Discovery drives millions in recoveries for Lovelace Health Plan

Analytics-based subrogation, COB and eligibility services improve health plan’s visibility, reporting and reduction of claims payment errors

ITASCA, IL (April 28, 2014) – Discovery Health Partners’ cost containment support for New Mexico-based Lovelace Health Plan has resulted in $16 million in recoveries and revenue optimization in two years, announced the company.

A mid-sized health plan, Lovelace has realized nearly $7 million in subrogation and COB recoveries working with Discovery Health Partners. These savings are the result of improved data mining, analytics, and modernized workflow available through Discovery Health Partners’ Intelligent Cost Containment Platform, which allows quick and accurate identification of cases for recovery.

By adding Medicare Secondary Payer (MSP) validation and premium restoration – a service that helps Medicare Advantage plans quickly and accurately validate MSP records, correct inaccurate records, and restore underpaid premium dollars – Lovelace has recovered an additional $7.1 million. A majority of these restorations were found within 120 days, with future revenue optimization forecast at $4.2 million annually.

“It’s a critical time for healthcare organizations to improve efficiency and performance. Discovery Health Partners’ reporting and analytics provided greater visibility into cases and trending. We also are impressed with how well their team partnered with ours,” said Karen Eskridge, Chief Operations Officer, Lovelace Health Plan. “Since working with Discovery Health Partners, we’ve pursued new savings, recovery and cost avoidance opportunities, improving our bottom line very quickly.”

Lovelace also engaged Discovery Health Partners for a Cost Containment Blueprint consulting engagement, which identified additional opportunities for cost savings and revenue generation.

“We look holistically at every health plan client’s cost containment program. Each has its own unique challenges and requirements, which our customized plans reflect,” said Paul Vosters, President and Chief Operating Officer, Discovery Health Partners. “Time and again, our clients say they value our flexible approach, partnership, and leading-edge case management and reporting tools.”

 

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Discovery Health PartnersDiscovery drives millions in recoveries for Lovelace Health Plan
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Case Study: northeast community health plan cost containment success

DHP-CSImagine if you knew that $2 million of your company’s money was scattered across the streets outside your office. It’s a windy day, your staff is tied up at a training session, and you’re meeting with clients all afternoon. Would you let it blow away?

The truth is, health insurers all over the country are throwing away millions of dollars each year, either by not performing or underperforming critical cost containment measures, such as subrogation and coordination of benefits. See how one community health plan boosted its savings by millions in a matter of months.

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Discovery Health PartnersCase Study: northeast community health plan cost containment success
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Discovery Health Partners enhances its Coordination of Benefits solution

ROLLING MEADOWS, IL (June 27, 2012) – Discovery Health Partners, a provider of intelligent, cloud-based healthcare cost containment solutions, today announced that it has integrated Medicare Secondary Payer Validation and Medicaid State File Validation to its core Supplemental COB services – further enabling health plans to save in paid claims, avoid unnecessary cost, and improve the integrity of their eligibility files.

Medicare Secondary Payer (MSP) Validation examines open MSP records for Medicare Advantage organizations to ensure that premium revenue generation opportunities are maximized. Medicaid State Eligibility File Validation confirms the validity of other coverage information collected by the state through its mandatory reporting. Now Discovery Health Partners’ Supplemental COB services utilize all relevant information—eligibility, claims, MSP, Medicaid State Eligibility Files, Query Only (HEW) Input files, and annual COB surveys – to enhance data mining and speed the process of identification, proper coordination, recovery, and eligibility system updates.

“As costs for employee medical insurance continue to grow, more health plans are adding supplemental COB services to their cost containment strategies,” said Paul Vosters, President of Discovery Health Partners. “Up to 10% of claims have coordination potential. We have a rich history as data experts and management consultants to augment internal COB programs.”

Section 111 reporting requirements have escalated the number of open MSP occurrences for Medicare Advantage organizations. This drives an increased number of premium adjustments – many of them invalid – that negatively impact a health plan’s revenue stream. Additionally, the information Medicaid MCOs receive from the state often contains outdated and inaccurate information; it is challenging to load such data into eligibility systems without overriding recent updates with erroneous information. Medicaid State Eligibility File Validation updates eligibility files with accurate coverage information, and ensures that claims are paid timely and accurately and overpaid claims are quickly identified and recovered.

Three software-as-a-service (SaaS) applications support Discovery Health Partners’ Intelligent COB solution: Discovery Identification℠ uses sophisticated data mining to accurately identify opportunities to coordinate benefits and generate cases for investigation. Discovery Case Manager℠ manages the COB process by housing all data and activities associated with each inventoried case. Discovery Dashboard℠ provides interactive analytical features for complete transparency and customized trend and case reporting.

“Staying on top of complex COB rules is our specialty. By utilizing our expertise in COB, we free up a health plan’s resources to focus on quick and accurate claims payment,” said Laura Cohen, Director of Client Advocacy and Coordination of Benefits Operations. “Our COB solutions blend technology, process improvement and workflow automation so all health plan member populations — Commercial, Medicare, and Medicaid – will no longer lose claims payment revenue due to poor data.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discovery Health PartnersDiscovery Health Partners enhances its Coordination of Benefits solution
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