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.

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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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Subrogation: 3 ways SaaS can help

For many health plans, the challenges associated with subrogation―the process of recovering healthcare claim payments that are a third-party’s responsibility―are significant. Outdated identification methods, potential member abrasion, slow validation processes, and marginal settlement rates all impact your ability to appropriately contain and recover costs.

How can you overcome these challenges and maximize recoveries in less time and at a lower cost? Software-as-a-Service (SaaS) applications are a way to enhance your subrogation programs and recoveries. Plans are finding that the combined power of transformative technology and in-house expertise facilitates a more effective, data-driven approach for finding and validating recovery opportunities with minimal member abrasion.

With this in mind, here are three simple but powerful ways SaaS solutions can help you optimize your subrogation operations:

#1: Make in-house recovery management more efficient and insightful

The power of automation allows health plans to do more with less. Built-in algorithms, advanced data-mining techniques, and machine learning work to effortlessly manage cases and shorten the information gathering process. Reporting and analysis give instant and sharable views into recovery efforts. Combine these solutions with user-defined customization options that can be tailored to your needs, and the once burdensome task of subrogation becomes a breeze.

#2: Gain accessible, easy-to-use, highly scalable, and secure solutions

With SaaS, there’s no need for rigorous installs or startups. The system can scale drastically and on-demand, depending on your organization’s needs. Most importantly, the security and fail-safe measures in place not only guarantee continued operations in an emergency, but also consistently ensure that HIPAA and HITRUST CSF® certification requirements are met.

#3: Do more at a lower cost

With the advent of cloud technology, SaaS offers a significant boost to the bottom line for any business. Every application can be accessed from a simple desktop, and processes have been streamlined to make it as painless as possible. Regular, non-disruptive system enhancements work to improve your solutions as well, so your recovery efforts—and your business—continually evolve without interruption.

In a highly competitive marketplace where claims accuracy and cost containment are paramount, SaaS applications can empower your plan with improved efficiencies and productivity―facilitating more accurate payment decisions and generating greater recoveries.

To learn more about the benefits of SaaS applications for subrogation, download our white paper or visit our Subrogation solutions page.

Heather RodemannSubrogation: 3 ways SaaS can help
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Case study: How Discovery is increasing healthcare subrogation recoveries

How Discovery is increasing healthcare subrogation recoveries

To view this case study, please use the quick form on the right.

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.

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3 bad habits that are good for healthcare subrogation

When it comes to getting better results from subrogation, forget everything you ever learned in kindergarten! Being unfair is…well, unfair; ignoring people is bad; and being pushy is rude.

But adopting a few “bad” habits actually can make your subrogation program stronger to drive better financial results and member feedback.

1. Be unfair

Not all subrogation cases are equal, so let’s not treat them that way. Some cases are worthy of more time and energy than others, so let’s find new and better ways to identify the right cases and use the most advanced methods to pursue them.

First, you have to be as certain as possible that a case has subrogation potential and this starts with the identification phase of your subrogation process.

For too long, the practice was to cast a wide net when looking for cases to subrogate. Anything that looked like a car accident or a slip-and-fall case ended up in the “verification” bucket. The problem with this “wide net” approach is that it funnels too many false positives into the process. Devoting time and resources to a case that has no recovery potential ties up your staff (which costs you time and money) and creates undue stress on members.

The last decade has seen advances in information science and technology that have allowed subrogators to more precisely identify cases that actually have third-party liability and can be expected to reach a settlement.

You can now mine claims data for details such as diagnosis codes and demographic data that signal a subrogatable case. In fact, ICD-10, which came out in 2015, has been beneficial for companies using data mining to zero in on claims with greater likelihood of having subrogation potential. Many health plans and vendors have adopted these techniques, which have allowed them to reduce false positives so they can use resources more efficiently and cost-effectively, while improving settlement ratios.

Recent years have seen the most aggressive health plans and vendors (including yours truly) begin to experiment with technologies that fall into the category of artificial intelligence, machine learning, and predictive analytics.

These emerging technologies allow us to build upon the improvements of the last decade by learning from subrogation results and automatically applying those learnings back into the case identification algorithms to become even more precise.

2. Ignore your members

Well, not really. But as you pursue the big business of subrogation for your health plan, keep an even bigger focus on your members’ experience. Remember that your members come first above all.

It has become clear to all of us in this business that we need to find more ways to verify the causes of injury and rely less on calling and mailing members repeatedly.  The first line of defense for your members is the identification process (described in #1 above), which allows you to more accurately identify cases that actually have third-party liability. With this smaller net, you minimize false positives, which as a matter of course, reduces unnecessary outreach to those members.

Additionally, you can take advantage of external liability databases and other third-party data services to augment your detection methods and further minimize member outreach. One use case for this type of service is medical malpractice and personal injury claims, which can be difficult to find using traditional data mining techniques. These techniques can shorten the lifecycle of subrogation cases by as much as 90 days, while minimizing member outreach.

3. Be pushy

The previous two subrogation bad habits lend themselves to the third, which is to be pushy. When we’re aggressive about accurately and quickly identifying and verifying subrogation cases, we increase our chances of not only reaching settlement more quickly, but also reaching a settlement that is agreeable to us and/or our clients.  How, you ask?

Prioritize cases

One way to get more aggressive is to prioritize cases by dollar values and “push” them to staff accordingly. Obviously, a case totaling $450,000 in claims demands more attention and resources than one totaling $4,000 in claims. Yet traditionally, all cases ended up in the same pile to be worked top to bottom. In subrogation, time is money.

The faster you act on a case, the better your chances of reaching a desirable settlement. But the faster cases pile up, and the more overwhelmed the team gets, the more this idea falls by the wayside.

Case management technologies can automatically drive prioritization methods throughout your subrogation process based on rules you define. As a result, you can get the timeliest and costliest cases pushed to the top.

Similarly, case management queues can assign specific cases to recovery specialists most suited to characteristics of the case. For example, if you can identify which team members are best at negotiating with difficult attorneys, then you can automatically push cases to those specialists.

Engage legal resources at the right time

Once you make it to the settlement phase of a subrogation case, it’s important to engage with your legal resources, whether internal or external, to aggressively pursue optimal recovery for the health plan.

Though settlement is typically the shortest phase in a subrogation case, it’s also the trickiest and most involved because it’s when you start talking about limited dollars available, you have to be articulate in legal arguments, you must have a strong understanding of the plan’s rights, and you must be able to aggressively negotiate to recoup dollars on behalf of the plan.

Subrogation lawyers and paralegals who are trained to manage these types of negotiations can navigate this complicated phase to quickly optimize your settlements.

Consider subrogation prepay cost avoidance

Health plans are showing a growing interest in identifying third-party liability before paying a claim. As health plans become increasingly adept at data integration for mining and analytics (either internally or through their vendors) they have more tools to inform pre-payment decisions.

If a plan is able to coordinate a third-party liability claim with a primary payer, it can avoid the cost without engaging in subrogation methods. Due to time constraints, pre-pay subrogation may prove to be more member intensive, requiring direct outreach to identify if there is another recovery source.

In the case of subrogation, as in most payment integrity functions, pre-pay cost avoidance has to be balanced with post-pay recovery. It’s never all or nothing. Even if the decision is to pay a claim because it appears that there is no liability or no other coverage available, the claim can be pended for potential post-pay subrogation.

Summary

Now is the time for subrogators to take a fresh look at the tools and techniques they use to identify, investigate, and settle third-party liability cases. Technology-enabled subrogation is the way to go, and fortunately for everyone, newer technologies are making it more possible than ever to narrow the focus on subrogatable cases, minimize member contact, shorten time to settlement, and maximize recoveries.

Learn more on our Subrogation solutions page.

Heather Rodemann3 bad habits that are good for healthcare subrogation
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Should health plans expect more from their subrogation efforts? It’s worth a look!

Health plans have been relying on Subrogation for decades to recover healthcare claim payments that are a third party’s responsibility.  It is typically regarded as a highly manual and time-intensive process that relies heavily on member contact to verify accident and coverage details. It is not often thought of as a center of innovation.

But recent years have seen some health plans and subrogation vendors experiment with information technology and analytics to help improve the identification of claims with subrogation potential, reduce member abrasion across the subrogation process, and improve settlement rates. Should health plans expect more from their subrogation efforts? We think so and here’s why.

1. Subrogation case identification

Identifying cases with subrogation potential is a delicate balancing act. If too many cases are opened, the result will be excessive outreach to providers (e.g., for medical records) or members (e.g., for information about an accident that could be subrogatable).

The more a health plan or its representatives reach out to providers and members for cases that don’t ultimately generate value (often referred to as false positives), the more those communities get frustrated with the health plan. Additionally, this creates inefficiency, costing the health plan time and money and generating no value from it. On the flip side, if too few cases are opened, then recovery opportunities are lost.

Let’s face it—we’ll never have all the information we need to make a perfect decision about which cases to pursue for subrogation. But we do need to explore ways to gather as much information as we can to make better decisions without irritating our important constituencies or leaving money on the table.

How can we fill in the picture? By leveraging more of the data that is available today and using analytic models, we can rely less on member outreach and manual inspection, while automating and speeding up some of the decision processes. For example, what can social media tell you about your members?  What can you glean from external property and casualty databases? Can you build business rules based on past experiences and observations to generate analytics that more accurately identify cases? Can you improve these models over time as you feed back results from earlier efforts?

2. Subrogation investigation and resolution

Again, this is a typically manual process requiring outreach to providers and members for information about the case. It’s an area ripe for inefficiency and member and provider abrasion. Within this step, we have identified opportunities across four areas that could result in better results with less waste and abrasion.

  • Outreach modality: Modality refers to the optimal outreach methods for patients and providers. Would you expect that a retired, Medicare Advantage plan member in their 60s would be more likely to answer the phone in the middle of the day than a 25-year-old who is likely to be at work? Would you expect traditional outreach methods such as letters and phone calls to work as well for a younger generation fixated on texts and email?These are simple examples of how we can build models that identify the best way—and potentially the best time—to reach out to different types of members. We can incorporate these and other measures into models that help determine the best path to reach members and achieve a response.Modality in an important concept because the member response rate is key to being able to work these cases and bring them to resolution in a timely fashion.
  • Natural language processing for automated document review: Incredible advances have been made in text analytics and natural language processing (NLP), which allow us to read, comprehend, and analyze incoming correspondence (including incoming medical records) and limit the passing of that info onto your staff only when the analytics show there actually may be savings here.
  • Work prioritization: You have an inventory of cases that need to be worked—how do you decide what comes first? Traditional wisdom says to prioritize the biggest cases and the oldest cases. Today, we have the ability to build models that look at the pool of inventory each day and make that determination based on more sophisticated observations in the context of that specific inventory. We may decide to look at when a case is going to court and prioritize that differently only as the court date draws near.
  • Work assignment: Looking at an inventory of cases, we have to decide who gets which cases to work. Individual experiences cause people to have different performance on the same case. There is an opportunity to look at the collective history of employees to determine their strengths and weaknesses and then make sure they are assigned as much of what they are good at as possible.

3. Subrogation recovery

Here, we look to optimize the same four areas that we did in the investigation and resolution step. The same types of analytics that drive investigation and resolution are applicable for the recovery work, where we also need to figure out how to optimize how we assign work and in what order. As an example, we may still be doing outreach to the hospital during recovery except that it’s a different part of the hospital and we’re seeking different information—financial versus clinical. We still have to figure out the best approach and time to contact.

This applies across prioritizing and assigning work as well. The work may be slightly different, but ultimately we should be able to leverage the work done on investigative models for what we’re doing in recovery.

For most organizations, leveraging analytics to drive improvements in payment integrity is more of an evolution that a revolution. I suggest starting small with a very specific problem that you believe analytic models can help you solve. From there, learn from your failures and build upon your successes.

For more information about how to get started on building analytics into your organization, read our blog post, “5 key roles your company needs for data analytics success.”

 

 

Discovery Health PartnersShould health plans expect more from their subrogation efforts? It’s worth a look!
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Webinar: 2017 Trends in healthcare payment integrity

2017 Trends in healthcare payment integrity

The 8 trends impacting payment integrity in 2017

Managing costs is the fundamental challenge facing all health plans today, and payment integrity is at the heart of this issue.

In this exclusive webinar on demand, payment integrity experts Paul Vosters and David Grice discuss the eight major payment integrity trends that have emerged in 2017 and offer recommendations for health plans that want to capitalize on those trends.

Please use the quick form on the right to view the webinar on demand today.

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Webinar: Next-generation subrogation solutions

Next-generation subrogation solutions

How can next-generation subrogation solutions improve your plan’s performance?

Featuring Elizabeth Longo, subrogation expert and Chief Legal Officer for Discovery Health Partners

During this exclusive webinar, you’ll learn how:

  • New technologies can provide full transparency into your subrogation program
  • Powerful and flexible software can fit the way you work and deliver better results
  • Advanced data mining can pinpoint the best recovery opportunities
  • Best practices for subrogation case management and workflow
  • Real-time dashboards and reports that provide visibility
  • To build the right team for top performance

Just complete the quick survey on the right for immediate access to this exclusive discussion.

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Guide: 9 Steps to optimized healthcare payer subrogation

Guide: 9 Steps to optimized healthcare payer subrogation

A proven process for next-generation subrogation

Discovery Health Partners has developed a nine-step intelligent subrogation regimen to ensure accuracy and scientific diligence. This guide incorporates a proactive approach to recovery, with advanced security and encryption standards that exceeds HIPAA standards.

Through the use of next-generation tools, such as predictive analytics and optimized workflows, healthcare payers are able to increase recoveries with lower costs and in less time.

Discover how you can improve your subrogation results with these proven subrogation best practices. Download your complimentary copy today.

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 PartnersGuide: 9 Steps to optimized healthcare payer subrogation
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White paper: Transforming subrogation operations with data, technology, and analytics

White paper: Transforming subrogation operations with data, technology, and analytics

Three ways Software-as-a-Service improves subrogation recovery results in less time and at a lower cost

The advancement of SaaS subrogation case management technologies, along with powerful analytics, has transformed the way in-house healthcare subrogation organizations can proactively manage subrogation with more information, automation, and visibility into the whole process. This white paper explores three ways SaaS subrogation solutions enable health plans to increase recoveries in less time and at lower cost.

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 PartnersWhite paper: Transforming subrogation operations with data, technology, and analytics
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eBook: Increasing recoveries with next-generation subrogation

eBook: Increasing recoveries with next-generation subrogation

Effective strategies for increasing your subrogation recoveries

A health plan’s successful pursuit of claim recoveries depends on an optimized subrogation process. Using the right technology and best practices for managing your plan’s subrogation program will improve your recoveries and your bottom line.

Download your copy of this exclusive eBook and learn how next-generation solutions can help your subrogation recovery:

  • Identify the best cases for recovery
  • Optimize the recovery process workflow
  • Measure and manage program performance

Just complete the quick download survey on the right for immediate access.

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 PartnerseBook: Increasing recoveries with next-generation subrogation
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