Trends in healthcare coordination of benefits

A changing environment drives the reevaluation of current COB practices

 

Healthcare coordination of benefits (COB) has been a relatively unchanged process in health plans for many years, but advances in data management, analytics, cloud-based software, and digital communications are causing some interesting trends to take shape in the COB world.  These technologies, which have transformed many industries, are making their way into payment integrity processes, where health plan executives are working to address the challenges that cause inaccurate claims payments and to improve the processes that are used to identify, avoid, and recover those payments.

Inaccurate member eligibility and primacy data is often at the heart of payment issues. In fact, with multiple people and processes responsible for updating member status, it’s no wonder we don’t see more payment problems than we do. Too often, member eligibility and primacy are updated based on the narrow lens of a single person or process at a single point in time. Trying to avoid or recover claims based on this data often puts members and providers in the middle, causing abrasion and dissatisfaction. And as we know all too well, member abrasion can directly impact a health plan’s bottom line with members opting for different plans and affecting Star Ratings for Medicare Advantage plans.

As cost continues to be a core issue for health plans, it’s time to look at better ways of controlling costs, correcting payment errors, and protecting premium revenue while shielding members and providers from the fallout. Five key trends – or potential trends – are recurring topics of discussion, research, and tests among health plans and their vendors.  We recently discussed these trends in a webinar that you can watch on demand, “Coordination of benefits: how the latest trends are impacting your plan.”  The trends discussed include:

  • Momentum away from pay and pursue: As payers mature in their overall payment integrity technologies and best practices, they are working to shift more of their COB efforts to avoiding inaccurate claim payments vs. recovering them on the back end. Pre-pay cost avoidance can yield a 40% increase over recovery, so the business case speaks for itself. However, this more proactive approach requires more sophistication in areas of data integration and analytics to quickly and accurately identify claims that are not the plan’s responsibility.
  • Emergence of “matching” services: There seems to be a push among large health plans to require vendors and other health plans to leverage data matching vendors for eligibility validation. We find that this data is most useful for identifying “leads,” or potential cases of other insurance that can be further investigated. Plans can then focus their COB resources more intelligently for a better return on their efforts.
  • Attempts at using analytics: Our industry has a growing appetite to incorporate analytics into COB processes to identify members with the highest probability of other coverage.  Increasing the use of analytics throughout payment integrity generates many potential benefits, including reduced cost of COB and reduced member abrasion. While many health plans are making small steps in this area, there is still a long way to go.  Rules-based analytics can tell us, for example, that a member who is 65 should be on Medicare and we should investigate whether that is the case. But beyond that, predictive analytics and machine learning technologies can help us look at multiple factors (age, demographics, and disease categories) to more closely pinpoint members that may require COB.
  • Balancing COB efforts with risk of member and provider abrasion: Health plans are demonstrating increased frustration with traditional methods of member and provider outreach, which can result in abrasion. As a result, plans and their vendors are looking at new ways to get the information they need while communicating with constituencies on their terms. This may include using a combination of traditional communication channels as well a member and provider portals, mobility, and automation (such as using 270/271 transactions) to exchange information in more productive, cost-effective ways.
  • The need for data integration is outpacing the industry’s ability to provide it: The trend here is simply that the industry is not evolving fast enough to meet the data needs of all parties involved. Bringing together data from a variety of sources, including claims, social media, Section 111, CMS, states, providers, and much more, is necessary to support areas of eligibility, analytics, and pre-pay cost avoidance. But as an industry, we are still largely unable to sustain the high volumes of data, integrate it properly, ensure its accuracy, and access it fast enough to inform payment decisions.

To learn more about these trends and some ideas for moving forward, listen to our on-demand webinar. You can access the webinar from our web site.

Kathleen CortezTrends in healthcare coordination of benefits
read more

Webinar: The latest trends in healthcare Coordination of Benefits (COB)

The latest trends in healthcare Coordination of Benefits (COB)

How are the latest COB trends impacting your plan?

Discovery Health Partners payment integrity experts discuss the benefits and challenges of today’s COB trends. In this free webinar, we’ll discuss:

  • Why the complexity of member eligibility status makes COB more challenging than most realize
  • How the road to pre-pay cost avoidance is paved with good intentions and hidden landmines
  • The push to use data matching services to validate member eligibility
  • Ideas to minimize member abrasion in the COB process
  • Obstacles to improving data integration and automation in the COB process

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

Discovery Health PartnersWebinar: The latest trends in healthcare Coordination of Benefits (COB)
read more

Infographic: Five trends in healthcare Coordination of Benefits (COB)

Five trends in healthcare Coordination of Benefits (COB)

Take your COB program to the next level

Healthcare coordination of benefits has been a relatively unchanged process in health plans for many years, but advances in data management, analytics, cloud-based software, and digital communications are causing some interesting trends to take shape in the COB world. Health plans increasingly use this technology to improve processes that identify, avoid, and recover inaccurate claims payments.

This infographic covers the top trends impacting Coordination of Benefits today:

5 COB trends infographic - Discovery Health Partners

For more information

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

Discovery Health PartnersInfographic: Five trends in healthcare Coordination of Benefits (COB)
read more

Discovery Health Partners wins new healthcare customers

Intelligent Cost Containment Software Delivers Transparency, Control and Savings 

ITASCA, IL (September 19, 2013) – Discovery Health Partners  today announced that it has added new healthcare organizations to its client roster and expanded current customer portfolios, demonstrating demand for effective analytics-driven payment integrity solutions that reduce and contain healthcare spend.

Since January, Discovery Health Partners has won multiple new healthcare clients seeking proven solutions for healthcare subrogation, COB recovery and eligibility services.  They include Paramount Health Care, a large southern integrated health care services system, a leading mid-Atlantic health plan, and a leading western health plan.

Additionally, current client Lovelace Health Plan expanded its partnership with Discovery Health Partners with a Cost Containment Blueprint consulting engagement, which identified new opportunities for cost savings and revenue generation.  Fallon Community Health Plan, another client, extended its relationship with Discovery Health Partners to include Medicare Secondary Payer (MSP) Validation and Premium Restoration in addition to existing services provided for subrogation and COB.

“Discovery Health Partners has been a true partner in every sense for our recovery and cost avoidance programs,” said Karen Eskridge, Chief Operations Officer, Lovelace Health Plan.  “Their team has helped us to reduce erroneous claims payments and improve reporting; working together, we’ve also broken down obstacles and identified new savings opportunities we hadn’t seen before.”

Discovery Health Partners recently published the following client successes:

  • Within the first year, a mid-sized health plan with more than 230,000 members (including 30,000+ Medicare Advantage members) realized nearly $3.5 million in subrogation and COB recoveries.  By adding MSP Validation and Premium Restoration, the health plan recovered an additional $7.4 million dollars in six months. The health plan’s total two-year forecast for these services is nearly $15 million.
  • A community health plan with more than 200,000 members (including 30,000+ Medicare Advantage members) realized incremental savings of more than $2 million with Discovery Health Partners’ subrogation and COB services in seven months. The health plan expects to recover an additional $2.4 million in subrogation claims over the next six to 12 months. MSP Validation and Premium Restoration Services are expected to recover an additional $8.4 million in 2013.
  • Seeking greater transparency and the ability to respond faster to employer group reporting requests, another health plan adopted Discovery Health Partners’ cloud-based subscription software for on-demand analytics and case management tools. As a result, the health plan decreased their resources, support needs, and capital expenditures.

“Our flexible offerings, client advocacy, and leading-edge tools are highly valuable to our clients’ cost management programs,” said Paul Vosters, President and Chief Operating Officer, Discovery Health Partners. “We help clients look holistically at their cost containment efforts, and we will customize a plan and approach to meet their unique requirements. We quantify the results to show the difference we make.”

 

 

 

 

 

 

 

 

 

 

 

 

Discovery Health PartnersDiscovery Health Partners wins new healthcare customers
read more

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
read more

Laura Cohen joins Discovery Health Partners

ROLLING MEADOWS, IL (March 12, 2012) – Discovery Health Partners, a provider of cloud-based healthcare cost containment solutions, announced the addition of its newest executive management team member, Laura Cohen.  As Director, Client Advocacy and Coordination of Benefits (COB), Ms. Cohen serves as an ambassador for client engagements and manages new client onboarding and customer relations, including retention, growth, satisfaction, reporting, and business development.  Dually, Ms. Cohen oversees operations and product development for Discovery Health Partner’s COB offering.

“Laura’s extensive experience directly aligns with our priorities, which are to continue serving our growing roster of customers with excellence; further build and differentiate our COB solution; and expand the business,” said Paul Vosters, President and Chief Operating Officer of Discovery Health Partners. “Laura’s customer focus, industry knowledge, and financial savvy are a tremendous asset.”

Ms. Cohen brings a 20-year track record in health insurance customer service, business development, financial operations and administration, and profit-building. Prior to joining Discovery Health Partners, Ms. Cohen was Vice President of Operations at ACS Recovery Services, a Xerox Company. In this role, Ms. Cohen had complete responsibility for all claim overpayment identification and recovery services for large healthcare payers. Her achievements were numerable, including significant revenue and profit growth, division performance optimization, increased staff productivity. In 2009, Ms. Cohen was named Line of Business Innovator of the Year. She also earned the designation of Lean Six Sigma Champion.

Previously Ms. Cohen served in the capacity of Line of Business Controller at ACS, where she was responsible for transitioning all Primax Recoveries financial reporting, cash management, human resources, payroll and benefit functions to ACS after acquisition, and handling ongoing reporting to ACS corporate thereafter. Previous to the ACS acquisition, Ms. Cohen was Chief Financial Officer/Controller for Primax. Earlier in her career, Ms. Cohen worked at BABCO Investments as Controller/Consultant and at Advanced System Applications in various financial and accounting roles.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discovery Health PartnersLaura Cohen joins Discovery Health Partners
read more

Healthcare claim recoveries jump with Discovery Health Partners

ROLLING MEADOWS, IL (July 13, 2011) – Discovery Health Partners, a provider of cloud-based healthcare cost containment solutions, today announced that it has successfully improved claims recoveries for all customers who have implemented its Intelligent Full Service Subrogation and Overpayment solutions – even driving a recovery increase of 40%  for one customer.

Since its 2008 founding, Discovery Health Partners has broken new ground within healthcare cost containment by launching the industry’s first purely cloud-based platform that offers Subrogation, Dependent Eligibility Verification, Coordination of Benefits and Information Analytics solutions in a fully outsourced model or via SaaS (pay-as-you-go) for in-house management – or in any combination in between.

“Traditional recovery and overpayment methods are antiquated, slow, complex and opaque. Analytics and cloud computing are driving a major wave of change in healthcare cost containment, and we’re at the forefront of it,” said Paul Vosters, President and COO of Discovery Health Partners. “Greater visibility and transparency enable organizations to monitor, control and improve their programs and those of their vendors. This insight is essential for better recoveries and operational savings.”

Discovery Health Partners’ customers include national and regional health insurers, healthcare providers, and self-funded organizations such as Humana, Lovelace Health Plan, Meritor, The Mentor Network and Rush System for Health, among others.

The intelligent platform enables customers to monitor their recovery operations more closely, manage other vendors on a single platform, and even compare their recovery operations to others through industry benchmarking. Three proprietary applications – Discovery Identification℠, Discovery Case Manager℠ and Discovery Dashboard℠ — identify cases for investigation; provide start-to-finish case management tools; and offer interactive analytics for visibility into current cases, real-time and historical views, and a range of customizable reports.

Rapid scalability is an additional benefit of Discovery Health Partners’ cloud platform. Within three weeks, Discovery Health Partners successfully began processing claims for a major national health plan with five million lives. The platform also supports massive data growth as Discovery Health Partners approaches petabyte-level claims analysis.

“We’ve raised the bar for methods in healthcare and benefits cost containment,” said Vosters. “Savvy organizations today expect higher standards for transparency, advanced analytics and reporting, and flexible delivery in healthcare recovery.”

 

 

 

 

 

 

 

 

 

 

 

 

 

Discovery Health PartnersHealthcare claim recoveries jump with Discovery Health Partners
read more