Transforming payment integrity with transparency

As the healthcare industry continues to transform, it has become clear that the need for increased transparency is one of the critical drivers of change. Health plans are being asked to share more information with a broad range of stakeholders in an effort to control costs and drive improvements in efficiency. In the context of payment integrity, increased transparency will enable health plans to enhance processes, increase performance, and transition from recoveries to pre-payment cost avoidance.

Payment integrity has traditionally lagged behind other areas of health plan operations because of the complex mix of internal teams and vendors supporting payment integrity initiatives. With no single owner of these programs, it is difficult to identify common data standards and metrics. This situation leads to a fragmented and inconsistent reporting environment, which limits visibility into program delivery and performance across the organization.

Discovery Health Partners not only embraces this trend toward transparency, we’re developing solutions that lead it.  We view transparency as a cornerstone of our solutions and a central component of both our product strategy and client delivery. We are committed to providing our clients with tools to analyze, evaluate, and manage the delivery of their payment integrity solutions. The key to our strategy is the Discovery Dashboard, a powerful reporting and analysis solution that puts meaningful information at our clients’ fingertips.

We believe the right dashboard solution will give health plans transparency and visibility into their complex payment integrity ecosystem via an integrated web-based solution. It must be able to:

  • Rapidly incorporate data from third-party vendors or internal systems
  • Utilize terminology and data elements that are consistent across solutions
  • Apply the clients’ own language and business structure

A dashboard should also give business users the ability to define their own information perspective and organize data by business unit, funding source, division, or region.

Of course, the best solution will complement technology with deep experience and expertise in payment integrity – taking payment integrity data, reporting, best practices, and metrics, and incorporating them into reporting templates.

To build the Discovery Dashboard, we have worked closely with our clients to identify what is important to them and their organizations. The Dashboard includes a suite of pre-defined standard reports for each solution area, as well as a report-writing tool for generating custom reporting. With our Dashboard, the previously opaque process of payment integrity solution delivery is now visible in detail. Business users are able to evaluate the performance of their payment integrity initiatives, monitor trends, identify outliers and root causes, and take corrective action. Users can also easily drill down from high-level performance analysis to examine case-level detail. Most importantly, health plans have the power to evaluate all of their payment integrity initiatives and drive real improvements in performance.


Paul VostersTransforming payment integrity with transparency