Checking in: How to offer vendors a concierge experience

Checking in: How to offer vendors a concierge experience

When we created Pareo®, from its inception we knew vendors would be an important stakeholder in the payment integrity ecosystem. As our payment integrity solution has grown (in many ways, shaped by our incredible clients), it has cemented our belief that focusing on payment integrity suppliers is an important way we can better meet the needs of modern health plans. 

As you likely know, including more vendors in your payment integrity operations is likely to boost your recoveries. Yet, managing relationships with them can feel burdensome when we don’t have access to the right tools or information. That’s why we’ve set out to give those suppliers working with Pareo what I like to call the “Ritz Carlton experience.” 

That’s because — as with every relationship — you get from your vendors what you put in. We want to enable our clients to give their suppliers a five-star experience when working together. We developed Pareo Supplier Optimization to give your PI department all the tools they need to work effectively with vendors by boosting transparency, increasing engagement rates and contributing to improved recoveries. Perhaps you’ve discovered for yourself the value Pareo brings but you’re still looking for other ways to increase vendor experience. If so, read on.

Request a brochure and learn more about Pareo’s Supplier Optimization functionality.

7 Ways to Treat Your Vendors as Well as Customers

So much focus has been given to improving member satisfaction at health plans (with good reason — it’s important). But your vendors are such an important part of health plan operations, why not focus on their satisfaction as well? Are you giving them everything they need to help you maximize your return on investment? 

As you look to technology to improve supplier relationships, be sure to cover all your bases by striving for these 7 important functions that can lead to a better vendor relationship:

1. Share goals. The most successful vendor relationships function more like partnerships, rather than transactions. You both have the potential to provide greater value to the other.


“Vendor management is not negotiating the lowest price possible but constantly working with your vendors to come to agreements that will mutually benefit both companies.”



2. Communicate clearly and consistently. Transparency allows everyone to be on the same page. Both sides should be able to easily provide access to information on project progress — without asking for silo-ed status updates. “There may be issues between you and your vendor, but constant communication and a dedication to continuous improvement will make the difference,” writes Brian Fielkow.


3. Plan ahead. Set expectations on service level agreements, contract terms, etc. Surprises and emergencies are inevitable, but should be the exception with a well-thought out vendor plan. 


4. Pay on time. Their invoice should never be a surprise. Paying in a timely manner communicates to vendors that their work is valued.


5. Provide process training for your vendors. They have their area of expertise, which likely does not include “how you do things.” Set them up for success by bringing them to the table.


6. Be reasonable and accountable. Vendors are third-party stakeholders that rely on you in order to perform at their best. Likewise, you rely on them to meet their goals. Respect is a key part of the vendor-payer relationship and for health plans, that means being reasonable and accountable in vendor relations.


7. Make the most of meetings. The quarterly business updates that characterize most third-party payment integrity vendor relationships can be more valuable than out-of-date “status updates.” They can be meaningful strategy sessions, if the day-to-day communications are taken care of.

Talk to ClarisHealth about how Pareo®advanced payment integrity technology is helping health plans successfully implement their digital-first strategies.

Modernizing communication with providers

Modernizing communication with providers

Time to move past playing telephone with providers. Here’s a better communication strategy for health plans. 

By relying on fax machines and snail mail to communicate overpayments, underpayments, denials, and just about everything else, the payer-provider relationship sometimes looks like very dysfunctional pen pals. The cost of managing this unwieldy process is too high for both parties, but new options for electronically communicating are emerging. Here’s a candid look at how your health plan can modernize its approach to provider communication. 

What solutions have been proposed to improve payer-provider communication?

Remember the grade-school game of telephone? You sit in a circle and pass a message around by whispering it into the ear of the person next to you. Then the last person has to say to the group what they heard and often, the message varies hilariously from the original. What’s been happening between payers and providers isn’t all that different, only it’s not very funny. 

There are real costs and consequences associated with poor communication. And besides, moving away from telephone conversations is considered a first-step solution to improve provider communication. So what’s replacing phones and fax machines?

Two solutions have emerged as leaders in the effort to improve traditional communication problems: the Blue Button initiative and electronic payer-provider portals. Each is complex in its own right but are summarized below: 

    • The Blue Button initiative was introduced last year and aims to provide greater access to claims data. Several ONC/CMS proposals have been issued to promote health data sharing, more broadly, across healthcare organizations. These initiatives tend to be more focused on healthcare point-of-care decisions, though, rather than getting paid. Recently, CMS announced the Medicare Blue Button, a pilot program planned for launch next month. Other data sharing initiatives involving APIs have also been recently announced. 
    • Electronic payer-provider portals are solutions more focused on communicating about claims: overpayments, underpayments, denials, prior authorizations, medical records documentation. Last year, CMS administrator Seema Verma stated she wants physician fax machines gone by 2020, replaced by digital health information exchange. But to be effective, digital health information available via portals should be all-electronic, real-time communication in order to truly drive engagement and efficiencies.

What’s clear is that outdated methods of communicating between payers and providers will no longer suffice, either due to regulation or market demand. Furthermore, in order to meet consumer demand, payers and providers have to find a better way to share data. 

“People die because we don’t provide access to data in a real-time basis. The most important thing we can do is figure out how to coordinate that care in real-time so we can directly impact and save lives,” says a leading Blues plan president and CEO.

Where does Pareo® fit in? 

Pareo is a technology solution for health plans that fosters improved communication with providers through native, built-in tools. By automating some communication needs, streamlining others, and eliminating errant messages entirely (such as duplicate medical requests), Pareo allows health plans to make strides in digitizing health communications with providers. Importantly, a communication and engagement module like ours can serve to bridge the gap between data sharing and actually getting paid (something payers and providers alike appreciate). 

Pareo enhances Provider Communication efforts through: 

  • Faster payments with less manual intervention
  • Improving trust/NPS with providers
  • Facilitating alternative payment models
  • Growing recoveries

Payers need a way to see the bigger picture — a way to aggregate data and make informed decisions quickly. With an electronic provider communication mechanism in place (like Pareo), data sharing initiatives like Blue Button and APIs become actionable ways to move the needle and, even more importantly, save lives.

Talk to ClarisHealth about how Pareo®advanced payment integrity technology is helping health plans successfully implement their digital-first strategies. 

Be the change agent you wish to see at your health plan

Be the change agent you wish to see at your health plan

8 essential skills every change agent needs to navigate the future of healthcare

Whether you’re already leading change at your organization or hoping to do so soon, most health plan employees need to be well versed in change management as the industry braces for rapid innovation. Becoming an agent of change at your organization requires the type of holistic thinking that the healthcare industry notoriously struggles with. 

Based on our own experiences helping leading health plans implement change, here’s a look at how stakeholders can cultivate the 8 skills necessary to navigate the changing landscape, identify opportunities for innovation, and lead others into the future of healthcare. 

Change agent: a leader who has the skills to navigate an organization through change management initiatives

8 essential skills necessary to being a change agent:

1. Multigenerational influence

Unquestionably, health organizations successful in adopting change are embracing multigenerational influence in leadership (it’s even considered a competitive advantage). Representing all generations in leadership can help health plans respond to changes driven by upcoming generations, especially millennials

“The most successful companies will be the ones that let go of slow decision making processes and adopt a new talent base that is comfortable with experimentation, testing, learning — and even comfortable with failing,” writes Forbes. This cross-generational agility furthers a broader initiative of change management: culture. And culture is key to enacting true change says Becker’s Hospital Review.

2. Connecting change management to performance management

Healthcare has changed in scope and complexity in recent years, and reports indicate that errors – despite technology improvements – are on the rise. This leaves some to speculate that effective processes haven’t kept pace with rapid growth at health organizations. “The root cause of this organizational disease is not effort, but skill, specifically change management,” says Jim Molpus, Leadership Program Director at HealthLeaders. Molpus explains that in order to move the needle on change, leaders should embrace the facts when evaluating process vs. outcomes. 

3. Crisis management

Health plan leaders understand that reputation is important to consumers, but are we focusing enough on crisis management? In order to become the change agent your health organization needs, it’s vital to embrace the tenets of crisis management: communication, training, and preparedness. 

Leaders can train to proactively manage crisis by preparing for it. Organizations should implement a crisis management plan and incorporate it into change management initiatives. A focus on transparency can support crisis management. In Leading in a Crisis, authors Blair Sadler and Kevin Stewart posit that “leaders who promote and model transparent behaviors and instill a transparent culture in their organizations can use crises as learning and improvement opportunities.”

4. Appropriate technology training

Technology adoption can create stress and fear for employees, which is why it’s a good idea to for leaders to be fully trained in all necessary technology to guide easier changes in their organization. Hands on, ground-level encouragement can ease employees into higher usage rates. Keep in mind that change management requires constantly preparing for change – and technology is always improving. So technology training should be an ongoing, iterative process. Forbes Tech Council writes “it’s become impossible to separate business strategy from technological innovation.”

5. Insight into member satisfaction

To effectively lead change, we must be able to understand what drives member satisfaction. As more payers focus on member satisfaction, leadership should incorporate these initiatives into broader change management strategies. “While health plans generally are adept at managing the operational aspects of their business, a bigger challenge is addressing member expectations based on their experiences in other industries,” says HealthcareFinance

6. Awareness of new business models

Change agents should be aware of new business models – particularly evolving payment models and new technologies – that may affect the industry. According to a recent survey, about a third of health plan executives are bracing for major disruptions to business models. They believe that “new entrants, processes and technologies will upend current business models.” 

Anticipated areas of disruption include innovations in care delivery and refined member experience. Tracking proposed regulations and making other leaders aware of their potential impact is one way to ensure your organization can prepare for and quickly pivot as new business models arise. Payers may feel strained trying to anticipate and address every new business model, but they’re also poised to lead the change. 

“Health plans are in a unique position to drive innovation that will spread to each part of the healthcare ecosystem.”

Put on your cape. Your health plan may just save the healthcare system.

7. Entrepreneurial spirit

The willingness to take a risk and drive change is becoming an unwritten requirement for modern health leaders. This entrepreneurial spirit is marked by the following traits: 

  • Community-minded
  • Focused on advancement
  • Belief in oneself
  • Driven by “gut-feelings”

Being an entrepreneur is about “connecting the dots: those connection points of intelligence, wisdom, desire and ability that are innate to people,” writes Forbes. Though expected to find novel solutions and modernize, it’s difficult for health organizations to do so; the act of providing and delivering healthcare is different than the skills needed to drive growth through innovation. Entrepreneurial attitudes can prove particularly effective for health plans looking to bridge the gap and deliver change. 

8. Thought leadership

Connect with coworkers and establish yourself as an agent of change by embracing thought leadership, or the practice of becoming an informed opinion leader. In the age of social media, change agents can drive effective thought leadership through numerous channels. The practice of researching and informing others on industry-relevant topics can help leaders stay in-the-know on important topics as well as maintain impact and influence, while avoiding complacency

 “If leaders don’t feel comfortable with renewal and reinvention, they will begin to lose their impact and influence quickly.”



Power up with Pareo®

Talk to ClarisHealth about how Pareo advanced payment integrity technology is helping health plans successfully implement their digital-first strategies.

Prepare to Meet the Future with Data

Prepare to Meet the Future with Data

We revisit ONC’s Information Blocking Rule, recap public comments, and look at how health plans can meet data sharing  requirements.

Earlier this year, we wrote about the ONC’s proposed information blocking rule and how it serves as an opportunity for health plans. The proposed rule faced a public comment period (which closed last month) during which major industry concerns were voiced. The consensus by many seems to be that ONC’s rule lacks clarification in key areas while inadvertently increasing complexity (and cost) in others.  

But as they say, “the writing’s on the wall” for health data interoperability and broader access to electronic health information. Where does this leave health plans? A recent study by Deloitte predicts that healthcare organizations are standing at the precipice of innovation. But first, let’s look at the feedback that the proposed information blocking rule received.

Industry Response to the Information Blocking Rule

One thing we can agree on at this point: interoperability is a major objective for our industry. But those who would be affected by the Information Blocking Rule have asked the ONC to revise or even revoke the current rule. This includes the Federal Trade Commission, who despite being consulted on the proposed rule, issued a letter asking the ONC to consider refinements. Notably, eHealth Initiative (eHI) offered the following comments and concerns

Scope of “Electronic Health Information” is too broad, should be defined

Conditions and Maintenance of Certification (APIs)

      • Too complex and costly as proposed
      • Too much risk to providers and patients, specifically the proposed “Click Yes to Continue” model does not adequately portray data security risk to patient

Information Blocking

      • Healthcare actors should be defined in the final rule
      • Complex and costly documentation requirements

Greater Data Sharing is the Goal

The ONC has stated that greater interoperability is the goal of the proposed Information Blocking Rule. Improved data sharing is a worthy objective for health plans because it’s an easy effort to prove value on. Health plans have a competitive edge over their counterparts when they are more integrated with providers and members. In addition to priming plans to be compliant with whatever final rule is based, improving access to data is also key to readying for other initiatives, such as alternative payment models

Of course, we know that total healthcare data interoperability sounds like the answer to all your challenges. But once the hard work begins of solving this problem, it can feel like data sharing at the level required is next to impossible. We’re here to tell you it’s not; interoperability is a realistic goal with the right technology

Let’s frame the objective of the ONC’s Information Blocking Rule in a more approachable way: Healthcare stakeholders need real-time, accurate and contextual data access. And the real challenges? Healthcare organizations still struggle with interoperability, largely due to issues like administrative complexity. Messy (as in, unstructured) or missing data is still a problem as well. 

We know that our industry is on the precipice of innovation. The recent study from Deloitte referenced above and in our prior article posits healthcare is on the precipice of a “20 to 30 year industry transformation. The industry forces and the disruption that’s upon us are true indicators that we’re going to be going through a cycle of innovation.” Innovation made possible by radical data interoperability. 

ONC’s Information Blocking Rule has 7 exceptions. Do you know what they are?

See the official list here.

The Promise of Big Data

Improved access to data is considered a consumer-driven shift, one often compared to the Amazon experience where a consumer can have on-demand access to personal information. But getting personalized, real-time electronic health data at the click of a button is a lot more complicated than it sounds. And it requires a special relationship that has historically been difficult: high-level collaboration between payers and providers. 

Yet this demand is exactly the kind of opportunity health plans can seize upon as they search out competitive ways to utilize big data. Examples can be seen in the use of predictive analytics to mitigate risk, noted in this article as a “massive moneysaver” by one health plan who made a big IT investment. Reams of data are available to health plans — all that’s lacking is the right way to connect and analyze it. 

“Improving relationships with members and providers is already a focus for health plans, and data sharing is another way to accomplish that goal.”

Health plan of the future? It starts with data sharing.

One way of looking at the Information Blocking Rule is that it’s a proposed answer to a problem that health plans can take control of now. Improving data sharing isn’t just a proactive approach to anticipated regulation — it’s becoming an essential business function for health plans. To get started, health plans can focus on these three areas: 

Develop data analytics and predictive modeling know-how

Take advantage of opportunities to break down data silos by fostering relationships with providers, members and vendors

Look for existing technology that can support these goals: bring disparate data together, simplify data modeling, and provide a transparent communications platform

The future of data sharing is now. Pareo® is how.

Talk to ClarisHealth about how Pareo advanced payment integrity technology is helping health plans successfully implement their digital-first strategies. 

Can your tech do this? How to enhance your health plan members’ digital experience.

Can your tech do this? How to enhance your health plan members’ digital experience.

Health plans are shifting focus to ensure member satisfaction. Here’s how technology — even internal solutions — affect the digital experience of your health plan’s members.

Do you ever think about how different banking is now compared to 10, 20, 30 years ago? First came ATMs. Then debit cards. Then online banking. Today, if you step foot inside a bank, unless it’s for a high-trust/high-value conversation where only face-to-face will do, it’s a huge inconvenience. The world is filled with advanced technology and today’s consumers don’t care why healthcare lags behind. If the member experience you provide isn’t the seamless digital interaction they have come to expect, the next time they have a choice, will they choose you?

Health plans should focus now more than ever on the digital experience of their members to ensure satisfaction. Much like finance, the healthcare industry is becoming increasingly digital. Adding to that, many of your members are shouldering more healthcare costs than ever, which has them seeking clarity at the most granular levels. In a culture of choices, your health plan members are discerning clientele. 

Patients are Consumers

“Patients are increasingly becoming consumers because they have an increasing responsibility for the cost of their care,” writes Jonah Comstock. Statistically, you likely already know that member satisfaction is important because most of you are focusing on it. But what we can tell you is that regardless of a focus on digital experience, the big pillars of member satisfaction have not changed: service and value. 

Without nailing these basics, all the digital strategy in the world won’t help. Health plans are facing major shifts based on the consumer-focused mindset of the times. In short, your health plan member has choices now (and even those in group plans are being given more options by employers). 

Research shows that 42% of seniors prefer to shop for healthcare coverage online.


Basic customer service capabilities are part of the member-first focus shift at health plans. With the right focus on the tenets of member service, digital capabilities can augment them. When health plan members look for a good digital experience, that often means convenience, transparency and personalized communication. With the right technology, you can more easily satisfy these health plan member needs. 

Digital Experience Correlates to Member Satisfaction

While health plans have been citing an increased focus on the member experience, remember that doesn’t only mean the digital front door (e.g., health plan-to-member customer service-focused apps and portals). In a recent survey, 80% of Americans asked said they utilize online health information. 64% say they reference online provider reviews, and a quarter say they now use mobile tracking tools. 

The study’s author concludes, “Patient engagement in decision-making [is] associated with increased patient satisfaction and improved health outcomes.” For health plans, focusing on the digital experience of members is directly correlated with satisfaction. Create an experience that is highly engaging, and your member NPS is likely to be high (read more on measuring net promoter score [NPS] here).

While the correlation between an engaging digital experience and member satisfaction is clear, a new Forrester analysis says that only about half of health plan enrollees feel that their interactions with insurers are helpful. The analysis concludes, “Health insurers should take this into consideration when evaluating and adopting new digital customer service technologies like chatbots or real-time conversational guidance and analytics tools.”

What’s next? 

Any of your health plan’s internal processes and relationships with other stakeholders like providers and third-party service providers that could impact members are ripe for innovation. That level of comprehensive communication — with third-party suppliers, providers, and members — is exactly what ClarisHealth’s technology platform Pareo®is designed to offer. 

Talk to ClarisHealth about how Pareo advanced payment integrity technology is helping health plans successfully implement their digital-first strategies. 

What makes value-based care programs work? 3 keys to success

What makes value-based care programs work? 3 keys to success

Following up on our previous article, we look more closely at what successful value-based care initiatives have in common.

It’s not all that surprising that one of our recent blog posts, Medicare for All: Should it be feared by health plans? has quickly become one of our most popular. Value-based care programs, like what the federal government has switched to, are at the forefront of discussions regarding the future of healthcare. And a recent survey indicates that providers are actually willing to take on more risk under alternative payment models, which signals well for value-based care adoption. 

But it takes awhile to implement value-based care programs and that may leave many health plans wondering what they can do to be proactive. Here are 3 strategic initiatives your health plan can pursue today to ensure value-based care programs will be successful on down the road. 

1. Communication

We’ve talked a lot lately on the blog about communication and collaboration and with good reason: the future of healthcare demands it. As care models shift, the need to work effectively with other vested parties is paramount. 

Take for example a recent panel in which industry experts (18 in all) were asked to define the term “value-based care.” While the term “value-based payment” was broadly agreed on, experts could not come to a consensus on the meaning of value-based care reports FierceHealthcare. “In addition to these specific gaps in communication, the study highlighted just how valuable it can be for industry leaders to convene with others who may not share the same perspective,” says Meredith Williams, M.D.

Health plans can prepare for  value-based care by fostering better communication with internal and external stakeholders. As Williams points out above, sitting down with other experts in the industry to get on the same page is a powerful — and unprecedented — move. 

2. Transparency

Alongside value-based care runs another initiative: transparency. Real-time access to crucial medical details, patient access to data, and upfront pricing are goals associated with successful value-based care programs. 

True transparency is only possible when health organizations have a firm grasp on data. Yet interoperability remains a struggle: 74% of respondents in this survey list the “ability to aggregate and share information as an extremely important need over the next three years.” By 2020, 59% of healthcare payments will be from value-based care models, and that means health plans need to work now on integrative data strategies. 

A shift towards transparent practices can directly affect your health plan’s relationship with providers. The ability to collaborate with elements of the healthcare trifecta (patient, provider and payer) will grow increasingly important for health plans seeking to thrive in a value-based care environment. “If value-based care is about aligning what works best for the patient to a hospital’s financial incentives, then insurers and providers must work together to create the best outcomes,” writes Healthcare Finance

3. Technology

With communication and transparency as actionable goals for health plans seeking to prepare for value-based care, technology is a third and crucial piece of the puzzle. With the right technology solution, health plans can improve communication and engagement with key stakeholders while promoting more transparent data practices. “Data is much easier to connect with when you are able to see it in real-time,” notes Jason Medlin, ClarisHealth VP of Marketing & Business Development. 

Investing in IT and technology to foster innovation was a featured conclusion of the Deloitte report “The Health Plan of Tomorrow.” Switching from volume to value in healthcare models will require a sophisticated technology strategy. The goals of value-based care programs — largely focused on access to patient care data — are not currently achievable at many health plans. 

The fastest way to transform? Technology, says Healthcare Finance. A comprehensive payment integrity solution should also provide a way of interpreting big data to transfer into actionable insights. “Once an organization has its data and is able to analyze it, it can then pinpoint opportunities for changing the practice to improve efficiencies without compromising quality outcomes — and for improving patient care overall.”

The Healthcare Trifecta Matters More Than Ever

Payers, providers and patients make up what we refer to as the “healthcare trifecta,” and the effectiveness of this relationship directly correlates with the success of value-based care models. Even as payers and providers work towards improved collaboration and communication, health plan members also  seek more ready access to information. Health plans who focus on supporting and improving their relationships with providers and patients are poised to adopt value-based care more successfully.

Talk to ClarisHealth about how Pareo®advanced payment integrity technology is helping health plans successfully implement their digital-first strategies.