“The Great Pause” Brings Unyielding Uncertainty to Medical Loss Ratios but Also Opportunity

“The Great Pause” Brings Unyielding Uncertainty to Medical Loss Ratios but Also Opportunity

Are better-than-expected medical loss ratios in 2020 setting up payers to take a severe hit on profit margins in 2021? Go on offense by making moves that feature these 4 risk-mitigating hallmarks.

Six months into the novel coronavirus pandemic in the U.S., the crisis has affected the healthcare industry unevenly. While providers have been hit hard financially, health plans have experienced record profits due to a significant drop in medical expenses. But while they come under scrutiny for the current medical loss ratios, health plans argue this is a situation that cannot last. They expect a pent-up demand for healthcare coming in 2021 that will more than make up for this year’s health plan profit margins.  

None of us can predict the future. But we can still find a path forward for payers. One that helps you successfully navigate the short-term uncertainty around healthcare claims costs and poises you for long-term success. The “great pause” – as the initial lockdown period of 2020 is sometimes referred to – has changed our economy and the way health plans think about business operations for the long term.  

Will COVID-19 Delay the Payer Financial Impact? 

The Affordable Care Act mandated health plans spend at a minimum 80-85% of premiums on healthcare or quality improvements. The result is a medical loss ratio (MLR) calculated as follows: 

MLR = Healthcare Claims + Quality Improvement Expenses / Premiums – Taxes, Licensing & Regulatory Fees  

With the onset of the COVID-19 pandemic, as consumers avoided or deferred care, the “healthcare claims” portion of that equation shifted dramatically. This downward trend was most significant in the second quarter. A recent study found that in April 2020, total hospital admissions declined 34%, including COVID admissions. At the same time, visits to ambulatory practices declined 60%, and emergency room visits dropped off 42%.  

This lower-than-expected use of healthcare services has reduced medical expenses billions of dollars across commercial health plans leading to, in some cases, doubling of profits. But, what does the future bring?  

The “bad” 

Especially at the onset of the pandemic, several experts predicted catastrophic healthcare costs would accompany COVID-19 and severely hit payers’ bottom lines. That worst-case scenario hasn’t materialized, though some worry that higher costs are on the horizon as a result of early care delays. 

 Of particular concern are decreased rates of screenings, vaccinations and other preventive care. At least 40% of individuals surveyed reported delaying care due to COVID-19 through the end of June. This article cites studies that note a 46% decline in cancer diagnoses and an 85% drop in common cancer screenings. CMS data revealed 22% fewer vaccinations administered, 44% fewer screenings for physical and cognitive development, and 69% fewer dental procedures among children between March and May of 2020.   

 A predicted future spike in elective procedures is also worrisome. By some estimates, they make up 37% of health plans’ hospital admissions spending. Some of those 40% mentioned above who delayed care undoubtedly fall into this category. As of July, though, procedures had rebounded to 16% below baseline levels. And a September survey found 60% of patients are open to rescheduling their elective procedures this year, a figure that jumps to 71% among those whose needs are more urgent. 

 The “good” 

When COVID-19 forced consumers and providers to re-think healthcare encounters, it yielded a few moves that may lower costs in the short-term and the long-term: 

 Embrace of telehealth and virtual care: The adoption of remote patient monitoring, virtual visits and more has jumped forward and may help better manage chronic conditions, including behavioral health. By improving access to care, it might also help redirect the non-emergent visits that have historically ended up in the emergency department. As a PwC report noted, “Even if telehealth increases utilization, many payers see the platform as an opportunity to get members the right care at the right time in the right place while also saving the member and the employer money.” 

Creative healthcare solutions: From at-home dialysis and other home health treatments to reassessing the usual cancer treatment protocols, the hyper-focus on effectiveness has started to chip away at the “more equals better” healthcare idea.  

Alternative payment models: Those providers participating in contracts that prioritize value fared better financially than their fee-for-service counterparts – and achieve improved outcomes for their patients. Combined with modern payer initiatives that focus on social determinants of health, coordinated care, population health and the transparent data sharing that supports these moves, the current environment might signal a sea change in this shift. 

The “wait and see” 

Because we are still very much in the middle of this healthcare crisis, these outcomes – the “bad” and the “good” – are far from a foregone conclusion. In fact, the latest estimates – from the Willis Towers Watson actuarial analysis of employer healthcare cost – project 2020 totals to come in 3.3 – 9.9% lower and 0.5 – 5% higher in 2021 for a combined cost reduction of 2.8 – 3.8% from non-pandemic levels. Even still, the analysts warn about volatility around these costs. 

With this uncertainty comes risk for health plans. Uncertainty around when and where elective procedures will resume, the total COVID-19 testing and treatment costs, and how ongoing unemployment will affect insurance coverage rates all make it difficult to act with conviction. In response to this lack of assuredness in the market, some health plans have gambled on suspending long-planned strategic projects.   

However, while the novel coronavirus is our collective reality for the time being, it will pass eventually. With that in mind, does it make sense to make relatively short-term moves that may prove costly in the long run? 

4 Hallmarks of Win-Win Strategic Moves for Payers to Implement Now 

We might feel the impact of COVID-19 on healthcare through 2022. And especially in the face of potential healthcare cost volatility in 2021, health plans have to extend their long-term visioning. What strategic moves both mitigate risk now and move the needle on your competitive advantage in the future?  

Consider decisions that make sense, no matter what the future brings regarding medical loss ratios. Look for these four characteristics of moves that promise to propel your health plan past the risk-averse reactive mode that can result in inaction and unwanted setbacks. 

1. Easy to implement

When you think of plans that are easy to implement, policies and processes that are already in place may come to mind. For instance, when CMS provided payers flexibility on medical loss ratio reporting and rebates this year, health plans didn’t hesitate to exercise their options. Many had already taken it on themselves to provide direct support to consumers. This relief came in the form of waiving COVID-19 cost sharing, extending premium payment grace periods, and offering premium rebates and discounts.  

By the same turn, if your health plan is already in the process of pursuing an enterprise technology platform, consider how quickly you could realize savings from that decision. And how difficult it would be to get back on track if you abandoned that process. Emphasize your potential speed-to-value when you encounter these roadblocks, and it won’t steer you wrong.

2. Build empathy with stakeholders

As COVID-19 ravages your consumers, network providers and employer clients, any strategic move that shores up these relationships holds promise for long-term benefit. For example, extending telehealth benefits and continuing member engagement campaigns for consumer satisfaction. Evolving provider engagement programs to further ease their claims burden. And offering creative solutions to keep employer healthcare costs down. 

Some of these strategies build on the positive outcomes realized thus far into the pandemic, which also make them easy to implement. And they include policies that mitigate healthcare delays and may even lower healthcare costs, making them a good match for today’s challenges and tomorrow’s opportunities. 

3. Improve efficiency

No matter how healthcare costs impact medical loss ratios next year and the next, it pales in comparison to one perennial challenge. Administrative complexity makes up at least 10% of annual healthcare spending in the U.S. Reducing your administrative burden holds the greatest potential to increasing your profit margins.  

For that reason, prioritize decisions that will yield the greatest return on investment. Times like these increase the stakes greatly. And you simply can’t afford not to invest in solutions that could double or triple your recoveries while improving efficiency.

4. Reduce team frustrations

What issues did the pandemic bring to the forefront for your team’s day-to-day? For most of us, work flexibility and communication have become more important than ever. Work cultures that depend largely on face-to-face interactions have had to adapt quickly to maintain productivity. And your email inboxes may have taken a hit as their limitations as workflow tools have been tested. 

As a result, teams across all industries have quickly adopted virtual meeting solutions that may already have been in place. You may also consider secure, cloud-based collaborative technology platforms. Especially ones developed specifically for the healthcare industry can help you extend a work-from-anywhere posture and invite key external stakeholders into the workflow.  

Set Yourself Up for Success – No Matter What Medical Loss Ratios Bring 

While there continues to be talk about “getting back to normal,” we may have to recognize that the new normal equals uncertainty. We have to become agile enough to succeed under those circumstances. Take this opportunity to implement solutions that address inefficient processes. Innovate your way through broken relationships with stakeholders. A scalable technology platform like Pareo can help you transform your payment integrity function, which better positions you to successfully navigate unpredictable medical loss ratios and their impact on profit margins. 

 

NOW'S THE TIME FOR TOTAL PAYMENT INTEGRITY

Talk to ClarisHealth about how Pareo®, a total payment integrity platform, is driving innovation at health plans. 

5 Reasons for Health Plans to Choose a Scalable Payment Integrity Technology Platform

5 Reasons for Health Plans to Choose a Scalable Payment Integrity Technology Platform

Are you using an assortment of software tools to do work better suited to a platform? You might be missing out. 

When your health plan starts looking to upgrade your payment integrity and fraud management processes with technology, what do you turn to? A tool or a platform? It’s likely not an either/or decision. Situations where only a highly specialized, best-in-breed tool will do the job are myriad. But how can you ensure your organization doesn’t deploy dozens of disconnected tools when a scalable payment integrity platform that drives your health plan’s technology ecosystem is the ultimate goal?

Defining Terms

With technology, you have options when it comes to providing solutions to your challenges. Let’s level set on some definitions of two different approaches to technology solutions.

Tool: a standalone piece of software designed to perform a single specific function or a small set of functions. It is often disconnected from other systems and processes and serves one purpose. Sometimes referred to as an “application” or “product.”

Platform: a major piece of software, as an operating system or environment, under which various smaller application programs, processes or technologies can be designed to run. Can be architected as a set of interconnected tools running inside one digital framework and user experience. Typically modular and extensible by design. A platform can be delivered as an integrated solution stack or service.

Both tools and platforms can be extremely useful. But when using them at a complex health plan organization, their limitations and potential become clear. 

Specialized Tools for Specific Needs 

It’s easy to understand the appeal of legacy standalone products, popular apps and best-in-breed tools. Think about the utility of your reliable and familiar claims editor, the specialized nature of a member engagement chatbot, or the competitive advantage provided by a set of algorithms powered by machine learning. And because these tools are often specific to a discrete function of the business, the affected departments often have the autonomy to choose, purchase and implement products on their own. 

Beware complexity

As a result of this low-threshold acquisition process, a mid-size company, on average, uses over 150 software products. And, as this number increases, so does complexity. Not only are there increased security risks and billing owners but also necessary app connections – averaging over 5,000 connections for those 150 pieces of software. Most of these tools lose their usefulness if only one user can access them, or if they’re separated from larger processes and platforms, which necessitate these connections.  

 For example, what good is that member chatbot if it doesn’t seamlessly integrate with the CRM? How efficient is that front-end claims editor if it’s disconnected from auditor prepay and recovery efforts, which are also separate from provider engagement processes? 

 It’s all too easy to find a special tool that solves the problem of the day or translates a manual process into a digital one. But,  understanding that your health plan’s challenges and goals change at an increasingly rapid pace in today’s modern world, it pays to consider flexible technology frameworks that mitigate predictably fragmented processes. 

5 Reasons to Choose a Payment Integrity Platform

With the awareness that stakeholders and processes across the health plan are increasingly interconnected, and that the pace of change is accelerating, adopting technology with flexibility and data visibility in mind is a smart move. For health plans we speak with, that leverage is exactly what the platform approach to technology adoption provides. 

With cost containment efforts driving a significant portion of operational strategy, here are 5 reasons for health plans to choose a payment integrity platform: 

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1. Collaboration

As the fulcrum of the healthcare industry, health plan processes involve many stakeholders. Payment integrity efforts alone require third-party services suppliers, audit staff, the SIU and providers all to communicate at various points of the process. The tendency is to seek out collaboration or workflow tools to solve for this need – even though the key information that needs to be communicated exists outside of these tools. 

Fortunately, most platform solutions incorporate communication capabilities in addition to shared access to essential information, which allows multiple audiences to literally be on the same page. In addition, allowing every stakeholder to stay on-platform to perform their tasks creates efficiencies and stronger user habits. 

2. Seamless integration

No matter how comprehensive the functionality native to the technology platform is, outside tools – and even other platforms – will continue to be used throughout the organization. IT teams already have too many tedious integrations to manage: legacy solutions, specialized databases, cloud apps from various software vendors. But platforms turn projects that would usually require dozens of integrations into straightforward one-time connections. 

Integrating accounting platforms, CRMs, service vendor systems, provider systems, claims editors and more with a payment integrity platform provides unique synergies without overtaxing IT. Most are easily accomplished with low-code tools or simple API connections. This integration standard enables real-time data flow (unlike batch FTP) and can help health plans build a technology ecosystem that works toward healthcare data interoperability, which is mandated to be in effect for health plans by January 2021. 

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3. Detailed insights and analytics

Because health plans tend to use various disconnected pieces of technology, the associated data tends to stay locked in their respective silos – along with valuable insights the data provides. But gone are the days of matching business goals to queries on last month’s or last quarter’s information. With increasing demands from internal and external forces to tap into the value of enterprise data, health plans are answering the call with the help of integrative platforms. 

Payers can increase their data management and availability capabilities substantially when most of their PI work takes place on-platform. This improvement is especially true with cloud-based platforms. Particularly when coupled with data visualization capabilities, platforms enable a strategic shift in data ownership from a centralized IT function to business groups, giving more users the power to answer any question, with any data, in real time. 

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4. Configurability

Health plans tend to have unique processes and needs – even compared to other health plans – that require technology to be flexible to accommodate those differences. For most software tools, that requires custom development, which is either impossible (due to cost) or impractical (due to time). This limitation has led many a health plan down the path of building their own technology solutions with mixed results, which can include the risk of not being able to maintain a self-built tool over time. 

A hallmark of platforms, on the other hand, is configurability, which offers health plans an ideal blend of control and freedom. Solutions like Pareo, for instance, allow health plans to configure fields and workflows and user access to their specific situation, acquire additional functionality as needed, and seamlessly integrate other chosen platforms and tools to their benefit. All without substantially increasing internal IT lift by taking on software development, maintenance and security that splits focus from core operations. 

5. Scalability

The ability to collaborate and communicate with various stakeholders, seamlessly integrate with relevant technologies, derive actionable data insights, and configure your technology ecosystem determines whether your health plan can be flexible and agile. All of these platform benefits add up to a significant competitive advantage for health plans: scalability. 

Platforms support your goals to grow faster and innovate without worrying if your infrastructure and budget can accommodate accelerated plans. So, when you identify opportunities to extend product lines, boost customer service, increase operational efficiency and more that can substantially impact value, you are better poised to act on it.  

Pareo Goes Beyond a Tool 

The most successful technology strategies embrace the rapid pace of change. By taking a collaborative approach that acknowledges the interconnectedness of stakeholders and processes, health plans are much more likely to adopt a technology platform that accommodates varying needs and goals now and into the future. 

Health plans can certainly use Pareo for its discrete functionality – to manage vendors, optimize workflows, conduct data mining and complex clinical audits, engage with providers, coordinate benefits, move more efforts prepay, detect and manage fraud, and use data more strategically. But its potential to transform payment integrity operations comes to fruition when health plans leverage it as an integrative platform.

Pareo works best as the central hub for your health plan, connecting data points across your health information technology ecosystem in a way that allows you to maximize revenues, create efficiencies, achieve interoperability, and effectively manage your cost containment and fraud mitigation goals. 

NOW'S THE TIME FOR TOTAL PAYMENT INTEGRITY

Talk to ClarisHealth about how Pareo®, a total payment integrity platform, is driving innovation at health plans. 

Health Plans Launch Innovative Solutions to Respond to Mental Health Crisis

Health Plans Launch Innovative Solutions to Respond to Mental Health Crisis

Transparent data sharing supports seamless care coordination, relevant outreach that mitigates effects of chronic conditions. 

The novel coronavirus pandemic continues its near-perfect record as a harsh but effective teacher for the healthcare industry as it efficiently evolves systemic weaknesses into full-blown crises. Patient and procedure volume-based reimbursement structures? Check. Primary care access? Check. Healthcare coverage? Check. Now we can add the mental health status of Americans to that list. But, even with these issues, the ability to steer through the challenges and find our way to an appropriate solution is still within reach. And payers, with their increasing focus on whole-person care, are particularly suited to drive these changes.  

How can health plans promote improved access and outcomes in mental health while controlling costs associated with this expensive chronic condition during the pandemic and beyond? And what are the implications to health plan payment integrity operations? Let’s explore the landscape and potential solutions. 

Challenges: Access and Expense 

It’s estimated that 1 in 5 Americans suffer from mental health issues. It’s a problem that’s already been increasing in severity across our population, especially among teens and young adults. But with the onset of the pandemic, there are signs that figure may be increasing dramatically. 

Increased isolation, grief, job losses, pressures from juggling home/work/childcare responsibilities, extended uncertainty and more are creating and worsening anxiety and depressive disorders. And, among frontline healthcare workers and other essential employees, in particular, there are concerns with potential long-term PTSD-akin effects. Experts predict an associated increase in suicides, overdose deaths and substance use disorders as well. 

Why are these rising cases such a concern? There are two big perennial challenges associated with mental healthcare.  

Limited access to care

Without proper intervention and maintenance, there is risk of situational mental health issues becoming chronic and existing mental health conditions becoming increasingly severe. But while 20% of Americans experience mental illness, historically less than half receive treatment. This limited access to appropriate care has a variety of causes. While there are cultural barriers – concern about perceived stigma, for instance – structural barriers are just as restrictive.  

At least 60% of U.S. counties don’t have a single practicing psychiatrist, so even for those patients covered by insurance, access is an issue. They struggle to find in-network mental health providers that will take their insurance. One study found that these patients with commercial insurance were up to 15% more likely to receive out-of-network care than other chronic disease patients, and their cost burden was almost 4 times higher. 

And, for those who have managed to get treatment, the pandemic has limited their in-person visits and put their providers in a precarious financial position. Already vastly underfunded, fragmented and difficult to access, mental health providers have been just as impacted financially as other healthcare providers. But because relief funding is largely based on Medicare rates, rather than Medicaid, community behavioral health centers were less likely to pursue and receive support.  

Mental health and addiction providers estimate they will lose $38.5 billion in revenue in 2020, and more than 60% of providers had already been forced to close at least one program before the end of April. Close to half of mental health and addiction providers report their chances of survival at 6 months or less in the current fiscal climate, minimizing their ability to act as a safety net when they are needed most.   

Expensive to manage

Mental health conditions negatively impact quality of life and economic productivity, which are grave enough consequences. But in addition to the healthcare industry lacking sufficient mental health resources, it is also one of the more expensive chronic conditions to manage. In 2019, the U.S. spent over $225 billion on mental health services, or 5.5% of total healthcare spending, and that dollar amount has increased over 50% in the last 10 years.  

Direct spending on mental health services doesn’t paint the full picture. Mental illness is disproportionately associated with physical chronic conditions as well – cardiac, pulmonary and obesity comorbidities. In fact, depression quadruples the risk of a heart attack. And taken together, these issues create a much bigger impact. According to the CDC, 90% of national healthcare spending goes towards managing chronic conditions and mental health.   

Approximately 75% of those with severe mental illness (SMI) have at least one chronic physical ailment, and the number increases among vulnerable populations. One study of Medicare beneficiaries found 12.7% of spending was associated with mental health disorders, but mental health services only made up 4.2%. In fact, patients with an SMI reflected a 37% increase in physical healthcare costs, and an 18.4% increase for those with other common mental health disorders.  

Opportunities: Telehealth and Whole-Person Care  

Even with these systemic challenges associated with mental healthcare, promising signs have emerged that hold the potential to mitigate their effects, including rapid adoption of telehealth and payers increasingly focused on whole-person care.  

Accelerated virtual care adoption 

Telehealth use already found its niche in behavioral healthcare, especially in underserved areas. But with the stay-at-home orders, telehealth claim lines increased more than 8,335% from April 2019 to April 2020. Mental healthcare was a big driver of those visits, but chronic condition management made big gains in virtual care adoption as well.  

Teletherapy offers distinct advantages for mental health patients, not the least of which is extending access to mental health providers when availability or convenience is an issue. It also eliminates the need for travelling to an appointment, allows for a familiar environment and may even mitigate concerns of stigma. Mental health providers, too, see benefits by gaining insights into the home environment and allowing patients to more easily maintain valuable therapeutic visits. 

Even though many patients had little to no experience with telemedicine or other forms of virtual care, most have been pleased with the encounters and want to see it continue indefinitely. And, in the same way payers have seen success with virtual care for monitoring and managing physical chronic conditions – and creating patient trust in the process – there is reason to expect similar results with mental health conditions. 

Increasing focus on whole-person care  

Health plan models are increasingly centered around improving the delivery of person-centered care. How can you treat the whole person and engage provider, patient and other stakeholders after the encounter? Two different models of coordinated care for better integrating mental health are common.  

Co-location of services – where mental health and primary care providers physically exist in the same place – offer economies of scale, efficiency and improved outcomes that benefit health plans. Looser collaboration agreements don’t require a provider organization to deliver the full array of services, provided they work closely with others across the service delivery ecosystem to ensure coordinated access to care, but does necessitate a technology infrastructure that supports true data interoperability. 

For health plans, both models see the full array of services – for mental health and physical healthcare – covered under a single agreement with a goal of positively impacting utilization and health outcomes. And new clarity on privacy regulations makes it more straightforward for providers to coordinate care for those patients suffering through a crisis. 

Innovative approaches to coordinated care promise to unlock value for payers, providers and consumers by supporting alternative reimbursement models; offering leeway on care modalities to include telehealth, remote patient monitoring technologies, and care management home visits; and providing real-time care integration. Many health plans are relying on integrative technology solutions as a backbone to power a seamless patient care experience, and these benefits extend to behavioral health.  

Advanced Technology Enables Relevant and Sustainable Solutions 

While the challenges – and opportunities – are significant, health plans don’t have to pioneer entirely new programs in order to improve systems for mental healthcare maintenance and intervention. Engaging members and providers via current advanced technology initiatives can strategically extend this function. 

Member engagement 

A new poll confirmed what we already feel to be true as consumers: the healthcare industry is simply too complex to navigate effectively. Respondents overwhelmingly cited every aspect of healthcare – care access, management, and payment – as needing to be streamlined and simplified. “They want health plans and providers to end the fragmentation, simplify the experience, and deliver a fully connected encounter that makes healthcare as seamless as any other online endeavor.”  

Arguably, the system proves to be even more unnecessarily opaque for those experiencing mental health issues and their support system. And those with mental health disorders are at higher risk during the pandemic. Many health plans already prioritize seamless member engagement opportunities, supported by modern communication modalities. But, as we wrote in a previous article, consumers want to hear from their health plans more, especially with relevant information. One payer program of this type is already seeing the benefits. 

Additionally, more advanced solutions like population health management platforms, such as that offered through Pareo, allow you to proactively assess disease risk among your membership. Taking this opportunity to reach out to members about their telehealth options, the importance of medication adherence, information about prescription assistance, wellness options, chronic disease management, checking in with a primary care provider, how to better protect themselves from COVID-19 and more promises to yield significant dividends.  

Provider engagement 

Many behavioral health providers and facilities still receive most of their revenue from fee-for-service reimbursement, but from there member experience can unravel. Some payers will not give reimbursement checks to a facility directly, but rather to the plan member. This can create abrasion between the patient and provider as well as the provider and the payer, but that risk can be mitigated through strategies like prospective cost avoidance and coordination of benefits.  

However, in order for mental health providers to shift revenue management strategies, health plans need to be in a place where they can support prepay. Pareo is a seamless payment integrity solution that can power retrospective and prospective claims recovery. It does this in part through automated workflows and by housing relevant medical claims data, enabling plans to hold up their end of prospective cost avoidance.  

Related to mutually beneficial payment structures, a survey conducted in March 2020 indicated 74% of primary care organizations and 61% of behavioral health organizations participate in some form of value-based reimbursement. But, only 16% of those organizations have 20% or more of their revenue in such an agreement. With health plans looking to accelerate adoption of alternate payment models, it’s important to keep in mind what’s essential to their acceptance and ultimate success. 

Extending clinical data interoperability, integrated workflows, proactively identifying gaps in care, and real-time metrics are key components of modern value-based contracts. When health plans better engage with mental health providers, those providers are empowered to better support members. And transparent data sharing – like that supported by the integrative platform Pareo – extends health plans’ abilities to do exactly that.  

Pareo Provider is a seamless technology platform for real-time engagement with providers, including specialty providers. Not only for the purposes of payment integrity – though Pareo effortlessly accommodates complex reimbursement contracts and supports two-way communication on claims. But also new information on virtual care allowances, sharing quality metrics, getting credit for SDOH assessments and more – without increasing the provider or payer administrative burden.  

Pareo is a Single-source Solution for Payment Integrity Operations

Understanding trends in behavioral health management is vital to health plans, and payment integrity teams must take note of the implication of mental healthcare utilization on their operations. With only half of those who suffer from mental health conditions receiving care, and many members eligible for care struggling to find access to providers, complexities abound. Further, many mental health providers and facilities are using outdated payment models, because before the Affordable Care Act, mental health was often not a covered health insurance benefit.  

Pareo is a single-source payment integrity solution that can integrate with myriad data systems to power even the most nuanced retrospective and prospective claims recovery efforts. Within Pareo, features that support provider engagement, population health management and prepay can facilitate (and automate) facets of behavioral health claims management to create a better experience for payers, providers and most importantly – patients. 

NOW'S THE TIME FOR TOTAL PAYMENT INTEGRITY

Talk to ClarisHealth about how Pareo®, a total payment integrity platform, is driving innovation at health plans. 

Health Plans Pursue Tech-First Strategies for Consolidation Success

Health Plans Pursue Tech-First Strategies for Consolidation Success

How easy is it to merge valuable data when health plans form partnerships? Advanced technology provides the foundation for successful consolidation agreements. 

If you follow the tech scene at all, you may have seen the recent news about a failed autonomous vehicle collaboration between BMW and Mercedes-Benz. For health plans, one of the big reasons cited for why the partnership stopped before it really got started will sound all too familiar: it was just more complex and expensive to create a shared technology platform than anticipated. The mutual goals and expertise were aligned, but the technical barriers erased the benefits.  

While health plan consolidation experienced a brief pause at the onset of the pandemic, it has been a reality for some time and is expected to continue for the foreseeable future. What makes these associations more likely to be successful? It’s a distinct strategic advantage to know ahead of time. In this article, we look at the landscape around health plan consolidation, common challenges and – based on recent examples – how health plans can set themselves up for success with a technology-first mindset. 

Primary Drivers of Health Plan Consolidation 

As the healthcare industry increases in complexity, consolidation – of both payers and providers – becomes a more and more attractive option. Historically, large insurers acquired many of the smaller health plans that arose during the managed care era and this trend only accelerated with the enactment of the Affordable Care Act. Now, at least 75% of the payer industry is made up of highly concentrated markets, up 71% since 2014, according to a recent AMA study. That number continues to increase, driven by external factors and supported by health plans’ desire to innovate via partnerships. 

Broader market trends

When it comes to complexity – and uncertainty – the current healthcare environment has been hit with an excess of both. Even before the onset of the novel coronavirus pandemic and its unique concerns, the new healthcare data interoperability rules were finalized. The Rules require advanced technology that can support modern API connections. The push toward alternative payment models like value-based care succeed only with healthy provider relationships and trust fostered by transparent data sharing. Our rapidly aging population is resulting in higher healthcare utilization and more complex chronic conditions, which also requires more sophisticated care coordination 

At the same time, these trends have led providers to consolidate at an unprecedented rate as well. Deloitte models predict only 50% of current health systems will remain in 10 years due to consolidation. Hospital- and health system-employed physicians increased from 25% in 2012 to 44% in 2018. Because provider consolidation decreases payer leverage in negotiating prices, this situation has further inspired health plan consolidation.   

Payer innovation will be tested now more than ever, and altogether, these challenges are adding up to a perfect storm of drivers pushing payers toward increased affiliation. As explained by the leader of one health plan in the merger process, “The headwinds and changes in health care are so drastic, the competitive market changes so drastically [that] we can’t stand still.”  

Payer innovation will be tested now more than ever, and altogether, these challenges are adding up to a perfect storm of drivers pushing payers toward increased affiliation. 

Health plan operational synergies

In addition to external motivators, health plans must also find partners that are well suited to an alliance in order to pursue a dealWill the partnership provide the economies of scale opportunities and reduced administrative costs they seek? Will the sharing of valuable member data and lines of business prove advantageous to the organizations? When searching for an appropriate partner, 26% of payer executives prioritize those that maintain or increase their competitive advantages. Most merger/acquisition activity is justified, in large part, by operational synergies.  

Health plans may look to become leaders in product and innovation, population health and outcomes, member experience and advocacy, value or any combination of these. The good news is, according to a recent Best’s Special Report, health plan innovations and partnerships often thrive under change and urgency. “Innovation isn’t limited to technology. It also includes a company’s ability to generate ideas that can be incorporated into—and even lead to—new business models.” 

Consolidation Comes with Challenges

Once health plans decide to pursue an official relationship, that’s when the real work startsOutside of possible review by the FTC and the Department of Justice for proposed transactions that are valued at more than $94 million and/or are believed to “substantially lessen competition,” there are a few major hurdles to address during the serious due diligence part of the process, both cultural and technical. 

Managing public perception

No matter the payer motivations for consolidation, it pays to understand how employers, consumers and even providers perceive the new relationship. In a PWC study examining the expectation of increased healthcare mergers, they cautioned that affiliating organizations “will need to ensure that the deals they pursue pass the sniff test of employers and consumers seeking more affordable care.”   

Fortunately for health plans, two studies come down on their side, especially in markets where providers are highly consolidated. One indicates improvements in patient satisfaction associated with increases in insurance consolidation relative to hospital consolidation. Another suggests greater insurer concentration depresses healthcare prices, while the opposite is true for hospital concentration.  

If health plans emphasize and fulfill their goals of “better health solutions for members that can increase customer and clinician engagement, create better health outcomes, manage costs and improve affordability,” as one recent merging entity communicated, they should mitigate the concerns of consumers. 

Managing data and IT integration

In order to capitalize on administrative cost savings and sharing of valuable data, integrating technology of the merging companies is a necessity. But inadequately preparing for process and systems integration increases costs significantly over time. According to one expert analysisdoubled or tripled ongoing IT costs as well as increased complexity from a greater number of technology applications can result. 

Speed to integration can be an issue as well. With more than half of business synergies dependent on systems integration, increasing velocity in this area can enable health plans to realize revenue and cost synergies earlier and present a united front to members. For health plans that operate on legacy technology platforms and manual processes – especially with their high-volume of transactions – achieving interoperability and data and analytic extraction with speed will present particular difficulties. Completing most systems integrations within a year should be the goal. How can health plans achieve this ideal? 

Advanced Technology Eases Health Plan Partnerships 

If speed to technology integration and demonstrating value to members and employers is key to a successful partnership, payers with a tech-first mindset – and the ecosystem to match – will have the strategic advantage in these situations. Recent horizontal and vertical integrations in the payer industry have borne out this innovation strategy. And though advanced payer HIT has historically been concentrated among the largest players, there are signs that trend is changing. 

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A 2019 KLAS study of 40 payer organizations found that health plans are increasingly acting with eyes firmly on the future. Rather than waiting to innovate, they are “looking for modern technology solutions to help them manage multiple business lines and adapt to changing requirements for value-based care.” These decisions focus particularly on industry disrupting technology like Pareo 

With the understanding that relying on legacy technology and manual and paper-intensive processes minimizes their ability to scale, whether or not they are shopping a partnership, health plans are taking steps now to upgrade their position. It is much easier to consolidate processes with enterprise technology in place. In fact, enterprise technology platforms that “plug and play” may help scale process during consolidation. And combining organizations’ payment integrity and fraud, waste and abuse functions in an acquisition is an obvious area for potential savings.  

The setback experienced by two auto giants pursuing a non-exclusive partnership is nothing compared to the wasted resources by payers shopping a merger that ultimately fails. Discovering too late that plans of operational synergies can’t come to fruition because of entrenched manual processes in one or both parties is a real risk. But by adopting a technology-first mindset before a partnership opportunity presents itself – supported by leveraging an integrative platform like Pareo – health plans can more proactively position themselves for success in the modern healthcare landscape. 

NOW'S THE TIME FOR TOTAL PAYMENT INTEGRITY

Talk to ClarisHealth about how Pareo®, a total payment integrity platform, is driving innovation at health plans. 

4 Payer Responses to Primary Care Challenges

4 Payer Responses to Primary Care Challenges

Primary care providers are the foundation of the healthcare system. With the pandemic putting its future at risk, health plans can take 4 steps to address this challenge. 

It’s been said that the coronavirus pandemic hasn’t created any new problems; it’s just escalated existing ones. This maxim seems especially true for primary care providers. Primary care practices have really struggled during the pandemic – at a time when their role has never been more important. Patient volumes are down by more than half, which makes it difficult for them to stay afloat in largely fee-for-service arrangements. But even under ordinary circumstances, independent practices tend to operate at an unsustainable net loss of 20 to 30 percent a year. 

Primary care providers are the keyholders for our healthcare goals: improving the health of populations, enhancing the experience of care for individuals, increasing health equity and reducing the cost of healthcare. How can payers support primary care in a way that helps improve the clinician experience so they can better fulfill their role’s potential? Let’s explore the landscape around primary care, including how it has been impacted by COVID-19, how consolidation and other factors are affecting its future, and steps health plans are taking. 

Role of Primary Care  

Even before the novel coronavirus, Americans in an increasing number of “provider deserts” suffered from lack of reliable access to care. As a result, they experience some of the worst issues in our healthcare system: poor healthcare outcomes and increased healthcare costs due to complex conditions exacerbated by lack of management and overuse of emergency rooms. These vulnerable populations are more likely to experience adverse effects of COVID-19, and the difference comes down to primary care. 

2019 report found that Americans with dedicated primary care received significantly more “high-value” services, such as recommended cancer screenings, diagnostic and preventive testing, diabetes care and counseling. Those with primary care also reported better healthcare access and experience, compared to those without. These results are intuitive, but their significance can’t be overstated. 

A primary care provider is often termed the “quarterback” of the healthcare system. It’s usually the longest-term relationship a patient has and, especially in the current environment where interoperability is lacking, primary care often has the most comprehensive health information available. They know the patient health history and social determinants of health, and they understand how the healthcare system operates. 

Conversely, a person without a primary care provider – due to poor proximity, healthcare coverage, schedule availability, or a combination of these factors – may have access to a specialist or two, but they are likely largely relying on a cobbled together arrangement of emergency care and walk-in urgent care. None of which is designed for whole-person care and can lead to complicating events like dangerous medication interactions. 

Pandemic Impact 

With the patient volumes at primary care practices down significantly, revenues have also been cut in half. Even with CARES funding, small business loans and telehealth payment parity made available, it has been a struggle for this group of providers. Recently, the HHS provided nearly $6 million in funding for COVID-19 training and technical assistance activities to 52 state and regional Primary Care Associations (PCAs), which support non-profit and safety net primary care providers. While this is certainly a welcome lifeline, it covers only a small segment of providers and services and doesn’t address the administrative burden that is particularly onerous for primary care.  

A recent survey indicated in May that many practices are at risk of closing in a matter of weeks. Specifically, 45% report layoffs and furloughs, 28% skipped or deferred salaries and 14% have temporarily closed – numbers that have remained constant. In fact, one tool projects a catastrophic loss of family medicine physicians by the end of June – almost 60,000 fewer, leaving over 1,800 shortage area counties. 

Mixed telehealth success

While many providers have rapidly deployed telehealth and virtual care to continue to serve patients and minimize their financial impact, reimbursement  hasn’t always followed and some patients struggle with accessibility. The survey previously cited further revealed 84% of providers report patients struggle with virtual care, and only 57% say more than half of the care they provide is reimbursable while 18% have been denied reimbursement for virtual and telehealth. 

Patient care delays

While the current phase of reopening holds out hope for improving these issues, there continue to be areas of concern. Particularly, patients have been and continue to delay essential preventive and maintenance care due to financial issues. This situation has been growing along with the proliferation of high-deductible health plans. And, once again, the pandemic has aggravated it into a potential crisis. 

One recent survey indicated a third of consumers plan to reduce their healthcare spending. And, unfortunately, “consumers with complex chronic illness and those in healthy families were more likely than other groups to say they would adjust their spending on healthcare visits or medications.” 

Burnout

Altogether, these concerns are worsening a perennial challenge for primary care providers: burnout. A survey conducted last year indicated 79% of primary care physicians experience burnout, compared to 68% of physicians overall. A study published this year explains why the current crisis is intensifying the burn: too little time with patients, overwhelming paperwork, emphasis of profit over patient care. 

Researchers expressed concern about the extraordinary burden COVID-19 has placed on these professionals. “These findings tell us that we need to prioritize understanding and addressing clinician burnout at a system level and at a local level. The human cost, as well as significant physician shortages expected in the future, make this a critical public health concern.” 

Threats to the Future of Primary Care 

Demand for primary care providers is increasing more rapidly than supply, and provider availability is seen as one of the top barriers to meeting the healthcare needs of patients in this country. In 2013, 53% of states were already experiencing primary care physician (PCP) shortages. By 2025, experts expect that shortage will include 72% of states. 

The number of doctors going into primary care continues to decrease in favor of better-paying specialties. And consolidation – in the form of doctors employed by health systems or payers, or joining larger practices – continues to increase, which further decreases provider access and drives up healthcare costs. 

Another factor contributing to the primary care shortage is our rapidly aging population. For one, physicians themselves are growing older. Fully one-third of currently practicing physicians will be over retirement age in the next decade. In addition, seniors are a rapidly growing segment of the population, increasing by 50% over the next decade, and tend to require two to three times more healthcare than their younger counterparts. At the same time, there continue to be reports of primary care physicians exiting Medicare, due to lower reimbursement combined with higher administrative burden to participate.  

In fact, there is some evidence of primary care providers dropping out of onerous reimbursement arrangements entirely in favor of more predictable compensation models. So-called “membership medicine” like concierge or direct primary care (where patients pay upfront fees for access to doctors) is a small segment of how these physicians practice but is growing in popularity, especially in affluent areas.  

What providers encompass “primary care”?

When you think of “primary care” you may be only thinking of your family doctor. But primary care includes a broad spectrum of credentials – doctors, nurse practitioners, nurses, pharmacists – and a range of specialties that fulfill the general medical needs of patient populations: 

  • Family medicine 
  • Internal medicine 
  • Pediatrics 
  • General OB/gyn 
  • Gerontology 
  • Behavioral health 
  • Community health 
  • Optometrists 

How Health Plans Can Respond to Primary Care Challenges 

The future of primary care stands to impact all areas of quality and satisfaction in healthcare but, perhaps most relevant and impactful for health plans, are the ways it affects short-term and long-term healthcare costs. According to an expert on the intersections between public health, primary care, and health care policy, “If you think that investing more significantly in primary care and preventive public healthcare is expensive, try not investing. That’s way more expensive. And not just economically, you’re also ignoring the suffering that goes on as well.” 

In addition to the potential increased costs, consolidation is also not preventing a loss of primary care providers. As the new president of the AMA relates, “The recent issues during the pandemic with physicians who are employed by large health systems not being able to get the PPE that they need, being disciplined for wearing PPE in certain situations, being furloughed, being laid off, being disciplined just for doing what they thought was best for their patient, I think, highlights the importance of physician autonomy.” 

In the face of these challenges – impacting payer bottom lines, member satisfaction and health, and provider networks – health plans have a few avenues to pursue in shoring up this cornerstone of the healthcare system. Here are 4 ways that payers can respond to primary care challenges: 

 1. Extend telehealth

Health plans providing leeway on virtual care has been a real boon for providers and their patients. But, along with extending telehealth payment parity, effectively communicating those changes and appropriate education really makes this benefit useful. The leader at a technology provider for clinician practices noted, “Most physicians don’t even know how to code correctly for the phone call or virtual visit to take advantage of the changes Medicare (and other payers) have made during the pandemic to increase phone call reimbursement and pay for telehealth visits at the same rate as in-person visits.”

2. Promote value-based care contracts

We wrote before how those providers who were already engaged in alternative payment models were better prepared to weather the patient volume dips associated with the pandemic. Primary care providers seem especially suited to this model because of their role in preventive care and unique ability to screen for social determinants of health and impact overall patient care outcomes. For health plans positioned with advanced technology to offer real-time communication, two-way data exchange, and telehealth flexibility, their primary care provider networks should be better prepared to withstand perceived risks and more open to these modern arrangements.  

CMS is already piloting the Primary Care First project with similar structure and goals. The program covers a variety of providers – MD, DO, CNS, NP and PA – and will be active in 26 regions across the U.S. With a simple flat fee payment structure plus upside revenue sharing, it aims to reduce primary care practitioners’ administrative burden to allow them to focus on effective care and the doctor-patient relationship. 

 3. Continue prepay payment integrity efforts

When it became clear how seriously the pandemic was affecting providers, health plans fast-tracked their plans to transition more payment integrity efforts prospective. Because post-pay audits increase the provider administrative burden and increase costs for payers as well, this move to prepay is a trend that’s here to stay. Especially when combined with provider education and two-way communication, supported by an engagement platform like Pareo Provider, this activity should increase engagement with valuable network providers.

4. Support and engage providers

With the understanding that without providers, there is no effective healthcare system, health plans have been directly supporting providers financially. While this effort is admirable and well-intentioned, it is a short-term solution. But extending technology and policy to reduce providers’ administrative burden promise to offer long-term relief. 

The work providers have to perform in EHRs is particularly burdensome, with primary care providers particularly hard hit among specialties. With around 20 minutes per patient visit, on average, dedicated to this administrative task, it’s an outsized contributor to burnout and minimizes primary care availability. And this time doesn’t even include pulling medical records for health plans’ payment integrity needs. With real-time communication and seamless data exchange – supported by advanced technology platforms like Pareo – health plans can promote interoperability and reduce cumbersome administrative tasks. 

One health plan has launched a new partnership with this intent. This arrangement consolidates all necessary medical records and administrative processes like prior authorizations into one place. By allowing for a quicker and more structured view of patient information, it should reduce documentation time in favor of patient care.  

Pareo Transforms Engagement in Healthcare 

Even before the global pandemic hit our shores, the healthcare industry had been focusing on innovating in the face of coming disruption. Pareo was created with this initiative in mind, supporting health plans at the top of this chain to transform engagement in healthcare. The integrative technology platform may start with payment integrity, but it extends to real-time communication with providers – including primary care – to reduce their administrative burden and add to the time they spend caring for members. It’s an effort with real implications in reducing healthcare costs and improving outcomes. 

NOW'S THE TIME FOR TOTAL PAYMENT INTEGRITY

Talk to ClarisHealth about how Pareo®, a total payment integrity platform, is driving innovation at health plans. 

Health Plans Return to Payment Integrity

Health Plans Return to Payment Integrity

Now that the crisis-volume of COVID-19 cases has started to ease across the country, delayed elective procedures and in-person provider visits are beginning to resume. While providers return to some semblance of normalcy, health plans are returning to business as usual as well. Our health plan clients are making moves to resume retrospective payment integrity audits they paused in order to relieve the provider administrative burden. What does “back to normal” look like for the healthcare industry, and how can health plans do a health check on the lingering symptoms of the pandemic to ensure their return to cost containment operations goes smoothly?  

The “Great Pause” Brings Clarity for Health Plans  

While providers have borne the brunt of the pandemic, health plans appear to have weathered the first months of COVID-19 relatively unscathed – or have they? Even in the short-term, there have been significant changes for health plans. Changes such as receiving more telehealth claims than ever before, heightened data security challenges, and facing rapid upheaval of processes in an already administratively complex environment. What’s more, they have risen to the occasion to support their network providers and members, who have suffered significant hardships during this time.  

In addition, with the dramatic reduction in healthcare encounters, overall claim volumes have dropped as well, especially for those insurers whose populations reside outside of virus hotspots. Taken alongside pledges to accelerate payments to providers and reduce their administrative burden by minimizing claims recovery efforts to only the most egregious cases, this situation has left payment integrity departments with more breathing room in their day-to-day than usual. And it couldn’t come at a better time. 

During periods of great uncertainty like the industry is experiencing now, the most critical skill is adaptability: being able to focus on surviving in the current moment while also building toward thriving in a future that will look different. Increasingly for health plans, innovations to survive in the short-term and thrive long-term look like technology – including both novel uses for existing tools and new solutions to address new (and old) challenges.  

These were trends before the coronavirus pandemic, and the urgency of the situation has only magnified technology’s importance in supporting members, offering work environment flexibility and reinforcing relationships with providers. As the chief medical officer at one large regional health plan explains, “We need to be more open to change, step out of our comfort zones and embrace the unfamiliar. Barriers that have stymied innovation in healthcare aren’t as insurmountable as we once thought.” 

Increased Healthcare Utilization Results in 3 Claims Trends 

Now that health plans have navigated through the short-term impacts and are putting plans in place to position for long-term success, they are better prepared to adjust to the new normal of healthcare. A recent survey indicated that 80% of payer respondents expect a sharp increase in claims over the next few months. For payment integrity departments, that signals a return to processing claims as before, even as some changes in healthcare utilization are expected to continue for a while. Here are 3 claims trends health plans can look out for in the next phase of reopening. 

1. Resumed elective procedures, ER and outpatient visits

The state bans on elective procedures relaxed at the end of April, and patient activity is responding accordingly, albeit slowly. One survey indicates 70% of patients have rescheduled procedures for the second or third quarter of 2020, which holds true across all regions of the U.S. With that resumption, though, sites of care are changing with patients less willing to visit inpatient hospitals. Hospital outpatient settings, ambulatory surgery centers and a physician’s office were preferred. 

In addition, emergency department use and physician visits best conducted in-person are also rebounding. ER visits, which dropped 42% during April, have recovered 21-32% of volume, depending on patient age. Outpatient volumes recovered over 50%. 

As procedures and face-to-face encounters resume there is a concern that the delay may have caused conditions to worsen, resulting in more complex and costly claims. In one survey, “more than one in ten of those who skipped care reported that their condition declined because of their decision to postpone care.” 

2. Continued telehealth, home health claims

For the rest of patients whose maladies can be managed and addressed remotely, telehealth and other modes of virtual care are still a popular option. Its use increased more than 4,000% over the last year, growing from 0.17% of medical claim lines to 7.52%. Now that consumers – and their providers – have been prompted to try it, they have found telehealth lives up to its promise of convenience, without unduly limiting the effectiveness or person-to-person connection of the visit. It also comes at a lower cost, and a new report estimates at least 20% of care could be offered digitally. 

Home health, too, has found its moment for patients who, for instance, regularly receive infusion treatments, need dialysis or require post-operative care. These trends have accelerated due to advances in at-home technology along with payers temporarily relaxing restrictions. However, whether these prove to be temporary changes or a permanent shift remains to be seen. 

3. Increased behavioral health utilization

The stresses of living during a global pandemic, along with increased social isolation due to stay-at-home orders, have negatively impacted mental health conditions for many Americans. Prescriptions for antidepressants, anti-anxiety and insomnia medications spiked in the first months, many for first-time use. At the same time, while inpatient mental healthcare capacity and utilization has dropped, many patients have taken advantage of virtual mental health visits.  

One technology vendor executive attributes this increase to reduced stigma associated with telehealth, along with greater availability. That is a hopeful sign for wellness initiatives, and because counseling is one of the specialties more readily covered by telehealth even before the pandemic, this trend may continue indefinitely. 

How Health Plans Can Improve Payment Integrity Agility 

With the understanding that healthcare may be in flux until a reliable vaccine and/or treatment for COVID-19 is available, health plans are returning to their claims recovery efforts with sensitivity to how this activity affects providers and members. This transition requires agility, which is a cultural initiative and skill. As a leader at a large state-based health plan says, “We put these skills into action during the COVID-19 pandemic, making decisions rapidly to respond to the needs of our members and providers.” 

Responding to member and provider needs with tech innovations 

Adjusting to the rapid changes in healthcare to be responsive to member and provider needs may start with a culture shift, but technology is the enabler. Providers and members both are still reeling from the coronavirus impact, and health plans are best positioned with real-time data to promote seamless communication and continue the shift to prepay. 

Real-time data provides the insights needed to determine how and when to adjust the response. Health plans can leverage an integrative platform like Pareo to ingest data feeds from multiple sources for a fuller view of the claims environment. It’s a first step towards interoperability, which supports both members and providers. 

Seamless digital communication follows. At some point, health plans will begin to roll back the financial relief they have been extending to members and providers. The waived copays and cost sharing for coronavirus testing and treatment. The relaxation of prior authorization requirements. To ensure members and providers don’t end up holding the bag due to lack of knowledge, seamless two-way digital communication is key. Both internally with payment integrity departments and externally with members and providers.  

Pareo Provider includes a web-based portal designed to engage with providers on claims status, education, medical records exchange, data sharing and other relevant two-way communication to foster this valuable partnership. Request a Sell Sheet

Prepay claims processing has come into its own during the healthcare crisis to reduce abrasion with providers. It’s more sustainable than accelerating payments and CARES funds, which have many strings attached, and reduces the costs associated with reworking claims – for both payers and providers. While post-pay payment integrity audits will never cease entirely (combating healthcare fraud, in particular, is largely a post-pay activity), minimizing the administrative burden of “coming from behind” to adjust payments in favor of more prepay work is a trend that’s here to stay.  

Pareo Prepay supports this shift from pay-and-chase to working claims before payment with a concepts repository accessible across the payment continuum and configurable workflows that easily accommodate tight prepay timelines.  Request a Sell Sheet

The Bigger Picture 

Innovations in payment integrity have long been a goal at health plans. Health plans that we speak with continue to drive home the importance of data at this crucial time, to provide a measure of predictability during a situation that’s far from certain. Yet, connecting data from disparate streams and collapsing it into usable insights – insights which can be drilled down into – is still far from available to many health plans.   

Imagine a platform in which your entire payment integrity operations are fluid, accessible, operational – in real time. Imagine accessing configurable reporting that offers actionable insights, tracks KPIs, and connects previously disparate data streams.  

Advanced technology platforms like Pareo put this goal within reach for more payers – not just those with vast resources at their disposal. Pareo now more than ever has the chance to revolutionize the healthcare industry. Are you ready to learn more? 

NOW'S THE TIME FOR TOTAL PAYMENT INTEGRITY

Talk to ClarisHealth about how Pareo®, a total payment integrity platform, is driving innovation at health plans.