Core values help Discovery’s Subrogation team navigate the pandemic

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. 

Subro professional 2020

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
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Discovery Subrogation is where I find my passion

The end of June marks National Subro Professionals’ Day—in honor of these experts, Discovery is celebrating the month of June by spotlighting some of our very own Subrogation professionals who make a unique difference in the value we’re able to deliver to our clients.

Lisa Baldwin is a Subrogation Operations Team Lead. She is responsible for helping the Discovery Subrogation organization deliver on the company’s core values, including reliable results, trusted quality, and profound client value. A member of the Discovery family for two years, Lisa shares how Discovery has fed her passion for subrogation. 

To quote Bishop T. D. Jakes, “If you can’t figure out your purpose, figure out your passion. For your passion will lead you right into your purpose.” I know that’s true in my personal life, because managing a Kiss tribute band with my husband allows me to enjoy my passion for that type of music. I’ve also learned this to be true in my professional life. I found that my love for the legal field and negotiations has made subrogation a perfect professional fit for me.  

With six years of subrogation experience under my belt, it’s apparent that I’ve found my passion! At Discovery, I am able to share what I’ve learned to help the company shine. One of the reasons I came to Discovery was for the opportunity to help grow and mature our subrogation practice. The transition was perfect because we have a very diversified employee base of people like me who are working together toward continuously implementing best-practice processes and procedures, instead of just sticking with the status quo.

Now in my second year with Discovery, in March I became team lead. This is a newer role that was created for the purpose of focusing on productivity. I have responsibility for day-to-day activities with the subrogation specialists, and I also handle files as a Senior Paralegal. This has helped the team become more efficient so we can expedite the whole process for clients. We also work with the IT department to do user acceptance testing to ensure proper functionality of our processes and procedures prior to them going into live production. This improves the capabilities of our case management platforms, which also benefits clients.  

Being a mid-sized company in the subrogation world has lot of advantages. It gives employees equal opportunities to help shape our success and contribute ideas. It requires a lot of hard work, but here at Discovery, we collectively pull together and work to find the best solutions for the issues at hand. We are always working to find ways to deliver more value for our clients. 

In our Subrogation organization, we have an Idea Forum that’s open for everyone to submit their ideas for management to review and potentially implement. I must admit, I love the challenge of coming up with new ideas and then finding out one of my ideas was chosen! Some of the successful policies and procedures that I brought to the Idea Forum are already being implemented in our department. One of these is holding team lead roundtables where we bring in paralegals and leverage their knowledge, review case files, and discuss issues. These roundtables help us leverage our in-house subrogation expertise, level up our team’s knowledge, and, ultimately, serve our customers more effectively. 

It’s very rewarding to be able to contribute to progress and efficiencies within the Discovery Subro organization. Our leadership is very focused on engaging the whole team to ensure we’re bringing our best responses and results to our clients. It’s amazing to experience all the ways the Discovery Subro organization feeds my professional passion and encourages that passion to grow!

To learn more about what makes Discovery’s Subrogation solution unique, visit our Subrogation page or contact our team today.

Lisa BaldwinDiscovery Subrogation is where I find my passion
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Thriving during unsettling times

At the beginning of 2020, I had the pleasure of being interviewed by Authority Magazine on the things I do to thrive in the areas of body, mind, and heart. 

You can read the full interview here. 

Oh boy, how the world has changed since January! From the COVID-19 pandemic and shelter-in-place orders to racial injustices and protests, we live in an unsettling and different world. 

As I reflect on how I answered the question “how do I thrive?” in the original interview, it’s comforting to see that some of the things I hold most dear—Friday pizza night dates with my husband, family time, red wine!—are the same things that sustain me in our new world order. Of course, I’ve had to add some creative tweaks to my routine, but I’ve also found some new ways to continue to thrive amid COVID and this time of uncertainty.

I’ve captured my updated thoughts in this video—I hope you enjoy and find some inspiration that helps you to thrive!

Heather RodemannThriving during unsettling times
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Discovery Subrogation is like a family

The end of June marks National Subro Professionals’ Day—in honor of these experts, Discovery is celebrating the month of June by spotlighting some of our very own Subrogation professionals who make a unique difference in the value we’re able to deliver to our clients.

Sarah Kawash is Discovery’s Subrogation Specialist Manager. Sarah leads the onshore and offshore Subrogation Specialists in case development work and is responsible for helping her team deliver on the company’s core values, including reliable results, trusted quality, and profound client value. A member of the Discovery team for over six years, Sarah shares with us why Discovery continues to feel like a family.

Discovery Subrogation feels like a family

I always say that I’ve grown up at Discovery over the past 6 years, and my second family has been right here beside me the whole time. When I started at Discovery, I was fresh out of college with only prior restaurant work on my resume. Discovery introduced me to individuals that took me under their wing and showed me what corporate life was all about. The company has grown exponentially since I started in 2014, but the closeness I have always felt within the Subrogation department has not changed at all. While we are all here working to support our company and our clients, we’re also here to support our teams and each other. 

Like a family does, our Discovery team celebrates accomplishments and milestoneswhether it’s hitting metrics for the week, learning a new client, welcoming grandbabies, buying a new house—we’re all here, cheering each other on. I learned early on that my relationships with coworkers didn’t have to stop at business-related things.  Right away I experienced the support we give each other on everything, always.

The past few years, my Subro family and I have gone through it all together. When we raised performance metrics for our Subro Specialists, some of the team’s initial reaction was that the new targets weren’t achievable. Others on the team stepped up and cheered on those who were in doubt, offering support by motivating and convincing them we could not just meet, but exceed the new targets by applying our great work ethic. Now a year after the new goal was established, the team as a whole is overperforming on average and we continue to push and support each other to hit even higher. 

Discovery is very committed to setting and meeting high quality standards for our clients. Over the last nine months, the entire Subro team (not just the Specialists) have hit above and beyond our quality goals! One reason we’ve been able to accomplish this is because when someone is struggling, the teams work with one another, helping each other out, showing they have faith in their abilities and believe they can do it and achieve their goals. And the times when everyone on the team hits their individual goals—well, then it’s a real party and truly a celebration for us all! 

There are also the challenging times, to be sure. When things like the global pandemic take over our personal and professional lives, it’s easy to be negative. What I’ve seen from my Discovery family is that they’ll always do whatever it takes to help us stay positive. I am not saying negativity or going below the line doesn’t happen, but it never lasts long. We are truly all in it together—listening, learning, and pushing through.

Work goals and metrics aside, the personal support I see and feel from my coworker family shines the brightest. Two years ago, one of our Paralegals passed awayshe was like my second mom. A few weeks ago, we lost yet another Paralegalagain, she was like family. Each time was hard, and I would be lying if I said it has gotten easier. It never will. Having such a close-knit work familyeveryone coming together, telling stories, sharing pictures, reaching out, praying for each otherit makes the hardest things bearable. The texts and chats of people extending a hand or just reaching out to see if you are okay, these are moments I will treasure and remember forever.

Like most families, we know how to have a good time and celebrate here at Discovery! When one of our own was deployed this past April, the team gathered for a virtual happy hour to send her off. Additionally, one of the ladies on the team just became a grandmother for the first timeI absolutely love receiving texts of grandbaby pictures! If I’m having a bad day or just need to vent, I know I can message one of my peers and they’ll talk it out with me. I’ve gained so many close friends since my start at Discovery, and no doubt there will be more to come.

We all came to Discovery for a job, a career. I stay for the family I never expected to gain.

Sarah KawashDiscovery Subrogation is like a family
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Merging AI and human intelligence for big recovery results

Technology plays a key role in health plans’ transition to more proactive, data-driven payment integrity results. We sat down with Dan Iantorno, Chief Information Officer at Discovery Health Partners, whose team received the FutureEdge 50 award from IDG/CIO magazine for Discovery’s work with machine learning and AI. We discussed how technology is driving a transformation in payment integrity and what Discovery is doing to help clients access new technologies to improve revenue, avoid costs, and enhance their members’ experience. 

Data and analytics are transforming many industries, including healthcare. What are the biggest challenges health plans face when implementing these new technologies?  
We know that health care costs are skyrocketing, driven by administrative complexity, fraud, and abuse. It’s estimated that as much as $935 billion, or nearly 25% of total spending, is wasted in the US healthcare system every year. As a result, providers are under intense pressure to manage costs and ensure payment integrity, while at the same time continuing to provide quality care for their members.

Technologies that leverage artificial intelligence, machine learning, and analytics can enable plans to implement process efficiencies and dramatically increase recovery rates, while reducing member abrasion. But many health plans lack the internal tools and resources to identify and pursue recovery opportunities for high-cost, complex claims. Discovery is partnering with health payers to support data-driven payment integrity solutions and help them identify and pursue the highest-value cases to drive bottom-line results.

What are some of the ways Discovery is innovating to help clients transform their payment integrity approaches?
Since the company’s inception, Discovery has been at the leading edge of analytics-powered technology solutions to help clients address payment integrity challenges. Today, we are using machine learning and predictive analytics to tap into the potential of more than a decade of case outcome data to improve results, drive efficiency, and guide our customers to more proactive payment integrity strategies. Last year, we unveiled our Case Open Logic solution, an initiative that uses machine learning as part of our claims ranking process in our Subrogation practice. 

Rather than relying on human logic to prioritize the 2% of cases that result in 90% of recoveries, our solution uses machine learning to augment human intelligence by selecting the cases with the highest likelihood of success, doing in seconds what would previously have taken hours of manual work. These enhancements help validate subrogation claims faster and more accurately and identify cases that otherwise might be missed. The process also helps health plans reduce member friction because there’s no need to contact members unnecessarily on claims that are not of substance. This solution has delivered immediate results for our clients, and the technology shows great potential to enhance solutions across business lines. We’re very proud that our Case Open Logic solution was honored with IDG/CIO’s FutureEdge 50 award that recognizes cutting-edge applications of emerging technologies to advance business goals. 

What’s in store for the future of payment integrity and how will Discovery support health plans as they evolve their payment integrity strategies?   
Discovery’s data science team has a history of blazing new trails in the payment integrity industry. In 2020 and beyond, we will continue to innovate with solutions that drive results for our health plan clients and provide best-in-class models for the industry. For example, our investment in machine learning with our Case Open Logic solution has already helped us boost subrogation recoveries for our customers by 20%. Based on that overwhelming success, we intend to roll out similar machine learning capabilities to other lines of business such as Data Mining, Clinical Audits, and Coordination of Benefits (COB). The application of machine learning based on a decade of data enables Discovery to provide services that are immensely valuable to our health plan clients. Combining technology innovation with our team’s decades of experience in the health payer space is how we will continue to deliver game-changing profound client value.

Find out how Discovery Health Partners can help strengthen your payment integrity initiatives in 2020. Contact us today!

Dan IantornoMerging AI and human intelligence for big recovery results
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Protecting payment integrity through client-centered support

Unexpected events like the COVID-19 pandemic make it increasingly difficult for health plans to manage costs and ensure payment integrity. We recently sat down with Monica Frederick, Vice President, Account Management for Discovery Health Partners, to discuss how Discovery’s people and account management approach contribute to our clients’ success.

You’re a newer member of the Discovery Account Management Team. Can you share your experience prior to Discovery?

Over the past 20 years, I’ve held numerous sales and business development positions to support healthcare organizations in bringing new patient care modalities to the market. My experience on the medical side gives me insight into how managed care organizations can strengthen their payment integrity efforts so they can better manage costs and continue to focus on member care.

What makes Discovery a successful team and what are we doing differently to support our clients’ success?

Discovery has built a solid reputation for providing value to health plans by helping to solve their payment integrity challenges. We owe our success to our exceptional people and culture of accountability. Every employee across the organization understands the importance of their role and how they contribute to our clients’ success. And I see the whole organization working tirelessly to anticipate customers’ needs and earn their trust.

Communication is a big part of our approach to account management at Discovery. We talk to clients frequently in person and virtually, and we also conduct client surveys to hear directly from our clients on how we’re doing and how we can continue to provide profound value to our clients’ organizations.

Through this hands-on approach, we’ve learned that we do many things right. Clients especially appreciate how we advise them to determine the best course of action for their operations and provide timely follow-up to address their concerns. This valuable feedback also helps us identify opportunities where we can improve our processes and solutions to better meet clients’ needs.

In addition, we have a Client Council that brings together individuals across our client base whose voices influence the future of our business. We host in-person and virtual meetings with our Client Council to deepen relationships and understand what clients need to be successful. These meetings not only provide clients with valuable networking opportunities, but also offers clients opportunities to share insights and best practices with other health plan leaders and drive future innovations.

What is Discovery’s approach to account management, and how do we drive value throughout the entire engagement with a client?

Our approach is flexible to meet each client’s unique needs, but it always starts with earning their trust, by getting to know them and understanding their business operations. We listen closely to their concerns and create a plan that addresses their challenges and aligns with their strategy and priorities.

When clients join Discovery, we put together an implementation team with the right skills and specific expertise to ensure a smooth, accurate, and efficient implementation. Our approach is flexible and can wrap around or come behind existing vendors and processes already in place. Discovery’s multi-disciplinary teams work collaboratively and our experts evaluate each client individually. There is no one-size-fits-all approach.

Once implementation is completed, an internal hand-off to the Account Management team occurs and all unique attributes and needs for each client are discussed in detail. A dedicated account manager takes the lead to provide guidance and manage day-to-day activities and communicate the status of ongoing projects every step of the way. We don’t just hand over reports; we take time to meet regularly with clients to review their information in a way that’s meaningful so we can make recommendations for improvements and achieve their desired results.

What are some of the ways Discovery helps health plans address unexpected payment integrity challenges like the COVID-19 pandemic?

COVID-19 is unlike any event the healthcare industry has seen in modern times, thus health plans are faced with challenges they could not have imagined just a few months ago. Not only do health plans need to ensure their members receive the care they need and support their providers, health plans must also keep up with individual states’ mandates regarding “non-essential” claims processes and review of COVID-19 related claims. At the same time, they are struggling with reallocating resources to support critical COVID-19 initiatives while managing the shift to a remote workforce.

Discovery is proactively reaching out to clients to make recommendations, based on their business, to help protect premium revenue, pick up productivity shortfalls as needed, and help them protect their workforce. We continue to work diligently on behalf of clients as an extension of their teams to ensure they get the right information to support the continuity of their operations.

Discovery went remote with payment integrity operations over a year ago, so we’re in a great position to help support our clients business during the pandemic. Discovery views challenges as an opportunity to learn from individual clients’ needs. As COVID-19 plays out, we will continue to partner with clients to make sure we are supporting them and their challenges are addressed in a timely manner.

 

Find out how Discovery Health Partners can help contribute to your payment integrity success in 2020. Contact us today!

Monica FrederickProtecting payment integrity through client-centered support
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Infographic: Fixing payment integrity at the source

It’s a known fact that improper payments abound in healthcare. Given the effect that eligibility data can have on claims payments, a connected payment integrity approach is essential. Often, challenges arise from multiple sources of data, conflicting or inaccurate data, data integration challenges, manual workflows, multiple reporting systems, and more.

When eligibility errors occur, they affect many payment integrity areas such as coordination of benefits (COB), subrogation, and Medicare secondary payer (MSP) validation. Failing to address these issues leads to incorrectly paid claims, improper reimbursements, or claims that shouldn’t be paid at all—costing your plan millions.

Infographic: Fixing payment integrity at the source

Find out the top three causes of eligibility errors and learn how a connected payment integrity approach can help.

Discovery Health PartnersInfographic: Fixing payment integrity at the source
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How I Thrive: “My husband and I have a standing pizza and movie date night” with Heather Rodemann

As part of their How I Thrive series, Authority Magazine asked Discovery Vice President of Subrogation Operations Heather Rodemann for her take on how one can thrive in three areas—body, mind, and heart.

Click here to read the full article.

Heather RodemannHow I Thrive: “My husband and I have a standing pizza and movie date night” with Heather Rodemann
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Fixing payment integrity at the source

“New year, new me.” Seems like we hear this at the beginning of every year and hold on to the promise of moving on from the past and setting new goals for the future. Likewise, healthcare organizations are kicking off 2020 by charting new paths to address old problems and expanding into new initiatives to stay ahead of the competition.

Priorities such as increasing member satisfaction, provider relationships, and regulatory compliance remain top of mind for many health plans, which makes it a good time to take a fresh look at your payment integrity strategies and resources. Now is the time to evaluate how well your plan is maximizing recovery opportunities, improving cost avoidance strategies, and exploring premium restoration possibilities. To do this, you need to start at the source of your payment integrity challenges: eligibility data.

The impact of eligibility errors

It’s a known fact that improper payments abound in healthcare, many of which stem from eligibility errors made as a result of multiple data sources, outdated technology, manual processes, and members with other insurance coverage. When eligibility errors occur, they affect many payment integrity areas such as coordination of benefits (COB), subrogation, and Medicare secondary payer (MSP) validation. Failing to address these issues leads to incorrectly paid claims, improper reimbursements, or claims that shouldn’t be paid at all—costing your plan millions.

According to Gartner, billions of dollars are spent every year in improper claims payments across commercial, Medicare, and Medicaid lines of business. Gartner research states, “Payer CIOs must get proactive and leapfrog current performance by focusing on prospective payment integrity capabilities.” With this in mind, what can you do to strengthen your payment integrity approach?1

Identify inaccurate eligibility data

When taking a close look at eligibility data, your plan will want to determine which claims may have been paid incorrectly as a result of inaccuracies. We estimate that 20% of a plan’s membership will have other insurance, and of that 20%, the other insurance will be primary 17.5% of the time. For a 200,000-member plan, this represents nearly $5.4 million in incorrectly paid claims. When statistics like this are uncovered, the plan quickly realizes how important it is to keep its eligibility data in check.

Determine a cost-avoidance strategy

Avoiding improper payments is a core tenet of any payment integrity strategy. Accurate and trusted eligibility data plays a key role. We estimate that the same 200,000-member plan could save over $13.4 million by avoiding incorrect payments. With the right cost avoidance strategies founded on accurate eligibility data, the plan stands to see a significant impact to its bottom line.

Look beyond dollars and cents

When evaluating your payment integrity strategy, you will want to think beyond dollars and cents. Quality eligibility data will have a positive effect on administrative efficiency, member satisfaction, and provider relations.

By avoiding improper payments in the first place, you avoid the need to rebill, saving you and your staff valuable time and energy that might be channeled toward other payment integrity initiatives.

Member satisfaction is a key priority for any health plan. In fact, the member experience drives performance on CAHPS (Consumer Assessment of Healthcare Providers and Systems), which is a key driver of Star ratings. Eligibility data drives a diverse number of systems and processes including registration, enrollment, care provision, wellness, and customer care. All of these areas influence your members’ experiences with your plan.

Lastly, providers depend on prompt, accurate payment. When claims are denied as a result of recurrent eligibility issues, payer-provider relationships already burdened by administrative complexity are further strained. Ensuring accurate eligibility data and determinations not only improves efficiencies, it also helps to accelerate reimbursements, greatly improving relationships and alignment.

Consider a connected payment integrity approach

Given the effect that eligibility data can have on payments, you will want to consider a connected payment integrity approach and address any gaps in your technology. Often, challenges arise from multiple sources of data, conflicting or inaccurate data, data integration challenges, manual workflows, multiple reporting systems, and more. By creating a technology environment that can support connected payment integrity functions (e.g., claims recovery, subrogation, and COB), business managers and IT can come together in their thinking and create a single, trusted source of eligibility data.

 

Contact Discovery Health Partners today to find out how we can support your payment integrity initiatives in 2020 and beyond.

1Gartner, “U.S. Healthcare Payer CIOs Must Adopt Prospective Payment Integrity to Thwart Improper Claims Payment and Fraud,” February 13, 2018.
Jeff MartinFixing payment integrity at the source
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Jason Brown on the road ahead for payment integrity

As the industry transitions from volume to value-based healthcare, health plans face increasing pressure to better manage costs and ensure payment integrity. We recently sat down with Jason Brown, CEO of Discovery Health Partners, to get his thoughts on recent trends and how they’re shaping the road ahead in 2020.

Healthcare continues to change and evolve. What do you see as some of the trends setting the stage for optimizing payment integrity?

Health plans face a number of challenges when it comes to ensuring the right care is provided to the right member for the right amount. Complex billing processes, changing regulations, outdated and disparate data systems, and overlapping coverage all contribute to improperly paid claims. Today, nearly a third of claims are paid incorrectly, leading to billions in administrative waste.

In 2020 and beyond, we anticipate health plans will continue to struggle with rising healthcare costs, numerous competing priorities, and a lack of resources. Furthermore, changing regulations and mandates will continue to add layers of administrative and clinical complexity to a system already bogged down in paperwork. While there is no clear path to cost containment, there are ways health plans can work toward transforming their payment integrity approaches. An example is leveraging advanced technologies to move from retrospective payment to prospective payment—by detecting improper claims before they are paid, health plans can keep costs in check, increase member satisfaction, and most importantly, cultivate healthy provider partnerships.

What are some of the ways Discovery is helping health plans address their payment integrity challenges?

This past year has been an exciting time of innovation and growth for Discovery. We have an expanded suite of payment integrity solutions—Coordination of Benefits, Subrogation, Data Mining, Clinical Audits (in areas such as diagnosis-related group (DRG) audits and itemized bill review audits) and Premium Restoration. Our integrated solutions are designed to work together. This connected approach helps optimize claims recoveries and avoid future expenses across the entire claim lifecycle while reducing provider and member abrasion.

What makes Discovery unique is that our solutions start with our clients’ own data and processes. We leverage the latest analytical tools and technology like machine learning to identify patterns that present opportunities for cost recovery and cost savings. By blending artificial intelligence with human expertise, we identify hidden errors and root causes that are often overlooked. We also provide the highest levels of support to our clients, acting as an extension of their teams, to free up their internal resources so they can focus on other business priorities.

Since its inception, Discovery has been proud to provide flexible solutions that help health plans solve their payment integrity challenges. Our newly formed Client Council provides a platform for clients to share industry insights and challenges with their peers and help drive product innovations with Discovery. Going forward, custom-tailored solutions like ours will be key to helping plans manage costs while maintaining the high levels of care that their members expect.

What’s on the horizon for Discovery in 2020?

During the past decade, we’ve demonstrated measurable success by helping our clients improve operational efficiencies, increase claims accuracy and payment, and recover dollars back to their health plans.

From 2020 forward, we will continue to evolve existing solutions and create new forward-thinking approaches to help plans prevent and recover inaccurate payments. By expanding our use of data analytics and data integration and accelerating our investments in research and technology like machine learning and predictive analytics, we will help health plans capitalize on information to coordinate claims correctly. Once individual plans reach the point where they are paying the appropriate amount for the healthcare that’s delivered, they can re-invest in clinical care for their members.

At the same time, we will position clients to transition toward a more proactive approach to cost management. Reimagining the payments process and applying insights further upstream will be key to enabling providers to take advantage of opportunities to proactively change wasteful behaviors.

And of course, we’ll continue to keep our finger on the pulse of the industry. By building partnerships with our clients, industry organizations, agencies and others to learn about best practices and stay on top of the latest trends, we can prepare clients for the challenges ahead.

 

Find out how Discovery Health Partners can help strengthen your payment integrity initiatives in 2020. Contact us today!

Jason BrownJason Brown on the road ahead for payment integrity
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