Discovery webinar to review 8 key trends in payment integrity

Health plans take a fresh look at payment integrity process, performance, and management

 

ITASCA, IL (May  11, 2017) –Discovery Health Partners, a provider of payment and revenue integrity solutions for healthcare payers, will host a webinar May 18, 2017, at 12:30 p.m. CST to examine top trends in healthcare payment integrity and how they are impacting the way health plans manage the function. Titled, “Top 8 trends in payment integrity—2017,” the webinar highlights observations of the last year gleaned through hundreds of encounters with health plans by Discovery President Paul Vosters, and David Grice, VP of Strategic Account Development, and others within the Discovery team.

“Increased interest in protecting the bottom line is clearly driving increased interest in payment integrity,” notes Vosters. “We see payers exploring prepayment review as a cost avoidance strategy, questioning the performance of their payment integrity function, and rethinking their insourcing/outsourcing strategies.” Vosters and Grice both report that payment integrity has captured the attention of the C-suite based on its ability to impact plan performance.  These and other trends will be explored in the webinar.

Payment integrity is defined as the accuracy of the transaction that occurs between payer and provider. Payment integrity ensures that claims are paid correctly—by the responsible party, for eligible members, according to contractual terms, not in error, and free of wasteful or abusive practices. In our complex and dynamic healthcare environment, realizing good payment integrity is a challenge for both payers and providers.

Seats remain available for this event, hosted by Healthcare Education Associates and open to all members of RISE. Nonmembers may participate for a fee. To register, visit Webinar Registration here.

About Discovery Health Partners

Discovery Health Partners, a division of LaunchPoint, offers payment and revenue integrity solutions that help health payers improve revenue, avoid costs, and enhance the member experience.  We offer a unique combination of deep healthcare expertise and analytics-powered technology solutions to help our clients improve operational efficiency, achieve financial integrity, and generate measurable results.  More information about our solutions, including Coordination of BenefitsEligibilityMedicare Secondary Payer Validation and Subrogation is available at www.discoveryhealthpartners.com.

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Discovery Health PartnersDiscovery webinar to review 8 key trends in payment integrity
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LaunchPoint, parent of Discovery, announces new analytics executive

Steve Forcash brings expertise in payment integrity and analytics as the new vice president of analytics

 

ITASCA, IL (July 25, 2016) – LaunchPoint, a provider of payment integrity and risk management solutions, software, and services for healthcare organizations, today announced it has appointed Steve Forcash as Vice President, Analytics. A healthcare executive with strong experience in data and analytics, Forcash will be responsible for the advancement of LaunchPoint’s analytics vision and strategy operations, while partnering with LaunchPoint’s product strategy, finance, business operations, and information technology teams to assess opportunities, develop learning, and drive analytics adoption rates for LaunchPoint divisions Discovery Health Partners and Ajilitee.

LaunchPoint marked 4,700 percent growth over a five-year period and was named the 100th fastest-growing company on the 2014 Inc. 500 list and #14 in Healthcare. In addition, the firm was recently ranked the 4th fastest growing Chicago-area company on the 2016 Crain’s Fast 50 listing.

“The changing demands of the healthcare industry call for analytic-minded payment integrity executives like Steve,” said Terrence Ryan, LaunchPoint CEO.  “He will help improve payment integrity and risk management case identification and compel data-driven decision making, to benefit LaunchPoint and our clients.”

Since 2012, Forcash has served in senior management positions overseeing analytics and payment integrity operations at Change Healthcare (formerly Emdeon).  During this time, he oversaw gains in revenue per case improvements as well as managed the implementation of medical-record search capability to improve productivity. He also drove double-digit performance improvements to the post-payment audit and recovery organization through the development of analytic-driven claim valuation techniques. Previously, he held analytics leadership roles at MultiPlan, Inc. (formerly Viant), most recently as Vice President of Reporting and Analytics.

“I am passionate about the role of analytics in improving the cost-effectiveness of healthcare in our country. LaunchPoint is a fast-growing company, with advanced tools that allow clients real transparency into the process,” said Forcash. “I am excited about the opportunity to expand on our current capabilities, by adding more advanced analytic resources aimed at driving incremental growth for LaunchPoint clients. “

Forcash received his Bachelor of Arts degree, Cum Laude in Mathematics and Spanish from Augustana College in Rock Island, Illinois. Steve resides in Clarendon Hills, Illinois with his wife and two daughters.

About LaunchPoint

LaunchPoint operates businesses that provide information-driven solutions, software, and services for healthcare organizations. Its two divisions are Discovery Health Partners, a provider of payment integrity and risk management software and solutions for healthcare payers, and Ajilitee, a healthcare information and analytics consulting business. LaunchPoint has been named two years in a row to the Inc. 5000 list, recognized as one of the country’s fastest growing companies. More information is available at www.launchpointcorporation.com, www.ajilitee.com and www.discoveryhealthpartners.com.

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Discovery Health PartnersLaunchPoint, parent of Discovery, announces new analytics executive
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The real cost of the payment integrity challenge

Clearly healthcare is the most interesting and dynamic sector in the U.S. today. We are witness to an unprecedented transformation as healthcare stakeholders embrace new delivery entities and new reimbursement models, shift attention to building relationships with members, and explore new markets. There will be winners and losers in this game, and everyone is placing their bets.

The transformation underway is also forcing payers to prioritize where they are spending their money, and more attention is shifting to a corner of the ecosystem that has been neglected:  the efficiency of the billing transaction process between payer and provider, what we term healthcare “payment integrity,” or to state it more accurately, the lack thereof. As one speaker at AHIP Institute said, “there’s a lot of money changing hands for no apparent reason.”

Payment integrity ensures that a health claim is paid correctly—by the responsible party, for eligible members, according to contractual terms, not in error, and free of wasteful or abusive practices. As every payer and provider knows, determining whether a claim has been paid correctly requires departments full of claims analysts, auditors, and investigators.  And that’s the problem!

What is the cost of this waste and inefficiency?  The Institute of Medicine, a well-respected independent think tank, estimated that 30% of health spending in 2009—$750 billion—was wasted on unnecessary services and care coordination problems, excessive administrative costs, fraud, and other failures.  Focusing on payment integrity specifically, this included $190 billion in wasted administrative cost and $75 billion in fraud.  Earning wide coverage in media such as the NY Times and elsewhere, this report called for a system-wide reform.

More recently, an April 2012 study by Donald M. Berwick, former administrator for the Centers for Medicare and Medicaid Services (CMS), and RAND Corporation analyst Andrew D. Hackbarth estimated that five categories of waste consumed $476 billion to $992 billion, or 18 percent to 37 percent of the approximately $2.6 trillion annual total of all health spending in 2011.  This data suggests a problem of staggering proportions.

We estimate for healthcare payers that payment integrity problems cost them 3-7 percent of their paid claim dollars every year. That means, for example, a 500,000-member health plan with costs averaging $3,600 per member per year will pay $1.8 billion in claims, of which $56-131 MM will be wasted expense.  This hidden leakage is a problem not just for the payers (and their providers) who bear the direct cost of this administrative inefficiency.   It impacts the employers who underwrite the cost of group insurance, members who now shoulder more of the cost of care, and the economy at large as healthcare costs continue to consume more of our GNP.

Improved payment integrity is essential to a real healthcare transformation.   It is also a hidden source of funding for payers that could be put to work to enter new markets, engage with members, and tackle the challenges of reform.   It won’t be easy, and it won’t happen fast, but it is possible, as we’ll explore in future posts. We’ll examine how everything from technology to organizational structure can have a positive impact on payment integrity as we explore best practices, client case studies, and proven solutions. Stay tuned!

 

 

 

 

 

 

 

 

 

 

 

 

Discovery Health PartnersThe real cost of the payment integrity challenge
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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
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