Discovery Health Partners’ case open logic machine learning initiative receives FutureEdge 50 award from IDG

Itasca, IL – December 16, 2019 – Discovery Health Partners has been named an honoree of a 2020 FutureEdge 50 award from IDG’s CIO. This prestigious honor is given to organizations that are pushing the edge with new technologies to advance their business for the future. Discovery will accept its award at the AGENDA20 Conference held March 23 – 25 at the Sawgrass Marriott Golf Resort & Spa in Ponte Vedra Beach, Florida.

Discovery’s case open logic initiative was piloted earlier this year to test machine learning as part of its claims ranking process within its Subrogation practice. Already a leader in analytics-powered technology solutions for some of the top health payers in the country, Discovery saw an opportunity to leverage its decade of case outcomes data to fuel a subrogation model that eliminates hours of manual work, results in more accurate case identification, and reduces member friction. Discovery is implementing improvements and enhancements and intends to roll out similar machine learning capabilities to other lines of business such as Data Mining, Clinical Audit and Coordination of Benefits (COB).

“Discovery’s data science team has been blazing new trails in the payment integrity industry through advanced analytics and machine learning capabilities,” stated Discovery CIO Dan Iantorno. “Combining technology innovation with our team’s decades of experience in the health payer space is at the heart of how we deliver game-changing results for our customers.”

“The organizations in the FutureEdge 50 are doing exciting things that would have been unimaginable just a few years ago. For example, there’s a project using blockchain and quantum computing to establish trust; an indoor navigation system; and many uses of AI/ML for insights and efficiency,” said Anne McCrory, group vice president, customer experience and operations, events, and the FutureEdge and AGENDA20 conference chair. “We are honored to showcase these innovations and many others as we enter into a new era of sophistication with cloud, devices, and environments powering the technology-driven business.”

For more information about how Discovery Health Partners’ award-winning team and technologies are helping health payers solve payment integrity challenges to improve financial and member outcomes, visit www.DiscoveryHealthPartners.com.

About Discovery Health Partners

Discovery Health Partners’ mission is to deliver unique, actionable analytic insights and technology-powered solutions to help healthcare payers improve payment integrity, increase revenue optimization, and maximize efficiencies with government programs. Serving more than 70 health plans across the U.S., including six of the 10 largest U.S. health plans, Discovery has been recognized consistently for its growth—earning a spot on the Inc. 5000 list six years in a row and the Crain’s Fast 50 three times. For more information on Discovery Health Partners, go to www.DiscoveryHealthPartners.com.

About the FutureEdge 50 Awards

The FutureEdge 50 awards recognize organizations pushing the edge with new technologies to advance their business for the future. The successor to the Digital Edge 50 awards, the FutureEdge 50 will recognize not only established initiatives driving business success but also early-stage projects pursued for their watershed potential. These initiatives may be in R&D, proof of concept or pilot phases. With this, the FutureEdge 50 awards aim to bring the most cutting-edge trials and applications of emerging technologies – and the innovative cultures enabling them — to our audience at the AGENDA conference.

About CIO

CIO focuses on attracting the highest concentration of enterprise CIOs and business technology executives with unparalleled expertise on business strategy, innovation, and leadership. As organizations grow with digital transformation, CIO provides its readers with invaluable peer insights on the evolving CIO role as well as how leading IT organizations are employing technologies, including automation, AI & machine learning, data analytics and cloud, to create business value.

The award-winning CIO portfolio — CIO.com, CIO events, CIO Strategic Marketing Services, CIO Forum on LinkedIn, CIO Executive Council and CIO primary research — provides business technology leaders with analysis and insight on information technology trends and a keen understanding of IT’s role in achieving business goals. CIO is published by IDG Communications, Inc. Company information is available at www.idg.com.

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Discovery Health PartnersDiscovery Health Partners’ case open logic machine learning initiative receives FutureEdge 50 award from IDG
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Three ways to tackle the high cost of waste

New research published by the Journal of the American Medical Association (JAMA) estimates that 25% of U.S. healthcare spending, or $760 billion to $935 billion, is spent annually on waste1. According to the study, the greatest source of waste is administrative complexity, which accounts for $265.6 billion in annual waste.

Part of this administrative burden stems from a complex claims adjudication process impacted by legacy or outdated technology, a lack of clear contract or policy information, and no universal way for sharing information (e.g., member’s name, diagnosis code, etc.). These administrative challenges results in data and eligibility errors that are made throughout the claims continuum, resulting in millions of dollars in improper payments.

Life of a claim: Errors along the way

Payment Integrity continuum DiscoveryDespite the best efforts to address waste, administrative complexity in the healthcare system continues. Recent research from JAMA shows that measures to eliminate waste would result in a 25% improvement, but there’s more work to be done. Finding the root causes of errors is the most effective way to ultimately remove waste—and the high cost of it—from health plans’ payment integrity operations.

Here are three approaches to combatting the high cost of waste in your payment integrity strategy.

1. Reduce manual processes

Manual processes are often at the heart of human error. Manual processes are tedious, error-prone, and inefficient, contributing to the high cost of waste in healthcare. When your entire claims adjudication or payment integrity process contains manual tasks, the likelihood of error is high. Reducing or eliminating manual effort in your payment integrity processes will go a long way toward reducing waste.

2. Use technology to your advantage

Technology plays a key role in taking out waste from the payment integrity process. But outdated or legacy technology can create just as much waste as you might find with manual processes. With the right technology in place, you can modernize your payment integrity processes and reduce the amount of time and effort associated with correcting complex claims.

By the same token, emerging technologies like artificial intelligence and machine learning solve traditional payment integrity problems in new and innovative ways. These technologies offer analytics and predictive insights that can optimize your claims payment processes and drive data-driven decisions.

3. Look to a partner for advanced capabilities

A partner can supplement your in-house operations and offer the expertise you need to reduce waste. The right partner will bring robust capabilities that round out your core operations—capabilities like data mining techniques that prevent incorrect and unnecessary payments; industry experts who are up on the ever-changing and complex healthcare landscape; and processes that identify opportunities to correct, recover, and prevent improper payments at all points in the claims’ lifecycle.

The high cost of waste can threaten the viability of organizations throughout the healthcare ecosystem. With a holistic, connected payment integrity strategy built around these three tenets, your organization can improve operational efficiencies and achieve financial integrity by preventing improper payments—all while eliminating waste and generating meaningful results.

To learn how Discovery Health Partners can help you advance into the future of payment integrity, contact us today.

1“Waste in the US Health Care System: Estimate Costs and Potential for Savings,” JAMA, October 7, 2019.
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Insights and observations on the digital healthcare revolution

At our recent Discovery Client Council meeting, we had the pleasure of hosting Wheeler Coleman, CEO and Executive Partner of EC-United and a member of our Strategic Advisory Board. In this guest blog, Wheeler summarizes the key takeaways of his presentation on the healthcare digital revolution.

Survive or thrive

The digital revolution has been a game changer for all industries, and health payers are not immune. Startup companies are creating new business models and blending existing and emerging technologies to leap-frog and disrupt well-established companies and business protocols. There are also well-established companies in other industries that are entering the healthcare industry to the same end—to change the model and dislocate the existing players.

A few good examples of this are Amazon, Google, and Microsoft. These companies see healthcare as an industry ripe for an operational and administrative transformation that they can deliver through their powerhouse of technological capabilities and expansive digital footprint. To survive, payers must take this threat seriously. They cannot take their leadership position or their iconic name for granted. Resting on their laurels will very likely result in a slow death spiral.

Look at a company like Kodak. They were a market leader with a great brand. Did you know that they created the digital camera? But they were so happy with their position that they refused to make changes and ignored the red flags:

  • Hitting a revenue plateau
  • Competing on price / no differentiation
  • Big on data and short on analysis and actionable information
  • Neglected table stakes
  • Too much pride
  • Too deep in their comfort zone

Healthcare payers need to make sure they don’t fall victim to the same pitfalls. They are enjoying large revenues now, and too many are unwilling to reconsider their business models and leverage technology to maximize efficiency.

We’ve seen how this plays out in other industries. The following well-known companies were able to leap-frog the competition and disrupt well-established businesses by creating new models and leveraging existing and emerging technology.

Uber disrupted the taxi and limousine business models and, in many markets, expanded the demand for service by leveraging GPS, e-commerce, and mobile technology.

Netflix disrupted the cable and movie industries and recently their stock increased 20 percent due to increased subscriptions. This happened when 4G was introduced and movies could be streamed to individual homes. They quickly pivoted from shipping DVDs to digitally streaming movies. The outcome has been the end of the video rental business and a cable industry trying to play catch-up.

Airbnb disrupted the hospitality market and transformed how people approach travel accommodations worldwide by allowing people to lease their homes electronically.

These three different companies in three different industries each changed the playing field and caused disruption by using new and emerging technologies, redesigning how services were delivered, and lobbying for new rules and regulations. So, the question for us is not if, but when will this happen to healthcare payers? Those who are reluctant and slow to adopt emerging technology or work with new technology partners could soon find themselves like the Kodaks of the world.

How does this apply in healthcare?

The companies we’ve already mentioned, and so many more, have reset consumer expectations across the board. In healthcare, we must keep up with the evolving demands of the new “digital patient” by harvesting actionable information from all the data that is being generated by the internet of things. To do this, our options must be instant, seamless, and insightful:

Instant—Information is now in all our pockets and consumers demand information in real time. Historically, our industry has taken advantage of batch processing, but we need to change our processes and our information systems to allow for real-time processing.

Seamless—The relationship between payer, provider, and member needs to become real-time. Payers and providers must be able to exchange information in real time without impacting the member experience. The member does not want to know what’s happening behind the scenes.

Insightful—Consumerism and social networks are generating an unprecedented amount of data that we need to be able to harvest and transform into actions. The new generation of analytics (advanced analytics, ML, AI, robotic technology) will allow us to discover noncompliance and fraud more easily than ever before, but only if data is converted to information that triggers action by the payer, provider, or member.

The digital revolution is upon us!

To catch up and better serve consumer demands and stay ahead of competition, companies will need:

Strategic partnerships—Companies must seek non-traditional employees and partners.

Operational excellence—Companies must reduce costs and increase efficiencies.

Emerging technology—Companies must rapidly adopt and embrace new technology.

Healthcare has historically been a slow mover in this regard, but some progressive healthcare organizations have already begun differentiating themselves by providing a more customer-friendly, tech-enabled experience. Still, it’s not too late for those companies contemplating their next moves. The companies that make this a priority and quickly adapt to this inevitable change can survive and rise to the top of their sectors. But the clock is ticking, and for those organizations that continue with business as usual, time is running out.

To learn how Discovery Health Partners can help you advance into the future of payment integrity, contact us today.

Wheeler ColemanInsights and observations on the digital healthcare revolution
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