COVID-19 roundtable: Helping you get payment integrity done

Maintaining a high level of customer service and solution quality is challenging in any industry. And because our customers are in the highly-regulated market of healthcare and health insurance products, the services and outcomes we provide are under almost as much scrutiny as the plans we serve. And when you consider that many of our health plan clients are managing their own large teams of people and multiple vendors, it is increasingly important for vendors like us to deliver results quickly without a lot of babysitting. So how can a client be assured they are going to get the quality results they expect without holding their vendor’s hand the entire way through the project? Look for a vendor that has made attention to these several areas a priority:

Project management rigor

Does the vendor have a project management organization (PMO) that defines and maintains standards for project management within the organization? Even the most straight-forward implementations have many moving parts: staff to coordinate, multiple data files to integrate, and processes to align. The vendor’s PMO can manage these efforts with the goal of increasing efficiency, minimizing costs, and improving overall project delivery time and budget.

Quality management oversight

Having a quality management team involved in the oversight of projects and project quality can drive consistency of and accountability for best practices and validity of the payment integrity work as a whole.  Quality oversight applies to multiple facets of payment integrity, including process rigor, call center outreach, letter generation, and data quality to drive the right level of analytics. A model I recommend is having the quality management team led by General Counsel and/or a Chief Privacy Officer and reporting results to the executive team, board of directors, and clients.  This group should work closely with all departments to make sure quality delivery and client satisfaction are the foundation of every endeavor.

Account management bench strength

Making sure vendors have an account management group in addition to a project manager or sales contact can help ensure projects run smoothly, on time, and that client concerns are addressed effectively with the client’s best interests at heart. This single point of contact should manage all aspects of the client relationship, from implementation through execution and reporting. This includes tailoring projects to meet specific needs and acknowledges that each project and client for that vendor is unique and requires individual attention. Ideally, this team would be empowered to bring in the right subject matter experts to manage the client’s more complex  or individualized needs.

Employees: recruiting and benefits

Bringing on new clients and implementing ongoing solutions for existing clients creates constant demand to grow vendor staff. Making sure that your vendor has a system in place to properly manage and grow the recruiting team should be a priority as it can directly impact their ability to staff and execute client projects. Knowing the vendor has senior-level recruiters in place to implement creative and effective solutions to balance client needs with staff will provide clients with better service and long-term flexibility to support project peaks and staff unique project needs.

Technology power for a strong foundation

To service customers in a data-sensitive industry such as healthcare, security and HIPAA-compliance are critical. Attention to detail and procedure is crucial and the vendor’s technology should reflect an emphasis on security.  Vendor’s technology platforms should be able to provide the most secure results for customers while being able to quickly and cost-effectively scale and support client demands without compromising client expectations. HITRUST CSF is a risk- and compliance-based security framework widely adopted by the healthcare industry as the best practice framework of prescriptive and scalable security controls. I recommend asking your vendor if they are HITRUST certified, which will give you an added level of confidence in the vendor’s strength.

Thrilling clients with great results and outstanding service should always be a priority, but often vendors fall short when they don’t have the internal systems and process in place that make customer needs and outcomes a priority.  By focusing on critical client project priorities such as project management and quality, deep bench strength in account management, careful recruiting practices, and technology foundation, vendors are able to grow and scale seamlessly with their clients and meet and exceed client expectations and outcomes.