommend plans have a strong coordination of benefits (COB) program in place to ensure accurate and updated eligibility data while driving future cost avoidance.

Contact Discovery Health Partners today to find out how we can help you with your payment integrity efforts amid COVID-19.

Access the latest COVID-19 information from our COVID-19 response page.

Discovery Health PartnersHow COVID-19 trends are impacting payment integrity
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Tips for staying connected amid COVID-19

As the COVID-19 outbreak continues, Discovery Health Partners employees are grateful to work remotely to help slow the spread of the disease. Discovery implemented remote and work-from-home capabilities over a year ago, which positions us extremely well to continue to support our clients’ business with minimal to no interruptions. In fact, we’ve already seen that our business model has helped us continue to be the partner our clients need in these very trying times.

But let’s be honest. In recent days, school closures and state ‘shelter in place’ orders across the country have created additional challenges for those who must now juggle both working and learning from home. Recognizing that many are grappling with these new routines, we are providing a list of best practices Discovery employees are using to stay connected.

1. Communicate, communicate, communicate

You can still stay close with coworkers while remaining socially distant. Now more than ever, it is vital to remain transparent regarding projects and work life so that everyone is on the same page and shares the same expectations. This could mean daily brief work huddles, a quick text, more meetings, or in some cases, less meetings. Teams should come together on what will work best for them and what is needed.

2. Establish a workspace and routine

Whether you are working from home alone or with a partner or family, setting up a designated workspace and schedule will help break up the day into more manageable parts. In the office, you might start your morning by grabbing a cup of coffee or tea and prioritizing emails. Replicating that same routine at home can bring normalcy into this ‘new normal.’ If you have children who are tackling distance learning and virtual assignments, make sure they are sticking to their typical school routines (e.g., lunch, recess) as well. And more importantly, set up times to answer any questions. This will help them not only remain engaged but also establish good habits in their later years.

3. Take breaks and stay active

When working from home, it’s easy to get trapped into a mindset that you need to appear available every minute of the day. But breaks are just as important at home as they are in the office or school. Make sure to carve out some time to step away, minimize eye strain, and regroup. You can use this time to take lunch, talk with your partner and/or children, or go on a quick walk or run. You’ll find stepping away can help bring priorities into greater clarity and help you stay more productive throughout the day. And regular exercise is good medicine for both mental and physical health.

It’s hard to predict what lies ahead as the COVID-19 pandemic runs its course. And adjusting to a new routine in a new world can seem overwhelming at times. In the face of these challenges, there are opportunities to invest in connections with each other and transform the way we work. Please take care of yourself, and remember, we will get through this together.

 

Share your work-from-home tips with us on LinkedIn and Twitter.

Learn more about our response to COVID-19.

Discovery Health PartnersTips for staying connected amid COVID-19
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Infographic: Fixing payment integrity at the source

It’s a known fact that improper payments abound in healthcare. Given the effect that eligibility data can have on claims payments, a connected payment integrity approach is essential. Often, challenges arise from multiple sources of data, conflicting or inaccurate data, data integration challenges, manual workflows, multiple reporting systems, and more.

When eligibility errors occur, they affect many payment integrity areas such as coordination of benefits (COB), subrogation, and Medicare secondary payer (MSP) validation. Failing to address these issues leads to incorrectly paid claims, improper reimbursements, or claims that shouldn’t be paid at all—costing your plan millions.

Infographic: Fixing payment integrity at the source

Find out the top three causes of eligibility errors and learn how a connected payment integrity approach can help.

Discovery Health PartnersInfographic: Fixing payment integrity at the source
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Transitioning toward data-driven payment integrity solutions

Evolving payment models and new technologies are supporting health plans’ efforts to implement more proactive, data-driven payment integrity solutions. Discovery Health Partners discusses what’s in store for the future of payment integrity and how the company is helping clients make the transition from retrospective to prospective programs.  

Trends that are re-shaping payment integrity strategies

During the last decade, a number of emerging trends have impacted health plans’ ability to reduce their exposure and increase payment accuracy. Value-based contracting, for example, has left many payers struggling to figure out how to transition to the performance-based payment methodologies that center on cost efficiency, quality, and delivery standards. The changes around CMS’ reimbursement models for home health and skilled nursing can pose some challenges as provider and payers adapt to those changes and create new PI audit opportunities. Payment integrity programs can provide needed support in adapting to claims processing changes like these.

At the same time, providers themselves are evolving and making changes to their billing processes based on these new models. In order to mitigate potential payment errors, health plans are moving from a retrospective process of identification and recovery to a more cost-effective prospective approach. Through clinical audits focused on the provider type, place of service, and their reimbursement models, plans can verify that services billed were performed, ensure proper payments, and avoid the costs of recovery. Payment integrity has a role to play here. Focused payment integrity programs that take a holistic approach to claims auditing enable health plans to shift from cost recovery to prevention and cost avoidance, thereby increasing claim payment accuracy.

Helping transform payment integrity approaches

As industry needs change, Discovery has stepped up our payment integrity capabilities with the addition of new talent, technology platforms, and analytical tools. We continue to expand our core offerings, adding new services and strengthening our cost avoidance competencies to help clients address their payment integrity challenges. Furthermore, Discovery is adding resources through strategic partnerships, and last year we acquired HealthMind, which brought us core payment integrity expertise and an integrated end-to-end-payment integrity application enabled by analytics and workflow that greatly expands our pre-pay solutions portfolio. With this new platform, we are scaling our payment accuracy capabilities and portfolio and building focused solutions around urgent care, home health, skilled nursing facilities, high-cost drugs, and more to help clients shift their focus to cost avoidance while still supporting recovery operations.

Using data to evolve payment integrity approach

The healthcare industry is accelerating its adoption of cutting-edge technologies like artificial intelligence and machine learning to add efficiency and cut costs across operations, including in the payment integrity space. With the HealthMind acquisition, we’re well-positioned to support data-driven solutions and secondary code edit, provider audit, and data mining capabilities. This expands our ability to leverage analytics, artificial intelligence, and machine learning to audit millions of claims every month and find the “needle in the haystack” claims that yield the highest savings for health plans. We are also using analytics to identify patterns in client data that are specific to that provider. We can use that information to educate clients on how to address specific trends to improve their billing processes. We can also help them identify opportunities to change behaviors, so they are able to pivot to a proactive payment process.

Going into 2020 and beyond, our focus is to build on our technology foundation to provide full end-to-end payment integrity solutions for health plans that don’t have those resources in-house. We will also continue providing support for plans that have an internal payment integrity function.

Health plans are looking for a true partner who can help them support and enhance their payment integrity efforts so they can better control costs associated with incorrect billing and overpaid claims and improve administrative and medical loss ratios. With years of experience supporting both payment integrity and managed care, Discovery’s connected payment integrity approach—combined with our dedication to partnership, responsiveness, and relationships—delivers results that go far beyond financial value.

Find out how Discovery Health Partners can help strengthen your payment integrity initiatives in 2020. Contact us today!

Discovery Health PartnersTransitioning toward data-driven payment integrity solutions
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A year in review: top blogs from 2019

The new year is upon us and with it comes a new decade. It has been a decade of transformation for healthcare with regulatory changes, health system consolidation, healthcare consumerism, and new technologies that have forever changed the industry. 2019 has been a time of change and growth for Discovery Health Partners as well. Here are highlights from our most popular blogs of 2019 to remind you what we’ve been up to all year.

3 bad habits that are good for subrogation

In February, we talked about the three “bad habits” that can lead to successful subrogation: be unfair, ignore your members, and be pushy. In any other scenario, these tactics can get you into trouble. But for subrogation, being unfair requires that you not treat all cases equally. Ignoring your members is all about avoiding member abrasion. And being pushy involves aggressively identifying and verifying subrogation cases. Altogether, these tactics help improve the opportunity for quick and fair settlement of subrogation cases.

Why Medicare Advantage plans may be losing money on members with ESRD

In March, we featured a post about the challenges Medicare Advantage plans face with members with end-stage renal disease (ESRD). Though ESRD afflicts fewer than 100,000 people nationwide, the disease requires lifelong care—and a disproportionate percentage of medical expense. The blog discusses the gap in CMS premiums for ESRD members and what Medicare Advantage plans can do to better identify them.

It’s challenging to identify and restore underpaid ESRD premiums. Here’s how to solve that

Another popular blog continued the ESRD discussion, highlighting a systematic approach Medicare Advantage plans can take to restore ESRD premiums. This includes automating the process of sifting through data to identify potentially underpaid premiums and maximizing the 84 months that CMS allows plans to identify, investigate, and restore premiums. The blog identifies five key components of an effective ESRD program: analytics, investigation, remediation, restoration, and monitoring.

Subrogation: 3 ways SaaS can help

In July, we returned to the topic of subrogation with a discussion of how software-as-a-service applications can help. Plans are finding that combining SaaS applications with in-house expertise creates a more effective, data-driven approach for finding and validating subrogation recovery opportunities. Specifically, you can: 1) make in-house recovery more efficient and insightful; 2) gain accessible, easy-to-use, scalable, and secure solutions; and 3) do more at a lower cost.

Stay tuned to our blog for more insights on these topics and to see what 2020 has in store. You can also get the latest industry and Discovery updates by following us on LinkedIn and Twitter. Are you interested in learning how Discovery Health Partners can support your organization? Contact us today!

Discovery Health PartnersA year in review: top blogs from 2019
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Discovery Health Partners’ case open logic machine learning initiative receives FutureEdge 50 award from IDG

Itasca, IL – December 16, 2019 – Discovery Health Partners has been named an honoree of a 2020 FutureEdge 50 award from IDG’s CIO. This prestigious honor is given to organizations that are pushing the edge with new technologies to advance their business for the future. Discovery will accept its award at the AGENDA20 Conference held March 23 – 25 at the Sawgrass Marriott Golf Resort & Spa in Ponte Vedra Beach, Florida.

Discovery’s case open logic initiative was piloted earlier this year to test machine learning as part of its claims ranking process within its Subrogation practice. Already a leader in analytics-powered technology solutions for some of the top health payers in the country, Discovery saw an opportunity to leverage its decade of case outcomes data to fuel a subrogation model that eliminates hours of manual work, results in more accurate case identification, and reduces member friction. Discovery is implementing improvements and enhancements and intends to roll out similar machine learning capabilities to other lines of business such as Data Mining, Clinical Audit and Coordination of Benefits (COB).

“Discovery’s data science team has been blazing new trails in the payment integrity industry through advanced analytics and machine learning capabilities,” stated Discovery CIO Dan Iantorno. “Combining technology innovation with our team’s decades of experience in the health payer space is at the heart of how we deliver game-changing results for our customers.”

“The organizations in the FutureEdge 50 are doing exciting things that would have been unimaginable just a few years ago. For example, there’s a project using blockchain and quantum computing to establish trust; an indoor navigation system; and many uses of AI/ML for insights and efficiency,” said Anne McCrory, group vice president, customer experience and operations, events, and the FutureEdge and AGENDA20 conference chair. “We are honored to showcase these innovations and many others as we enter into a new era of sophistication with cloud, devices, and environments powering the technology-driven business.”

For more information about how Discovery Health Partners’ award-winning team and technologies are helping health payers solve payment integrity challenges to improve financial and member outcomes, visit www.DiscoveryHealthPartners.com.

About Discovery Health Partners

Discovery Health Partners’ mission is to deliver unique, actionable analytic insights and technology-powered solutions to help healthcare payers improve payment integrity, increase revenue optimization, and maximize efficiencies with government programs. Serving more than 70 health plans across the U.S., including six of the 10 largest U.S. health plans, Discovery has been recognized consistently for its growth—earning a spot on the Inc. 5000 list six years in a row and the Crain’s Fast 50 three times. For more information on Discovery Health Partners, go to www.DiscoveryHealthPartners.com.

About the FutureEdge 50 Awards

The FutureEdge 50 awards recognize organizations pushing the edge with new technologies to advance their business for the future. The successor to the Digital Edge 50 awards, the FutureEdge 50 will recognize not only established initiatives driving business success but also early-stage projects pursued for their watershed potential. These initiatives may be in R&D, proof of concept or pilot phases. With this, the FutureEdge 50 awards aim to bring the most cutting-edge trials and applications of emerging technologies – and the innovative cultures enabling them — to our audience at the AGENDA conference.

About CIO

CIO focuses on attracting the highest concentration of enterprise CIOs and business technology executives with unparalleled expertise on business strategy, innovation, and leadership. As organizations grow with digital transformation, CIO provides its readers with invaluable peer insights on the evolving CIO role as well as how leading IT organizations are employing technologies, including automation, AI & machine learning, data analytics and cloud, to create business value.

The award-winning CIO portfolio — CIO.com, CIO events, CIO Strategic Marketing Services, CIO Forum on LinkedIn, CIO Executive Council and CIO primary research — provides business technology leaders with analysis and insight on information technology trends and a keen understanding of IT’s role in achieving business goals. CIO is published by IDG Communications, Inc. Company information is available at www.idg.com.

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Discovery Health PartnersDiscovery Health Partners’ case open logic machine learning initiative receives FutureEdge 50 award from IDG
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