When a company sets hefty goals to deliver profound client value and create highly engaged employees, it’s not enough to communicate those goals to everyone. To be transformational, every single employee must be 100% committed to contributing to the company’s goals.
Discovery has invested in a comprehensive accountability model based on the concept that when people take personal ownership of the company’s goals and accept responsibility for their own performance, they work at a higher level to ensure their own success AND the company’s overall success.
Working with the culture management firm Partners in Leadership, Discovery has built a culture of accountability by sponsoring training workshops and holding weekly small-group huddles that let employees work on the four best practices of accountability—recognizing when there are gaps in execution, fully and personally owning responsibilities and aligning them to the company’s key results, creatively and collaboratively working on solutions, and actively executing on the solution while building an environment of trust.
“As I like to say, accountability is every Discovery employee’s best friend,” says Phil Garrison, VP of Human Resources at Discovery and the executive sponsor of the company’s accountability program. “For each of us at Discovery, the principles of accountability give us easy-to-use tools to improve our individual work performance, share honest feedback with each other, and contribute very directly to the company’s overall goals. The concepts are so foundational, they can even benefit us in our personal relationships.”
Discovery has integrated the model into many aspects of the company’s processes, onboarding, and expectations, and accountability is a cornerstone of the company’s culture. The company’s new Accountability in Action award is one example.
Each quarter, this award recognizes Discovery employees who demonstrate they have a stake in the company and go above and beyond to contribute to the company’s key results by living the “what else can I do?” attitude.
The first-ever recipient of Discovery’s new Accountability in Action award is Beverly Orwig, an MSP Recovery Specialist who has been with Discovery less than a year.
Beverly received the award—which includes a cash reward, an extra day off with pay, and other perks—for a small gesture done consistently at a challenging time for her team. When COVID-19 hit, Beverly recognized that the pandemic was causing a lot of stress for her coworkers and they were struggling to keep a positive mindset. She asked herself what else she could do to stand out, to make a difference. Beverly took it upon herself to start each morning by posting a positive message to motivate her team, help them push through the challenges, and hit their goals. Focusing on how the team was reacting to the new environment caused by COVID-19, Beverly knew that it can be very hard for people to stay engaged, stay aligned to company goals, and maintain a connection with the team. Beverly’s positive communication among the team members promoted the understanding that the team had the ability and would be able overcome obstacles.
Commenting on receiving the award, Beverly says, “I was beaming—winning made such an impact on me! It made me realize that one individual employee can make such a big difference in the company. This company empowers me every day. It’s what makes Discovery who we are—everyone pushing each other to continue the momentum, to move forward in the same direction.”
Beverly credits her supervisor Shawn Daniels with inspiring her and driving her motivation. “I never want to disappoint him,” Beverly explains. “When he sets a goal for me, well, I’m going to push to overachieve that goal. He takes a personal interest in me and my success and is consistently available to help me.”
Beverly feels she is succeeding at Discovery because of the tools and transparency that the company provides. “Discovery gives me all the tools I need and empowers me to do my job every day,” she says. If I don’t know something, there’s transparent management all the way up to the top to get questions answered. It doesn’t get better than that.”
“I want to be here…I want to come here every day. How many people can say that? I love coming to work every day.”
When she’s not demonstrating accountability at work, Beverly is a murder-mystery bookworm; enjoys Blues, jazz, and swing music; and spends weekends baking and cooking great dishes.
Discovery has built a culture of accountability throughout the company and created a quarterly award to recognize employees that have a stake in the company and go above and beyond by living the “what else can I do?” attitude.
Congratulations to Q1 2020 Accountability in Action award runners-up!
“Christine works to get the issues fixed rather than come up with temporary solutions. She is in constant contact and responds within minutes, often working late to make sure issues are resolved.”
“Chad identified ways that Discovery’s platform could better support the business. He immediately took ownership and spearheaded the development of an app in record time—in addition to his day job.”
If you’d like to learn more about the steps to accountability and building this kind of culture at your organization, we recommend the book The Oz Principle.
Discovery Health PartnersAward-winning Discovery employee proves that small acts of accountability make a big impact
The end of June marks National Subro Professionals’ Day—in honor of these experts, Discovery is celebrating the month of June by turning the spotlight on a few of our very own subrogation professionals who make a unique difference in the value we’re able to deliver to our clients.
Breanna Zima is a Subrogation Operations Manager. She is responsible for helping the Discovery Subrogation team deliver on the company’s core values, including reliable results, trusted quality, and profound client value. A member of the Discovery family for almost five years, Breanna shares with us how the COVID-19 pandemic has impacted her personally and professionally.
At the Discovery holiday party last December, my fiancé and I took a picture wearing 2020 sunglasses. I was thinking “2020 is going to be the best year yet!” We’ve been together for 12 years, have been planning our wedding for over a year, and were almost at the finish line. Little did any of us know what was in store for us right around the corner. The COVID-19 pandemic rocked everyone to the core and created obstacles most never imagined. Two weeks into the reality of the pandemic, my fiancé and I were faced with the difficult decision to postpone our wedding. We were devastated. We allowed ourselves to be sad for a time, but then picked ourselves up and focused on what we can control. My work as a Subrogation Operations Manager at Discovery has helped me navigate through these tough times.
I manage the paralegals on the recovery side who review applicable statutes, analyze case law, and negotiate resolutions that are most favorable for our clients. The commercial, Medicaid, and Medicare lines that I manage require specific skill sets and adaptability, which is especially needed during these challenging times.
Many of us don’t even realize how this pandemic has changed us as people. COVID-19 has tested my strength and ability as a leader. It has been hard to stay motivated. Not leaving your home for weeks at a time causes fatigue, pessimism, and a plethora of excuses NOT to do what we are responsible to do. What has helped me the most is staying organized and dedicated to my team members. I rely on them, and they rely on me. Period.
Back in April 2019, the Discovery Subrogation department went through the transition of moving to a remote workforce. So when the pandemic hit, I naively thought there wouldn’t be much change for us as a team. But surprisingly, our team mentality has shifted its perspective in an immensely positive way. Conversations and support among teams has greatly increased, and we now host more video calls than ever before. It is great to start our meetings with friendly, smiling faces! I try to make it a point to spend time asking everyone how they are doing, really pausing for answers, discussion, and support for one another.
Keeping our core values in mind—delivering reliable results, trusted quality, and profound value for our clients—is key for me to stay focused and positive on a daily basis. As the G.O.A.T. Michael Jordan says “If you run into a wall, don’t turn around and give up. Figure out how to climb it, go through it, or work around it.” We’ve been using the pandemic as an opportunity to focus on pending and settled files and clearing those out. With our focus on recoveries, our team’s productivity has actually improved throughout the pandemic, and that’s showing up in recoveries for our clients.
With many courts closed during the pandemic, our team has been picking up the phone and working with attorneys to resolve as many cases as we can. I’ve also been having more phone conversations with clients to add a human element to the conversations and make it more of a dialog and let them know we are here supporting them. And our offshore team has done an excellent job of reaching out to those we haven’t heard from in a while to get older files resolved.
I’ve noticed that parties are showing each other more compassion during negotiations and being more flexible. We’ve move from fax-based communications to emails so parties can negotiate back and forth more easily. We still have a lot of work to do, but I am proud to have the folks on the Subrogation team stand with me!
The pandemic has reinforced that I am a strong person and can handle whatever God places on my path, and I truly love this company and those who are a part of it. Most importantly, what keeps me going is my gratitude to have my career, a roof over my head, food on my table, and people in my life that have my back.
We cannot anticipate what the rest of 2020 has in store for us, and given the climate of our nation, all I can hope for is that love spreads and positive change marches forward for everyone. What I do know is that throughout Discovery’s history, we have found ways to build strong bonds, overcome obstacles, and stay positive. I know we will continue to do so!
To learn more about what makes Discovery’s Subrogation solution unique, visit our Subrogation page or contact our team today.
Breanna ZimaCore values help Discovery’s Subrogation team navigate the pandemic
Today’s blog post is the third in a special series of posts that celebrates the month of May as Global Employee Health and Fitness Month, the international observance of health and fitness in the workplace. Our series, titled “Mind, body, and stomach,” is the work of Jim Heffernan, senior accountant at Discovery and Employee Wellness Committee ambassador.
I do love me some food! I believe you could deep-fry just about anything and it would taste great. I know it’s not good for me, but it just tastes so good! Growing up in an Italian household probably didn’t help me learn how to make good food choices. When you are surrounded by breads and pastas and wonderful desserts, it’s not easy to pick healthier options to snack on.
Over the years, I’ve come to realize how important it is to incorporate healthier foods into my diet. Healthier foods help maintain a healthy body weight, increase proper nutrition, and promote an overall healthy body. Try some of these easy tips to improve your diet today!
Need some ideas on how to increase your intake? Add roasted veggies to your meal. Find seasonal vegetables, sprinkle with olive oil, and roast them up. Stack veggies on your sandwich. Most people already add lettuce and tomatoes, but consider slicing up a cucumber or shredding a carrot and adding it to your sandwich. Make it a lettuce wrap and swap out the bread altogether! Add fresh fruit to your cereal or oatmeal in the morning, or pair fruits with cheese and a good glass of wine for an evening treat.
Good carbs to eat
Carbohydrates are one of the body’s primary sources of energy and are an essential part of a healthy diet. A healthy diet should include more complex carbohydrates than simple carbohydrates. Complex carbohydrates are high in fiber and starch and take longer for the body to digest. They contain more essential vitamins, minerals, and antioxidants. Examples include grains, beans, and oats. Simple carbohydrates contain natural sugars easily digested by the body to provide quick energy. Examples of good simple carbs include fruits, vegetables, milk and milk products. Some examples of bad simple carbs include refined foods like soda, white sugar, and pastries. These are the items that should be a very limited part of your diet.
When you are cooking, try to use brown rice instead of white. Brown rice is a whole grain and higher in fiber than white rice, which has been processed. Brown rice also helps lower cholesterol, promotes fullness, and can help prevent blood clots. Another good carb to incorporate are vegetables, as mentioned above. Try baking a sweet potato or adding a side of roasted vegetables. You can’t go wrong with a simple side salad either—vegetable combinations are endless.
Water, water, water
Did you know that water carries nutrients to the cells in your body and oxygen to the brain? It helps the body absorb vitamins and minerals essential to the function of your organs. Water also helps regulate the body’s temperature and maintain bodily functions. It can boost skin health and lubricate joints, promoting beauty and reducing pain. Water is also a main component of the digestive system, converting food into energy and excreting waste from the body.
You might be thinking it’s boring to drink a simple glass of water. Well, it can be. But did you know there are many food options high in water content? Cucumbers, tomatoes, and spinach are over 93% water. Melon, apples, and oranges are over 85% water. Besides the water consumption, these fruits and vegetables are good sources of the daily nutrients our bodies need. I bet you could grab a few off this list of top hydrating foods and toss them together to make a delicious salad or fruit plate!
Another way to maintain a healthy diet is to add healthy snacks to your day. Healthy snacks can increase your energy level and help you lose weight. They can improve your concentration, increase memory, and enhance awareness. Be prepared—have an assortment of healthy options available to keep you on track. Examples of healthy snacks include an apple or carrot sticks. Grab a handful of cashews. Have a bowl of cottage cheese and add some berries. Looking for additional snack ideas? Check out SnackNation’s list of healthy and filling snacks.
In addition to these tips, keep in mind it’s not always what you eat, but how! You need to get to the root of your nutritional imbalances. It’s not always where you go for lunch, but how often you go and what you choose to eat. Are you eating food too close to bedtime on a regular basis? Are weekends becoming your cheat days and causing you to binge on unhealthy foods? Mindful eating can even be as simple as looking at how quickly or slowly you eat your meals. There are many factors to look at when trying to sustain a healthy diet. Just remember, baby steps—Rome wasn’t built in a day.
Find out more about Global Employee Health and Fitness Month here.
James HeffernanFood for thought—an ingredient for good health
Today’s blog post is the second in a special series of posts that celebrates the month of May as Global Employee Health and Fitness Month, the international observance of health and fitness in the workplace. Our series, titled “Mind, body, and stomach,” is the work of Jim Heffernan, senior accountant at Discovery and ambassador of our Employee Wellness Committee.
Not everyone loves the physical cards they were dealt. Believe me, I sure don’t! But there are so many things we can do to change that. First, it starts with your mental approach. You have to get in the right mindset to change the body.
Exercise can make you feel happier. It has been shown to improve mood and decrease feelings of depression and anxiety. It helps build stronger muscles and bones, helping to reduce injuries and prevent osteoporosis later in life. Exercise can increase your energy levels and reduce feelings of fatigue. It can reduce your risk of chronic disease and improve brain function. And, obviously, it can help with weight loss. According to the CDC, many people sit at a desk all day, making us much more sedentary and leading to weight gain and other medical problems.
Just because you might be working from home, don’t have access to a gym, or don’t have all the professional equipment doesn’t mean you can’t get a good workout. Sometimes you just have to be a bit creative. Here are some creative workout ideas that might inspire you.
Sounds very easy—and it is. Grab your favorite shoes and go for a walk. You might even want to invite a friend along so you can encourage each other. Walking can improve your mood and reduce anger and hostility. It will help you burn calories and is one of the best low-impact ways to change your body composition. Walking can boost your immunity and reduce your risk of disease.
Resistance training is a physical activity that is designed to improve your muscular fitness and endurance. Usually this training incorporates weights or tension bands into the workout. But let’s say you don’t have access to weights or bands—then what are your options? Try doing exercises that utilize your own body weight. Try push ups, sit ups, jumping jacks, squats. You can even do exercises while holding household items. One good exercise to strengthen your core is planking. Planking engages many muscles across the whole body to improve posture, increase muscle definition, and improve balance. There are always opportunities when at home to get a good workout. Check out this article for additional workout tips.
Yoga and Pilates
Yoga is a form of exercise that focuses on breath control, simple meditation, and body posturing for improved health and relaxation. Its purpose is to bring the body, mind, and environment into harmony. Some benefits of yoga include increased flexibility, muscle strength, and improved respiration. Check out this beginner-level yoga workout.
Pilates consists of low-impact flexibility and muscular strength and endurance movements. Its purpose is to increase muscle strength, particularly in the abdomen or core. Some benefits include a total-body workout, improved posture, and decreased pressure on your knees and joints. Check out this beginner-level Pilates workout.
Extra creative workout ideas
Do you like to dance? Even if you don’t, try putting on some fun music and dance like nobody’s watching. It’s a great way to get your heart rate up, burn calories, and improve muscle tone. Or try boxing/kickboxing. You can take a class or just set up a weighted bag in your house and throw some punches. It’s my favorite way to relieve stress! How about housework? I’m not a fan of cleaning the house, but adding some loud music can make it fun and help burn some extra calories. If these ideas don’t appeal to you, you can find all kinds of free workout videos online. Find one you like and try it!
Incorporating exercise into your daily routine does not have to be difficult or time-consuming. You don’t have to spends hours in a gym lifting huge weights to improve your overall appearance. You just have to find something you are interested in and stick to it. Make your workouts fun and change them up as needed. Set goals, encourage yourself, and achieve them. In time, you will see a difference, feel better, and—most importantly—improve your overall health.
Find out more about Global Employee Health and Fitness Month here.
James HeffernanThe body issue—because we all have one
FierceHealthPayer features an article by Jeff Martin, Vice President of Eligibility Operations at Discovery Health Partners. The article highlights the importance of making sure MA plans receive the revenue they deserve in order to ensure a stable financial picture during the COVID-19 pandemic.
Today’s blog post is the first in a special series that celebrates the month of May as Global Employee Health and Fitness Month, the international observance of health and fitness in the workplace. Our series, titled “Mind, body, and stomach,” is the work of Jim Heffernan, senior accountant at Discovery and Employee Wellness Committee ambassador.
An accountant by trade, I’ve been working on Discovery’s Finance team for over two years and have been in this profession for over 20. One thing I’ve found to be true—accounting and creativity are not a good mix on the job. It’s not a good idea to get “creative” with a company’s finances—it’ll usually land you on the front page of the Wall Street Journal for all the wrong reasons.
In order to express my creative side, several years ago I decided to sign up for an improv acting class to channel my creativity. I found this outlet to be more than just learning improv; it allowed me to be creative and confident with my comedy and found a whole new community to work with. In turn, I formed an improv comedy troupe and have enjoyed creating laughter ever since.
What I’ve learned first-hand over the years is that laughter is a very important part of health and wellness.
“A day without laughter is a day wasted.”
When was the last time you laughed so hard you cried? How did you feel after that bout of hysterical insanity? I bet it felt great. There are medical reasons for this feeling. It has been proven that laughter improves your heart, lungs, and muscles due to an increase in oxygen intake. Also, laughter can relieve stress and help you deal with difficult situations. When you laugh, the body releases endorphins, which are the body’s natural feel-good chemical. These endorphins lighten your mood and possibly help you live a longer life.1 Laughter is also linked to burning calories. And believe me, I’ll take a good laugh-until-you-cry moment over exercise any day!
We all need to increase our opportunities to laugh these days, especially while working from home due to COVID-19. With limited social interactions, finding the right way to express ourselves becomes more difficult. We need to find those outlets for laughter to continue to improve our well-being and keep ourselves interested and engaged. Here are a few ideas that can help bring some laughter into your otherwise ordinary day.
Fun with children
There was a whole television show based around kids saying the darnedest things! It’s very true. Sit down with your kids and tell funny stories and jokes. Pull out games or puzzles and play together. Suggest something crazy like an obstacle course through the house or dressing up in crazy outfits. You’ll be shocked how much you laugh and, in turn, your child will laugh with you. It’s important to take the time to have fun as a family.
Fun with pets
Laughter is an important part of human interactions. When you live alone with a pet, you tend to treat your pet as your companion, and he can provoke laughter in you. Think about it this way, if you talk to Fido, why wouldn’t you laugh with him, too? Get down on the floor and play tug-of-war or throw a ball. I bet you laugh. People tend to laugh when they see a dog fail at catching a ball or do something unexpected like jumping on the ball. This surely will bring a smile to your face.
Fun with co-workers and friends
Humor is a social activity. That’s why you laugh more watching a movie in a theater full of people rather than alone in your house. Reach out to your co-workers or friends. Schedule a meeting for lunch and share some of the funny things that have happened to you or your family—you may be surprised how happy this will make you. Nowadays, you can do almost anything virtually, from playing games to happy hours. You just have to find the right platform and enjoy the fun.
It’s important to find opportunities that work for you based on your individual style. There are many multimedia platforms, ranging from television shows and movies to online videos to visiting a comedy club. During this time, there are many comedy clubs that are offering online performances and classes you can take. Check your local neighborhood listings for these opportunities.
There are literally hundreds of possibilities for increasing laughter in your life. You need to find what’s funny to you. It can be as easy as finding some simple items like comic strips or funny photos—put them on your refrigerator, add funny quotes to your home office, watch your favorite funny movies, or listen to comical podcasts when you need a humor boost. I think it’s safe to say that we are all experiencing a certain degree of new stress these days. Find a way to laugh about your own situation and give yourself the permission to laugh at yourself! Feel the stress melt away. Make it a habit to find the funny every day and improve your overall well-being.
Find out more about Global Employee Health and Fitness Month here.
COVID-19 roundtable: Helping you get payment integrity done
What you can expect from this webinar
The COVID-19 pandemic has quickly and drastically changed the way we’re living and working these days. This webinar helps health plans solve payment integrity operational challenges associated with the COVID-19 pandemic.
Learn more about working from home, security infrastructure, and productivity
Gain insights from Discovery’s own experience transforming to a remote workforce company over a year ago
Use the quick form on the right to view the webinar on-demand.
Discovery’s accountability culture motivates employees to work at a higher level for their own success and help the company achieve its key results. The Accountability in Action award has been given to Beverly Orwig, MSP Recovery Specialist.
Discovery’s Wellness Committee ambassador Jim Heffernan shares healthy snack alternatives in the third post of this special series to celebrate the month of May as Global Employee Health and Fitness Month.
Discovery’s Wellness Committee ambassador combats workout excuses that come with working from home in the second of a special series of posts to celebrate the month of May as Global Employee Health and Fitness Month.
In the pre-coronavirus world, companies moving to a remote workforce could take months to develop and implement their plans. But the sudden onset of COVID-19 gave companies very little lead time to figure out how to set up and support employees to work from home. With no time for formal training, many organizations have been left wondering how they would help their employees stay motivated and productive in this new way of working.
Discovery moved to a remote workforce model over a year ago and has gained a wealth of work-from-home expertise. Hoping to help other organizations thrive in this new remote world, we’re sharing some best practices based on what we learned.
1. Culture eats strategy for breakfast
Often attributed to management guru Peter Drucker, this adage reminds us that a company’s culture is often the glue that binds employees together and drives the desired behaviors throughout an organization. This holds true—and perhaps becomes even more important—when the “office” is virtual. Leveraging your organization’s culture will help employees feel more connected to each other and to the company. And it’ll create a virtuous cycle—the more you reinforce your culture, the stronger it’ll get. Is cross-functional team collaboration an important part of your culture? Use regular recurring meetings and communications—weekly emails from the CEO, monthly company meetings—to showcase how your teams are working collaboratively.
2. Effective managers manage, wherever their employees are
Whether employees are in a physical office or working from home offices, effective managers are the ones who use the right combination of motivation, monitoring, and feedback to keep their teams productive and engaged. When faced with the need to manage their teams remotely, some managers may require more support than others. It can’t be overstated how important it is to invest in helping managers be effective—the ROI is huge. Tap into your highly-effective managers as resources to help build up other managers’ skills. Conduct regular meetings and trainings to reinforce best practices and develop management skills. When the pandemic hit, Discovery pivoted from monthly people manager meetings to weekly check-ins. This allows people managers to problem-solve the new COVID-19-related challenges their teams may be experiencing.
3. Make your expectations clear and water what you want to grow
Pandemic or no pandemic, a key to a company’s ability to reach its goals has always been setting clear expectations and ensuring that all employees understand those expectations. Clear expectations act as a connecting force throughout your team and organization, creating alignment so everyone is working together to make the right things happen. At Discovery, we’ve defined our expectations through our five Core Values—Trusted Quality, Reliable Results, Applied Innovation, Mindful Stewardship, and Profound Client Value. These values guide every single employee’s decisions and actions.
Being clear with expectations must be coupled with holding ourselves and others accountable. Team and company leads need to proactively manage their processes in order to get the results they expect. Water what you want to grow—reinforce accountability, reward positive behaviors, celebrate employees who demonstrate their commitment to goals. When employees are remote, it’s critically important to do these things in a way that others can “see.” Discovery uses an online “Impressions” portal for giving and receiving kudos to employees who demonstrate behaviors consistent with our expectations. Everyone in the company can see who’s living our Core Values.
4. Trust…and verify
If you’ve clearly set expectations and are holding people accountable, then you’re well on your way to mastering this best practice. Being remote requires a good deal of trust that employees are managing their time effectively and concentrating on the right things. But you must also check in and check up. Make it a priority to connect with team members on a regular basis so they know you want to stay connected to what they’re working on. This also gives you an opportunity to ensure every team member has what they need to do their job effectively. Use a combination of instant messaging, video conferencing, email, phone, texts, or whatever works best for you and your team to be available and responsive when questions come up. Remember to also check in with employees frequently just to ask how it’s going.
5. Flexibility is free productivity…and free employee engagement
Flexibility is the secret sauce for helping remote employees stay productive. Nearly everyone’s daily life has been disrupted by social distancing, work furloughs, school closings, and other changes. Managers can help remote employees stay on task by working with them to establish schedules, processes, and timelines that balance individual needs with those of your team. Even a small accommodation like moving a meeting by 15 minutes can make a big difference. And remember, life at home still goes on even while employees are working. Learn to embrace those everyday interruptions!
6. Above all else, stay connected and communicate, communicate, communicate
Make sure your teams know what’s going on and have the information they need to do their jobs. People crave personal interaction, and working remotely can cause feelings of isolation and being cut off socially from coworkers. Carve out time during the day for your employees to connect with others. Take virtual coffee breaks or meet-up by video conference to brainstorm ideas, problem-solve, or just talk. You can even plan a virtual happy hour, virtual escape room, or other team events. It doesn’t have to be formal; be sure to lean on your employees for ideas. An unexpected benefit of working virtually is that co-workers are often more open and relaxed outside the office environment. Use this to your advantage and get to know each other on whole new level!
COVID-19 has presented some unique challenges for organizations suddenly transforming to a remote workforce, and it may take some trial and error to find the right approaches to managing in this new environment. By focusing on the things that are important at all times—culture, effective management, clear expectations, flexibility, and communication—you and your remote workforce can indeed thrive!
Please stay safe and remember we’re all in this together!
At the close of 2019, healthcare predictions echoed the challenges of years past: complex billing processes, changing regulations, and rising healthcare costs. It was no surprise that health plans would continue to tackle these long-standing issues that contribute to improper claims payments in 2020. Little did we know, though, that payers would find themselves facing these challenges in very unexpected ways amid a global pandemic.
Health plans, bracing for the full impact of COVID-19, will need to find ways to navigate the uncharted course―a course that is no longer focused primarily on cost efficiency, quality, and delivery standards. Rather, a new course is taking shape that centers on safety, performance, and demand.
Promoting safety and well-being
In response to the COVID-19 pandemic, most states have issued shelter-in-place orders, requiring non-essential businesses and staff to work from home. Health plans are now faced with either remaining open as a critical operation or moving operations to newly established remote environments. For some plans, the transition from offices to mandatory work-from-home settings can present initial challenges (e.g., operational requirements, data security). As these challenges are addressed, payers are also working with their provider partners to increase access to care while protecting providers and the community. For example, the expansion of remote care and monitoring services help support social distancing and reduce the risk of exposure to COVID-19.
Facing financial performance impacts
The total number of COVID-19 cases continues to rise, prompting healthcare associations to recommend the suspension of elective surgeries and procedures to maintain sufficient capacity to treat patients and minimize risks of exposure. As those types of claims decrease, we anticipate a spike of high-dollar inpatient claims to treat individuals affected by COVID-19. In fact, a recent analysis by S&P Global estimates a severe COVID-19 pandemic could cost U.S. health plans more than $90 billion in medical claims alone1. While several major health plans have recently pledged to waive costs associated with COVID-19 treatment, we can expect these costs will cause health plans to experience significant financial stress.
To offset these great costs, we recommend health plans with large Medicare populations to look to other areas to positively impact revenue. For example, Premium Restoration (the recovery and protection of premium revenue) is one way to maximize financial performance in 2020 while not disrupting COVID-19 initiatives.
Increasing demands on healthcare organizations
It’s no surprise that as COVID-19 cases continue to grow, so are claims for testing and treatment and, more importantly, high-dollar inpatient stays. To this end, the Centers for Medicare & Medicaid Services (CMS) has issued new guidelines that lift restrictions and offer more flexible coverage options (e.g., tele-health). The American Medical Association (AMA) has also provided special coding advice to help healthcare professionals during the COVID-19 public health emergency. And in an effort to help ease the strain the pandemic is creating for healthcare providers, health plans are suspending reviews on COVID-19 related claims
With so many rapidly changing policies and requests, the regulatory burden is mounting for both health plans and providers alike. It will be more important than ever to make sure your plan has the correct member eligibility to avoid months of catch-up. Given these uncertain times, we highly recommend plans have a strong coordination of benefits (COB) program in place to ensure accurate and updated eligibility data while driving future cost avoidance.
Medicare Advantage enrollment and the number of confirmed COVID-19 cases are on the rise. According to the Centers for Disease Control and Prevention (CDC), older adults and individuals who have health conditions like heart, lung, or kidney disease may be at a higher risk for complications.
Your Medicare Advantage plan relies on the Centers for Medicare and Medicaid (CMS) for information regarding other health insurance and certain health conditions. When this information contains errors, it affects your bottom line. For many Medicare Advantage plans, the losses can be more than they realize.
What can your Medicare Advantage plan do to maximize its financial performance during these challenging times?
You can begin to recover the premium dollars owed to your health plan by performing a retrospective review of eligibility data. Going back seven years, you can review your monthly membership report (MMR) files to look for indications that the health plan is owed additional premium reimbursement for certain members.
What are the top reasons for missed premium restoration cues?
There are several cues that a plan may miss when it comes to premium restoration:
Incomplete data aggregation from the plan’s IT department
Inaccurate member questionnaire data
Section 111 reporting inaccuracies by commercial plans
Inability to completely or accurately validate a member’s other insurance
ECRS Web rejections that should actually result in premium reimbursements
Finding the causes of these missed cues can be difficult. Would you even know if your IT department is sending you incomplete data? What if you cannot get another insurer to validate eligibility information for a member? If CMS denies a seemingly legitimate eligibility update, do you know how to overturn that?
How Discovery can help
Discovery Health Partners can strengthen your premium integrity efforts by taking a closer look at Medicare Secondary Payer (MSP) validation and members with end-stage renal disease (ESRD). A recent analysis by S&P Global Ratings states that COVID-19 will end up costing U.S. health insurers more than $90 billion in medical claims.1 More than ever, it is important for plans to chart a course for transformative action that not only protects their premium revenue but also protects their workforce. With more individuals working from home and being allocated to support critical COVID-19 initiatives, Discovery is ready to continue working diligently on behalf of our health plan clients to identify eligibility issues and premium reductions.
We have helped clients restore millions with our Medicare Secondary Payer Validation solution:
$2.1 million for a 20,000-member regional plan
$16 million for a 30,000-member Midwest plan
$5.7 million for a 200,000-member Blues plan
In addition, our ESRD Premium Restoration solution has helped clients restore:
$6.5 million for a 160,000-member Medicare Advantage plan across a two-year engagement
$4 million for a 230,000-member Medicare Advantage plan seven months after implementation
$3 million for a 100,000-member Medicare Advantage plan in 12 months
The amount of potential restoration opportunity is a function of four parameters:
Successful validation of inaccurate records
Number of months of restoration opportunity for each incorrect record
Average monthly restoration amount
CMS acceptance rate of corrections submitted
Contact Discovery Health Partners today to find out how we can help you with your premium restoration efforts as your health plan navigates the impact of COVID-19.
Access the latest COVID-19 information and guidelines from CMS.