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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Three ways to tackle the high cost of waste

New research published by the Journal of the American Medical Association (JAMA) estimates that 25% of U.S. healthcare spending, or $760 billion to $935 billion, is spent annually on waste1. According to the study, the greatest source of waste is administrative complexity, which accounts for $265.6 billion in annual waste.

Part of this administrative burden stems from a complex claims adjudication process impacted by legacy or outdated technology, a lack of clear contract or policy information, and no universal way for sharing information (e.g., member’s name, diagnosis code, etc.). These administrative challenges results in data and eligibility errors that are made throughout the claims continuum, resulting in millions of dollars in improper payments.

Life of a claim: Errors along the way

Payment Integrity continuum DiscoveryDespite the best efforts to address waste, administrative complexity in the healthcare system continues. Recent research from JAMA shows that measures to eliminate waste would result in a 25% improvement, but there’s more work to be done. Finding the root causes of errors is the most effective way to ultimately remove waste—and the high cost of it—from health plans’ payment integrity operations.

Here are three approaches to combatting the high cost of waste in your payment integrity strategy.

1. Reduce manual processes

Manual processes are often at the heart of human error. Manual processes are tedious, error-prone, and inefficient, contributing to the high cost of waste in healthcare. When your entire claims adjudication or payment integrity process contains manual tasks, the likelihood of error is high. Reducing or eliminating manual effort in your payment integrity processes will go a long way toward reducing waste.

2. Use technology to your advantage

Technology plays a key role in taking out waste from the payment integrity process. But outdated or legacy technology can create just as much waste as you might find with manual processes. With the right technology in place, you can modernize your payment integrity processes and reduce the amount of time and effort associated with correcting complex claims.

By the same token, emerging technologies like artificial intelligence and machine learning solve traditional payment integrity problems in new and innovative ways. These technologies offer analytics and predictive insights that can optimize your claims payment processes and drive data-driven decisions.

3. Look to a partner for advanced capabilities

A partner can supplement your in-house operations and offer the expertise you need to reduce waste. The right partner will bring robust capabilities that round out your core operations—capabilities like data mining techniques that prevent incorrect and unnecessary payments; industry experts who are up on the ever-changing and complex healthcare landscape; and processes that identify opportunities to correct, recover, and prevent improper payments at all points in the claims’ lifecycle.

The high cost of waste can threaten the viability of organizations throughout the healthcare ecosystem. With a holistic, connected payment integrity strategy built around these three tenets, your organization can improve operational efficiencies and achieve financial integrity by preventing improper payments—all while eliminating waste and generating meaningful results.

To learn how Discovery Health Partners can help you advance into the future of payment integrity, contact us today.

1“Waste in the US Health Care System: Estimate Costs and Potential for Savings,” JAMA, October 7, 2019.
Discovery Health PartnersThree ways to tackle the high cost of waste
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eBook: The modern guide to COB

eBook: The modern guide to COB

Manual and error-prone Coordination of Benefits processes contribute to millions of dollars in annual waste

Save time, resources, and paper with advanced technologies that can help you transition from cost recovery to cost avoidance.

Download our eBook and see how a modern COB approach can help you:

  • Increase recoveries
  • Improve cost avoidance
  • Reduce administrative costs
  • Achieve greater member and provider satisfaction

Discovery Health PartnerseBook: The modern guide to COB
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Discovery will co-present with Humana at the NASP 2019 Annual Conference

Discovery Health Partners will co-present with Humana at the NASP 2019 Annual Conference

Date:  October 27-30, 2019

Location: Gaylord National Resort & Convention Center, Washington, DC

The NASP 2019 Annual Conference features over 60 educational sessions among 9 subrogation tracks: auto, general, health, management, product liability, property, specialty, fundamentals, and workers’ compensation.

On Tuesday, October 29, at 2:00pm, Heather Rodemann, Discovery VP of Subrogation Operations, will present alongside Nicole Hepburn, Humana Subrogation and Other Third-Party Liability. The session, titled “How to Acquire and Keep Top Subrogation Talent,” will help attendees identify the soft and hard skills needed to ensure success for subrogation professionals across the spectrum of roles—from call-center employees to leaders—including potential interview questions and skill assessments. During this session, attendees will learn the keys to an onboarding training program that ensures that new hires are set up for success; find out how to drive employee engagement and job satisfaction, including employee recognition and performance incentive programs; and learn more about career pathing that increases employee retention and allows them to move up and laterally within the subrogation department.

Visit the NASP 2019 Annual Conference page to register.

Discovery Health PartnersDiscovery will co-present with Humana at the NASP 2019 Annual Conference
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2019 NHCAA Annual Training Conference

Discovery Health Partners is a proud sponsor of the NHCAA Institute for Health Care Fraud Prevention’s Annual Training Conference (ATC)

Date:  October 15-18, 2019

Location: Nashville Music City Center, Nashville, Tennessee

The NHCAA Institute for Health Care Fraud Prevention’s Annual Training Conference (ATC) is recognized as the single-most important healthcare anti-fraud event, spotlighting trends and emerging schemes.

This event brings together industry leaders from the private and public sectors to share information on best practices to detect, investigate, prosecute and prevent fraud, waste and abuse.

Visit the Discovery Health Partners team in Booth #312 at this year’s ATC to learn more about how a connected payment integrity approach can help you:

  • Dig deeper into your data with a pre- and post-payment Data Mining solution
  • Find and validate more members with other health insurance
  • Maximize recoveries from other responsible parties
  • Detect and deter billing errors
  • Reduce waste and drive revenue growth

 

Visit the NHCAA Institute for Health Care Fraud Prevention’s Annual Training Conference page to register.

Discovery Health Partners2019 NHCAA Annual Training Conference
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Case study: Coordination of Benefits (COB) for healthcare payers

Case study: Healthcare Coordination of Benefits (COB)

COB solution drives measurable cost savings and millions of dollars in recoveries for three health plans

As these three cases demonstrate, the Discovery Coordination of Benefits solution was designed specifically to address critical COB challenges, with an emphasis on flexible delivery models that support our clients’ unique requirements.

Harnessing the power of our Healthcare Analytics Platform, our COB solution enables fast and accurate identification, investigation, case management, dashboards, and analytics, as well as insourced or outsourced delivery.

Download this insightful case study today.

Discovery Health PartnersCase study: Coordination of Benefits (COB) for healthcare payers
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Cathy Eddy joins as newest member of Discovery Health Partners Strategic Advisory Board

Itasca, IL – September 17, 2019 – Discovery Health Partners today announced that Health Plan Alliance founder and former president, Cathy Eddy, has joined its Strategic Advisory Board. Discovery’s Strategic Advisory Board is charged with guiding the company in advancing its industry-leading solutions portfolio to help health plans proactively avoid costs, improve the accuracy of claims payments, and protect the erosion of premium revenue through emerging technologies, services, and best practices.

“We are thrilled to welcome Cathy to our Strategic Advisory Board,” stated Discovery CEO Jason Brown. “Her passion and leadership in the health plan industry is renown, and we consider it a privilege to have her taking an active role with Discovery as we pursue aggressive growth and innovation goals while delivering the best possible payment integrity outcomes for our customers. There are few who know the needs of provider-sponsored plans—a key customer group for us—better than Cathy. Her insights will help us to continue to align our services to these health plans’ goals.”

Cathy founded the Health Plan Alliance in 1996 (formerly HMO Alliance), an organization that helps provider-sponsored and independent health plan members be more competitive in their individual markets by sharing a broad knowledge base, identifying performance improvement methods, enabling collective purchasing, and sharing insights. Under Cathy’s leadership, the Health Plan Alliance grew to 50 members. She retired as president in April 2018. In addition to her leadership at Health Plan Alliance, Cathy has extensive advisory and speaking experience with numerous boards and health organizations.

Formed in May of 2019, current Discovery Strategic Advisory Board members include: Amanda Fox, Healthcare and Insurance Practice Partner, Spencer Stuart (retired); Michael Cotton, CEO, Providence Health Plan; and Wheeler Coleman, CEO, EC-United, and former CTO at HCSC.

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.

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Discovery Health PartnersCathy Eddy joins as newest member of Discovery Health Partners Strategic Advisory Board
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Case study – How Discovery is increasing healthcare subrogation recoveries

Case study – How Discovery is increasing healthcare subrogation recoveries

Discovery Health Partners leverages people, process, data, and technology to improve subrogation results for healthcare payers.

Discovery Health PartnersCase study – How Discovery is increasing healthcare subrogation recoveries
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Discovery: Three Subrogation client success stories

Discovery: Three Subrogation client success stories

This case study shows how Discovery generated millions in subrogation recoveries with Discovery’s analytic-driven, member-sensitive approach.

For more information

Please visit our Subrogation page or open the contact tab on the right to get in touch with a Business Development Associate.

Discovery Health PartnersDiscovery: Three Subrogation client success stories
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Overview Brochure

Overview Brochure

Our MSP Validation and Premium Restoration solution quickly and accurately validates MSP records, corrects inaccurate records, and restores underpaid premium dollars..

Discovery Health PartnersOverview Brochure
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