Payment Integrity Perspectives: how health plans innovate
By ClarisHealth
Payment Integrity Perspectives: how health plans innovateNov 29, 2021
A Vision for Payment Integrity
This season, as we have followed L.A. Care Health Plan's journey building a payment integrity function from the ground up, we've seen them go from a few thousand in unsolicited recoveries to $131 million in overpayment avoidance and recoveries in just a few short years. That's a triumph by any measure. But if you've learned anything from the L.A. Care team, you might have guessed that isn't the pinnacle of their ambition. As they look back on how far they've come and look forward to their next challenge, they still have their focus firmly planted on a vision for a fully mature payment integrity function.
In this episode, Shonnie Davis, Gladys Oswell and Erik Chase tell of how they’re incorporating more of the organization and sharing their insights in order to shift more to overpayment prevention.
Joined by Yaw Agyemang, Jeff McNeese, Dana Ryan and Andrew Walters of ClarisHealth who discuss the value of partnership, focused goals and starting small to achieve big gains.
Guests:
L.A. Care Health Plan: Shonnie Davis, Gladys Oswell, Erik Chase
ClarisHealth: Yaw Agyemang, Jeff McNeese, Dana Ryan, Andrew Walters
3 Elements Needed to Internalize Payment Integrity
As we've followed L.A. Care Health Plan's story of payment integrity transformation, they have discussed how important third-party service vendors have been to that journey - especially when combined with the efficiencies, oversight and transparency enabled by the program optimization capabilities in Pareo. But their ultimate goal will be familiar to most health plans. How can they do more overpayment detection and prevention with their own resources?
In this episode, Erik Chase and Shonnie Davis tell of how they have combined technology, internal subject matter experts and outside analytics content to maximize the recoveries initiated by their own resources.
Joined by Jeff McNeese, Cassie Bishop, Coy Page and Andrew Walters of ClarisHealth who discuss the value of the “outsource to insource” strategy and how health plans can engage in a non-traditional vendor relationship focused on root-cause remediation.
Guests:
L.A. Care: Erik Chase, Shonnie Davis
ClarisHealth: Jeff McNeese, Cassie Bishop, Coy Page, Andrew Walters
Measuring the Value of Payment Integrity
One of the primary reasons health plans seek digital transformation is for its potential as a more reliable source of information and insights. L.A. Care Health Plan was no different, but the stakes were even higher. Because the payment integrity function was relatively new, they were under arguably greater pressure to increase visibility and definitively prove their value and impact.
In this episode, Erik Chase, Gladys Oswell and Shonnie Davis tell of how their value and focus evolves over time as their function matures and how they’re collaborating cross-functionally to share those insights via Pareo.
Joined by Coy Page, Dana Ryan and Jeff McNeese of ClarisHealth who discuss the value of insights and analytics in a health plan’s ability to measure the success of their strategy – and move their payment integrity program forward.
Guests:
L.A. Care: Erik Chase, Gladys Oswell, Shonnie Davis
ClarisHealth: Coy Page, Dana Ryan, Jeff McNeese
Harnessing the Innovation of Payment Integrity Services Vendors
We can't tell the story of L.A. Care Health Plan's accelerated path to payment integrity results without talking about the efforts of services vendors. Even with their innovative strategies, this traditional approach has played a key role in allowing L.A. Care to quickly ramp up capacity.
In this episode, Erik Chase and Shonnie Davis tell of how they added vendors, stacked to greatest effectiveness, to jumpstart innovation. And how Pareo helps them manage these relationships efficiently, with an eye toward optimizing value. From their point of view, win-win vendor and health plan relationships are made possible through setting big goals and improving transparency.
Joined by Tara Dufrene of ClarisHealth as well as Jon Downie and Valerie Thompson of TREND Health Partners who provide a vendor perspective on this unique dynamic.
Guests: L.A. Care: Erik Chase, Shonnie Davis; ClarisHealth: Tara Dufrene; TREND Health Partners: Jon Downie, Valerie Thompson
Scaling Payment Integrity to Accelerate ROI
When the L.A. Care Health Plan payment integrity team looks at how far they’ve come in 4 short years, the differences are startling. Their early success made the case for the work they do. And the efficiencies created by Pareo allow them to go further, faster.
In this episode, Gladys Oswell, Erik Chase and Shonnie Davis tell of their experiences scaling payment integrity results across the organization. Joined by Andrew Walters, Cassie Bishop, Jeff McNeese and Yaw Agyemang of ClarisHealth who tell of collaborating on new opportunities to push overpayments identification, recovery and prevention forward at L.A. Care.
Guests:
L.A. Care: Erik Chase, Shonnie Davis, Gladys Oswell
ClarisHealth: Andrew Walters, Cassie Bishop, Jeff McNeese, Yaw Agyemang
Building Payment Integrity from the Ground Up
On their way to achieving an annual $131 million recovery rate, L.A. Care Health Plan had to build their team, onboard and manage vendors, and acquire a technology solution to enable their expansive vision.
In this episode, Erik Chase, Shonnie Davis and Gladys Oswell tell of their payment integrity function’s beginnings in 2017 and how they embraced the challenge by starting small to find early success. Joined by Jeff McNeese and Yaw Agyemang of ClarisHealth who tell of Pareo’s origins as a vendor management technology solution that caught L.A. Care at just the right time.
Guests:
L.A. Care: Erik Chase, Shonnie Davis, Gladys Oswell
ClarisHealth: Jeff McNeese, Yaw Agyemang
Introducing L.A. Care Health Plan
Welcome to a new season of the podcast from ClarisHealth, the leaders in innovative technology for health plans. Payment Integrity Perspectives is designed for health plan leaders and other influencers in and around healthcare who want to innovate.
What to expect from the season: This season, we’re following L.A. Care Health Plan who built a payment integrity function from the ground up – with a little help from advanced technology platform Pareo – and found incredible success in the process.
Why you should listen: How can a health plan find the right partner, select the right technology, reduce their risk and navigate complexity so they can continue to successfully innovate and scale their efforts? L.A. Care’s payment integrity experts tell all.
How Highmark Uses Pareo for an Integrated Approach to Claims Cost Containment
How has Highmark Blue Cross Blue Shield achieved an industry-leading 27:1 ROI on their payment accuracy and FWA operations? Join us for a live webinar on Thursday, April 8 when Kurt Spear, VP Financial Investigation and Provider Review for Highmark, will share how an integrated technology ecosystem powered by Pareo is driving real results.
Learn:
- How to make the business case for adopting a payment integrity technology platform
- How advanced technology allows health plans of all sizes and types to achieve value
- Why it’s important to connect pre- and post-pay avoidance and recovery operations
- How you can address medical savings pressures from outside stakeholders to better compete nationally
- What finding the right partner means for your innovation goals
Register: https://www.clarishealth.com/resources/highmark-pareo-for-integrated-payment-integrity-webinar/
The Importance of Partnership When Adopting Technology
As technology buyers, it’s all too easy to get caught up in feature/function evaluations at the expense of other considerations. But is that the only predictor of health plan success?
How your technology solution is delivered, and by whom, is a large factor when considering how successful a technology project will be. In this episode, ClarisHealth experts Kenya Adams, Mattie Stremic, Stacey Parker and Christie Hill explore how partnering with clients throughout the relationship can make all the difference.
How Can Technology Help Health Plans Navigate Complexity?
Technology solutions are often the cornerstone of a health plan’s innovation journey. But, as you build your technology stack, ask yourself: Is it simplifying your existing burden? Or, adding even more complexity to your organization and processes?
Every step along the way, technology can either pave the way for innovation or split your focus. In this episode ClarisHealth experts Stacey Parker, Tanner Plauche and Misty Ganguly explore how a payment integrity platform’s architecture, development and implementation can help you better navigate complexity.
Reduce Your Health Plan's Risk When Selecting Advanced Technology
How can health plans evaluate the increasing number of technology choices available to them and find a partner to match their vision - without taking on unnecessary risk? In this episode, experienced payment integrity leader Ben Roberts explains how transparency, flexibility and comprehensive solution offerings set some vendors apart. Joined by ClarisHealth payment integrity and FWA experts Mark Isbitts, Jim Weathersby and Jason Medlin who explore how to answer the “build vs. buy" question and what to look for in a strategic technology partnership.
Technology to Answer Your Innovation Goals
With your health plan's goals around digital transformation and the increasing number of technology choices available to you, you may start to ask yourself: Are you doing enough to innovate? Healthcare is only increasing in complexity, so the longer you wait to start, the more out of reach success can seem.
In this episode, ClarisHealth payment integrity and FWA experts Mark Isbitts, Jason Medlin and Yaw Agyemang explore what health plans stand to gain by moving decisively on their innovation strategies. From controlling their own claims payment accuracy efforts, to integrating siloed functions, and improving provider relationships.
The Value of Transparency for Health Plan Technology
How exactly does advanced technology help health plans innovate? In this episode, ClarisHealth payment integrity experts Jim Weathersby, Michael Gilbertson and Jason Medlin discuss the value of transparency. How sharing information between health plan internal payment integrity functions, third-party services vendors and other stakeholders fosters a free flow of ideas. As a result, payers experience greater returns and can more easily capitalize on other opportunities for innovation.
Why ClarisHealth?
Why is ClarisHealth telling the story about how health plans innovate? In this episode Jeff McNeese, Tara Dufrene and Ryan Nowers tell about the origins and early days at the company. How they started helping health plans solve their biggest payment integrity challenges with technology and what the future looks like for healthcare innovation.
An Introduction to Health Plan Innovation
Welcome to a new podcast from ClarisHealth, the leaders in innovative technology for health plans. Payment Integrity Perspectives is designed for health plan leaders and other influencers in and around healthcare who want to innovate.
What to expect from the show: Each season, ClarisHealth experts follow a health plan on their “hero’s journey” as they work through a knotty problem to arrive at an innovative solution.
Why you should listen: Through these relatable stories, you will find the inspiration in your own health plan’s day-to-day and understand how to achieve transformation with the right technology.