Will AI finally make good on its promise to healthcare?

Will AI finally make good on its promise to healthcare?

Artificial Intelligence continues to be a much-hyped “trend” for healthcare technology but adoption lags. Here’s what AI is — and isn’t — and why this may be the decade it takes hold for health plans.

When IBM Watson, the AI supercomputer created by IBM, won Jeopardy! and then moved on to a career in healthcare (via Watson Health in 2015), the industry was abuzz with possibilities. Sci-fi speculation ran rampant and then fell flat, when in 2017 it was revealed that IBM Watson wasn’t exceeding — or even meeting — expectations. AI capabilities were muddied by the hype, and adoption of the technology continues to be slower than expected. 

However, AI is a powerful force in technology and crucial to disrupting the healthcare industry. And in 2020, AI is poised to improve rapidly (it was recently reported that Google’s AI system was more accurate than experts in finding breast cancer).  Let’s explore what AI is — and isn’t — and why it’s here to stay. But first, a few definitions:

Artificial Intelligence: Intelligence applied to a system with the goal of mirroring human logic and decision-making. AI is utilized for the purpose of successful knowledge acquisition and application, which it prioritizes over accuracy. AI simulates intelligence (the application of knowledge). It is a combination of technologies, comprised of machine learning and predictive analytics.

 

Machine Learning: An application of AI that allows a system to learn on it’s own. ML learns from data, and it aims to increase accuracy (success is a lesser concern). ML simulates knowledge. Source

 

Data Mining: Unstructured data that is collected, often for the purposes of data analytics.

 

Predictive Analytics: Data that has been collected is utilized to try and predict behavior/outcomes (often called Data Science). To analyze data, it is routed into a report, at which point humans or artificial intelligence apply multiple factors to make predictions about expected outcomes. Predictive Analytics often implies that a machine has performed the analysis and offered a prediction (rather than a human).

Is 2020 the year for AI?

Experts predicted that AI would grow rapidly in 2019, but adoption waned. Additionally, a growing number of consumers (and regulators) are becoming uncomfortable with “black box” AI. Forbes points out, “As humans, we must be able to fully understand how decisions are being made so that we can trust the decisions of AI systems. The lack of explainability and trust hampers our ability to fully trust AI systems.” 

In all industries, AI can vary greatly by product and generalized claims can be misleading. In healthcare, relying on AI before explainability has been satisfied is a large risk. Yet, creators of the algorithms that power AI will often refuse to disclose how they work, citing proprietary information.  

The lack of explainable AI is a huge hurdle to applying (and approving) the technology’s use in clinical care settings. For example, when a study showing that AI could interpret risk of patient death based on ECG test results with greater accuracy than physicians, without being able to explain how it did so, doctors expressed amazement — and discomfort. “It’s still unclear what patterns the AI is picking up, which makes some physicians reluctant to use such algorithms.” Furthermore, lawmakers are still grappling with how to regulate the technology, and those outcomes can play a significant role in health tech.

Early adopters in the healthcare payer sector understand the benefits and risks associated with AI all too well, and skepticism of vendor claims of AI is high (and rightly so). However, the value of AI is steadily increasing, and AI compute has been doubling every three and a half months. In fact, 2020 was a remarkable year for the advanced technology. The AI Index 2019 Annual Report calls out the following technical performance achievements: 

  • In just a year and a half, large image classification systems are training much faster on cloud infrastructure, down to 88 seconds in mid-2019 from three hours in late 2017. Costs to train these systems have also fallen.
  • Progress on natural-language processing classification tasks is “remarkably rapid,” though performance on NLP tasks that require reasoning has not kept up

If investment dollars are any indication, AI technology will continue to boom. Last year, global private investment dollars in AI topped $70 billion: 6.1% of those investment dollars were attributed to drug, cancer and therapy while 3.9% was given to fraud detection and finance. 

How AI is Applied to Healthcare Technology

AI is expected to permeate every facet of healthcare, with annual spending on advanced technology estimated to be more than $34 billion in 2025. But AI is not a solution in and of itself; it’s an application of various methodologies, and this causes some confusion. The current applications of AI in healthcare are narrow and highly functional, especially given that the quality of the technology itself can vary based on the vendor.  

Some current applications of AI for health plans include: 

Fraud, waste and abuse solutions

Value-based care initiatives

Claims Management

Coordination of Benefits

Predictive Analytics

Potential applications for advanced technology are much broader and include increased efficiencies and improved patient outcomes. Surveyed physicians have reported that AI is already improving the time they spent with patients, and 78% of healthcare business leaders say that the advanced technology “has helped drive workflow improvements, streamlining operational and administrative activities and delivering significant efficiencies toward transforming the future of healthcare.” Yet, explainability may hamper some AI adoption in the coming year. 

“Differentiating on price isn’t going to be the way to win in healthcare; differentiating on experience will be.”

Heather Cox, Humana’s chief digital health and analytics officer, on why Humana is investing in AI to enhance patient experience

In the coming year, healthcare payers will see technology disruptors enter the market. For many plans, a selection of effectively managed vendors will be the most effective strategy to drive ROI, though health payers will have to be careful of hype, particularly from tech vendors who lack industry experience. What works for one sector — say, finance — does not easily translate into healthcare, which is often more complex, more heavily regulated, and more data sensitive. 

Health payers will need to see all the moving parts of their tech ecosystem, including real-time metrics on vendor performance, in order to be able to see vendor lift, even if AI capabilities are touted. Increasing visibility across disparate departments and retrieving data from silos are exactly the type of improvements that show AI at its best. 

How Your Health Plan Can Utilize AI

You might think that being a fax/email/spreadsheet organization means your health plan is woefully out of date, but you might not be as behind as you fear. While AI can offer much-needed technology advantages to health plans, it isn’t capable of solving all payment integrity problems on its own. If a technology vendor is touting its AI capabilities, the solution should be more than a “black box of mystery.” You can and should deeply question and demand specific capabilities in regards to AI from a technology vendor. 

That said, AI is a crucial technology for health plans to adopt or expand upon within their organization. The massive amounts of data inherent in healthcare systems have presented a problem for the industry as a whole. With AI, data can be mined and utilized to harvest useful insights. Historical data can be loaded into the system and utilized alongside real-time data for predictive analytics. Pareo® offers multiple applications for AI as part of a broader “one-source” system insight platform for health plans and payers.

Despite IBM Watson falling short of expectations, AI technology will only continue to improve and the past year has proved that. At this stage, AI technologies may be more commonplace than you realize, but the true abilities of artificial intelligence vary between technology vendors. The most powerful way to harness AI capabilities is when they are applied as part of a broader solution, an advantage provided by an integrative platform like Pareo®

Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.

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Top 10 Reasons Health Plans Choose Pareo

Top 10 Reasons Health Plans Choose Pareo

It’s almost 2020, and forward-thinking health plans have a choice when it comes to total payment integrity solutions.

From smaller regional plans with 100k members to large national health plans with millions of lives covered, Pareo scales to accommodate all needs. Here are the top 10 reasons that health plans choose Pareo:

1. Reduce Administrative Spend

Health plans often seek out Pareo as a total payment integrity solution that eliminates administrative complexity, reducing overall spend. It’s estimated that 10% of all health care spending in the U.S. is wasteful, attributed to administrative costs that would be eliminated by more efficient processes.

The burden of cumbersome, manual admin processes lead MCOs to miss timely provider payments, tightening their provider network and placing an unnecessary burden on patients and providers.

For managed care organizations (MCOs), the cost to coordinate benefits is estimated at 12% of a health plan’s entire spend. ClarisHealth’s solution simplifies and automates workflows, allowing our clients to quickly optimize operations and reduce costs for coordination of benefits.

2. Optimize Relationships with Business Partners

For many health plans, bringing on more business partners to improve recoveries is a top-level goal. However, the inability to see the “bigger picture” makes it extremely difficult for health plans and their business partners to plug in easily or operate at maximum utilization. Pareo is able to optimize relationships with business partners, allowing health plans to grow their recoveries and easily coordinate goals with third-party payment integrity partners.

Pareo is able to benefit both health plans and business partners by offering easier onboarding, real-time feedback, fast turnaround on new concepts, and multi-beneficial sharing of information that’s customized to each business partner. We view our technology as a crucial connection that improves technology capabilities for health plans.

3. Eliminate Work Silos

Work silos are a byproduct of company structures, based on natural development of ideas and workflows within departments. However, it’s widely understood that these silos prevent the overall growth of an organization. The healthcare industry in particular has suffered from data siloing in large part due to manual, inefficient work processes.

As health plans seek to centralize their payment integrity efforts and break down data silos, they turn to Pareo. Our total payment integrity technology supports initiatives that break down silos, such as change management techniques, by culling system-wide data and presenting it through a single portal.

4. Organize Big Data

Data is an integral part of health plan operations, but many organizations struggle with the task of managing so much information. Pareo assists with process digitization, allowing our clients to move beyond spreadsheets and into a more dynamic platform.

When managing data is no longer of primary concern, health plans can move into activities that generate a higher return on their investment. Faster decision making and utilizing predictive analytics (both available with Pareo) can take a standard data report and turn it into actionable insights — all in real-time.

5. Modernize fraud,  waste and abuse mitigation

Health plans that want a more robust fraud prevention program seek also to address waste and abuse, a holistic approach that keeps a tighter cap on improper payment rates. Our clients use Pareo to …

  • Analyze post-adjudicated and post-pay claims data (useful as the Federal government is starting to look at how health plans do this)
  • Intelligently flag potential waste and abuse claims
  • Automate claims and auditing workflows
  • Introduce the application of AI technology 

Waste and abuse actually outsize fraud, but the terms are perceived as more ambiguous, resulting in the use of limited technology rather than broader solutions. Health plans may mistakenly think they’ve got payment integrity “covered” when they really only have fraud-prevention technology in place. By addressing a health plan’s entire payment integrity continuum, Pareo helps our clients transition more post-pay activities to prevention. 

6. Improve Provider Engagement

As more providers collect payment upfront and more payers look closely at member satisfaction, the intersection between the two has narrowed. Proactive health plans are seeking to improve provider engagement with the understanding that doing so has a direct effect on member satisfaction rates, and they’re choosing Pareo as the technology that supports this.

Keeping your health plan’s providers happy will also keep your members satisfied.

By automating activities, providing access to necessary claims documentation, and removing redundancies, Pareo is able to significantly minimize provider abrasion. We are firm believers in tracking a Net Promoter Score with your health plan’s providers as way of measuring improved engagement.

7. Control Claim Spend

Why settle for 1-2% as the rate of return on claims when you can get up to 10% by using Pareo? Total system visibility is required in order to control claim spend, but without understanding what’s possible, many health plans settle for less.

Overspending is a huge problem in healthcare, accounting for about $1 trillion of total healthcare expenditures in the U.S. With Pareo, you can actively track your spending on claims in real-time, allowing your health plan to quickly correct course. Excessive administrative costs, missed prevention opportunities, and unnecessary services are all causes of overspending. Pareo’s advanced analytics module allows health plans to gain traction on claim spend, improving recoveries and furthering ROI.

8. Access a community

I think by now many of us understand that organizations suffer when information isn’t shared. Health plans are seeking technology solutions that afford them access to shared expertise. While accessing a group of people who are looking for the exact same solutions that you are is incredibly valuable, another perk of being a member of a community of users is reaping the benefits sown by early adopters. Those first movers are often working closely (whether they know it or not) with QA to ensure your software experience is all the better. In addition, first movers can easily become super users and a source of community knowledge for other members.

Numerous health plans — of all different sizes, with different lines of business, etc. — all working within a common platform is a feature of the SaaS model, not an accidental by-product.

True, health plans have not historically unified on matters of business practice. At a time of rapid disruption, it’s helpful to realize that collaborative organizations have proven more effective. Real benefits of collaboration among departments, with other stakeholders and even with other health plans include: reducing administrative costs, fast-tracking innovation, and improving working relationships.

9. Integrate fragmented systems

Disparate data systems are being abandoned, but as API integration becomes the norm, many health plans are learning not all technology is created equal. With the declaration of APIs as the “better” solution for interoperability, health plans will need technology ecosystems that support integration and allow them to connect and visualize data in a meaningful way. 

The ability for a health plan to share data is mandated — and will continue to be closely watched and regulated once the Proposed Rules become final. For many, the ability to meet or exceed interoperability rules brings health plans to a “disrupt or be disrupted” type of choice. 

10. Transition more efforts to prepay

Post-pay concepts in a prepay environment? That’s just a pipe dream for health plans. Or is it? Payment accuracy isn’t a problem that’s going away anytime soon, but pay-and-chase is expensive for health plans to maintain. Leaders are looking for more ways to prevent improper payments from ever occurring but in order to do so, comprehensive insight and management is needed. 

ClarisHealth works with health plans to develop a specific implementation and use plan for Pareo that meets and often exceeds the goals you’ve outlined for your plan. The ability to transition more claims to prepay requires transformative technology solutions that can integrate disparate systems, such as those offered by Pareo. 

Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.

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Behind the Curtain: What to expect when you implement Pareo

Behind the Curtain: What to expect when you implement Pareo

Pareo is a unique platform that integrates with other software solutions to provide a comprehensive look at a health plan’s payment integrity processes. Here’s how we approach implementation of enterprise technology.

Just got word that your health plan is adopting Pareo® as a comprehensive payment integrity solution? Here, we pull back the curtain on what all goes into ensuring your health plan and Pareo work together in perfect harmony.

How We (All) Got Here

Our path to Pareo wasn’t all that different than yours. We started with a seemingly-unsolvable problem: How could we get a better view on everything we needed to see in order to effectively manage claims operations? With time, talent and industry expertise we developed a platform designed to transform payment integrity operations and shifted our focus to healthcare technology. 

We acknowledge that when you offer folks a solution they’ve never seen before, you have some educating to do. As such, here are some resources from our archives that touch on some of the steps leading to adoption and implementation of Pareo: 

Meet the Team

ClarisHealth has a team of experienced professionals dedicated to ensuring your Pareo implementation is a smooth transition. Leading the pre-Implementation team is Ric Stubblefield, Director of Implementations. Ric has overseen implementation of healthcare Software as a Service (SaaS) solutions like Pareo for nearly a decade, managing large teams of project managers and specialists while also serving as the main point of contact for clients during the process. 

At ClarisHealth, the Implementation team works closely with Product Support to guide clients through each stage of Implementation and ensure a seamless hand-off after the implementation project is complete. Our post-Implementation team lead is Yaw Agyemang, Director of Product Support. Yaw leads a team of product consultants who ensure that the functionality of Pareo meets the needs of our end users. He has decades of healthcare industry experience and has been a key contributor to shaping Pareo into the solution it is today. Yaw’s team serves as the ongoing point of contact for Pareo users. 

Why does this matter? As industry vets, we understand our clients and their frustrations because most of us have either been in your shoes or worked so closely to this industry that we know the long-running pain points you face. Under Ric and Yaw’s leadership, we’ve selected team members that are uniquely devoted to your success: 

    • Problem-solvers with a results-first focus
    • Industry experience
    • Clear communicators
    • Proven methodology with training every step of the way

Pareo Implementation in 7 Steps

Though we cater our implementation process to meet the needs of each individual client, our decades of experience have taught us to follow a seven-step process to guide each implementation project:

Project Kickoff

The Implementation team will review the statement of work (SOW) and develop a communication plan that establishes meeting and reporting cadences. At this stage, we will review the major components of each project and identify key deliverables. Known challenges are also acknowledged as our team prepares for discovery. 

Discovery

VP of Operations Kevin Jordan works closely with our Implementation teams in a discovery process that reviews workflows, user access (including role definition), reporting needs and process exceptions. During this phase, we also conduct a technical discovery. This includes the review of data file layouts, frequency of delivery and reviewing claim system integration requirements and file formats. This includes identifying vendor submission file formats.

Data Gathering

We conduct data gathering operations throughout the project. Initially, this phase consists of defining roles and rights for each user. Our team will also gather vendor details and load order, creating and reviewing sample reports. Data definitions are created as well as integration file formats. This is the stage when we begin communication with vendors and initiate training.

Configuration and Data Transfer

Configuration is dependant on the process workflows defined in the discovery phase, for both test and production environments. Clients can expect their reporting and dashboards to be created during this phase, configured and loaded into Pareo for review. As such, historical claim, provider and member data files are loaded and mapped. Custom fields are also tested and reviewed in this phase.

Testing

In the testing phase, we use sample vendor files and test all loading logic, review validation workflows and test claim system integration. Reports and dashboards, reviewed in the previous phase, are evaluated closely here for accuracy. Also, all user roles are security tested in this phase to ensure accurate access has been granted.

Client Sign-Off

In the test environment, once approved, the client signs off on the work that has been done. This triggers the creation of the production environment. Once the production environment is created, data migration occurs after which a final review is conducted before final sign-off in productions. 

Go-Live

The last leg of the process! During go-live, health plan and vendor production files are submitted into Pareo. Any issues found at this stage are actively managed by the Implementation team. Once resolved and when all parties agree that go-live is a success, the client is transitioned to the ClarisHealth customer success team! 

Average implementation projects last six to nine months, though this timeframe very much depends on a client’s needs and the SOW. As we implement Pareo at your organization, we have structured our process to include best practices allowing us to act in a secondary role as a software implementation consultant. This approach allows us to offer greater value to clients, who rely on us to lead them through this transition. 

This consultative mindset continues post-implementation. We have internal teams solely focused on developing education and other training tools and delivering those to clients in an ongoing manner to support engagement and utilization of Pareo. 

NOW'S THE TIME FOR TOTAL PAYMENT INTEGRITY

Talk to ClarisHealth about how Pareo® comprehensive payment integrity technology is helping health plans deliver on their most advanced digital strategies. 

Managing Medical Record Requests a problem? We’ve got the solution.

Managing Medical Record Requests a problem? We’ve got the solution.

How to manage medical record retrieval processes with multiple clinical audit vendors.

Is your health plan missing out on the potential of having multiple clinical audit vendors because you’re concerned about overlapping medical record requests? That uncoordinated approach to medical records retrieval is unnecessary in the modern age of vendor coordination and provider communications. 

For health plans that are ready to maximize their returns, improve recoveries and avoid the abrasion created by redundant medical record retrieval processes, Pareo® is your answer. Pareo is a comprehensive payment integrity solution that works by making data more accessible, connecting it to multiple stakeholders and managing real-time communications (including those related to the claims process and associated with technology vendors). With these efficiencies in place, health plans are able to maximize their recoveries by adding clinical audit vendors. Data is no longer siloed — it can be seen, used and leveraged by health plans. That’s the power of Pareo. 

Overlapping Medical Record Requests Begone

Suppose your health plan were to prioritize adding clinical audit vendors without a broader management tool in place. One of the very real side effects of this practice is overlapping medical record requests. It’s frustrating for everyone, especially providers who seek to prioritize patient care over cumbersome administrative processes. 

In instances where health plans have a lot to lose (recoveries, valuable providers, plan members), clear communication is crucial to success. We understand that our clients need to do more than just talk at stakeholders; they need to intelligently coordinate with vendors, providers and members in a streamlined but meaningful way. 

Unfortunately, some of the payers we speak with feel forced into an impossible decision: improve provider relationships OR recoveries. This approach, while understandable, is unnecessary. What if you could do both? What if expanding recoveries through adding vendors — a smart strategy for scaling health plan payment integrity operations — wasn’t stressful on providers? 

Harmony: Vendor Coordination + Provider Communications

By eliminating the fear of overlapping medical record requests, you are free to stack the best vendors to your advantage. Directing vendors to laser focus on their area of expertise creates more potential for finding anomalies; for example, having vendors concentrate on a line of business (e.g. Medicare Advantage, Medicaid, commercial). Data tells us that any time a health plan adds a vendor in a multi-pass capacity, their ability to increase recoveries improves dramatically. 

But don’t leave providers out of the loop. Health plans often run a planned series of audits that parallel those that a provider performs. With Pareo, each party can be on the same page about these audits; knowledge and understanding of them beforehand can minimize redundancies, says Healthcare Finance.  But as we all know, it’s not as simple as straightforward communication between a payer and a provider. Vendors are an important component as they rely on data to deliver results. 

Enter Pareo Clinical.

Pareo Clinical: Eliminates Risk Around Medical Record Requests + Retrievals

Tackle risk, reduce inefficiencies, increase nurse auditor throughput, improve your net promoter score (NPS) and increase recoveries with Pareo Clinical. Our solution provides gates and custom logic that streamline the medical records retrieval process to coordinate with vendors, eliminate duplicate requests and auto-route submissions to the appropriate auditor with smart tagging so nothing gets overlooked. 

To enhance communication, our solution creates a unilateral or bi-lateral portal of communication for our clients that allows them to not only communicate with vendors but with another very valuable player: providers. We understand that in today’s IT ecosystem, a true solution has to “speak” with multiple stakeholders in a way that removes redundant, wasteful processes. 

Those communications streamline activities that can be automated. But perhaps just as important, Pareo allows for sophisticated coordination between all stakeholders. With our technology, even pending requests — days outstanding, notes on interactions, etc. — can be tracked to prompt proper follow-up strategies. These efficiencies mean more clinical audit vendors and less abrasion with providers. In today’s world where health plans are being asked to do more with less, a scalable, comprehensive solution is the strongest way forward. 

Learn more about how Pareo supports health plans, providers and third-party vendors

Talk to ClarisHealth about how Pareo®advanced payment integrity technology is helping health plans stride confidently into an uncertain future.

Should You Build Your Own Supplier Management Solution?

Should You Build Your Own Supplier Management Solution?

Take our quiz to help you decide if build or buy is right for your health plan. 

By now, you likely realize that your health plan needs a way to manage the many third-party vendors that allow you to maximize recoveries and optimize costs. The question is, should you build a solution internally or buy one?

We routinely run across health plan stakeholders in the midst of customizing their claims editor and other resource-intensive but relatively manageable IT projects. Most recently, we encountered a health plan considering building their own vendor management solution. That they need a solution is understandable. That they plan to build it themselves begs the question, “Are you a health insurance provider or a technology company?”

You know building your own software is going to cost more than you budgeted for, your IT resources are already constrained, and your expertise may be limited. But if your needs are truly unique, why look for a flexible, robust technology solution created with the support of industry-wide insight when you could devote millions of dollars to a solution of your very own?

In all seriousness, building a software solution with the ability to plug into dozens of independently-operated platforms (as in the case of third-party vendors) requires some heavy lifting. Are you ready? Let’s find out!

Should You Build or Buy a Vendor Management Solution? The Quiz

To take this quiz, view the following slideshow and record your answers. 

 

Results

 

Perhaps you’ve already tried to build your own IT solution, and it didn’t go anywhere. Or maybe you’re on the fence about building something that’s already on the market. However, you aren’t sure if what’s out there is really what you need. Not all vendor management solutions are the same, and we’ve learned that our clients appreciate the customization opportunities that Pareo® offers. In fact, we offer the ability for health insurance providers to completely outsource vendor management to us.

Because you’ve likely tried to build a software solution before, you may face internal pressure to just “make it work.” Here’s a helpful guide that discusses what it takes to successfully develop software (hint: It’s not simple). Borrow a page from tech company playbooks and take a realistic approach to any internal software development efforts.

You may – or may not – be able to successfully build your own vendor management solution. But it’s important to ask if IT development is really your true calling. Most health insurance providers we speak with develop internal software solutions as a means to an end. They quickly realize that the upkeep and maintenance associated with these insular solutions is not manageable. That’s because building an internal IT solution isn’t the same as buying one from a company whose sole focus is solving the types of challenges your health insurance company faces.

“Technology alone delivers no value. It’s the combination of a clear strategy, the right technology, high-quality data, appropriate skills, and lean processes that adds up to create value. Any weak link in this chain will lead to poor value delivery from IT,” writes McKinsey. As you evaluate whether or not to build or buy your own vendor management solution, consider all the elements at play. Technology alone isn’t enough; to be successful, you’ll need a force behind your internal IT development.

You are the healthcare insurance unicorn – an IT-heavy, resource-laden organization that really can build your own internal software. We would ask you though, why reinvent the wheel? If a great vendor management solution does exist, and can be customized, why not tackle a software development project for which there isn’t already an answer?

“Building custom software can unlock a host of benefits, but companies should only pursue that strategy if a) better software can provide a competitive advantage relative to your competitors, and b) you are building a large business that can spread the cost of a proprietary system over a large number of clients,” writes one Forbes contributor with experience on the matter.

Taking on a software development project like this may derail your small IT resources, who would be better focused on their core competencies. We suggest exploring solutions that are already built and extremely customizable, like Pareo®. Not only do we offer the technology you need to manage multiple third-party vendors, but we also walk small health insurance plans through the steps of payment integrity program creation. Still sound like a little more than you’re ready for? Consider completely outsourcing vendor management.

By outsourcing vendor management, you can quickly implement a successful payment integrity program that your IT department can plug into. Consider what qualifies as “good” when it comes to vendor management: “Good vendor management allows your organization to build a successful and stronger relationship with your suppliers or service providers.” Can you really do that if your time, attention and money are caught up in developing software to manage vendors?

Final Thoughts

In an age where customer-centric technology projects are increasingly consuming the insurance industry, building a supplier management solution yourself may just be a waste of time. We developed Pareo® to specifically address the concerns of this industry: Function, Flexibility, ROI.

In fact, it’s not uncommon for Pareo® clients to see a 10x return on their investment. Read our latest case study to learn more.

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Creating a Community of Users

Creating a Community of Users

When you adopt Pareo®, you gain access to a large community of health plan professionals offering shared expertise.

From time to time, we like to remind our readers that “you don’t have to go it alone.” That isn’t just an empty catchphrase we use to market to new clients. In fact, when you adopt Pareo® at your health plan you’re actually getting much more than an advanced payment integrity solution. You’re also gaining access to shared expertise. The industry terms this a “community of users,” and here’s why we think Pareo users especially benefit from ours.

Tech Comes to Life

Pareo is more than a “pile of code.” Numerous health plans — of all different sizes, with different lines of business, etc. — all working within a common platform is a feature of the SaaS model, not an accidental by-product. The ability to socialize with other users is the ultimate cherry-on-top for health tech solutions, according to Harvard Business Review. In an increasingly digital age, we value the ability of our payment integrity technology to come to life through a community of users.

But what is a user group, exactly? It’s a tiered-group comprised of users that form an association (the user group) hosted by the technology developer. These groups serve to aggregate knowledge and as others have pointed out “at its best, this model delivers constructive and purposeful relationships between and among all three players and remains symbiotic in nature.”

What’s more, when you find a payment integrity tech solution that has a community of users associated with it, you know it’s truly something special. As a self-described “user-group junkie” says: if a product is truly great, users want and benefit from a community (case in point: Apple). For those considering building their own payment integrity technology solution, the benefit of accessing a community of users alone may be big enough to compel them to buy into an existing platform instead.

Not a First Mover? Become a Fast Follower.

If you’ve ever been a part of a community of users (and chances are, if you’ve visited on online forum for a piece of technology, you have), you’ll notice some subsets within the group. Those that are early adopters to the technology may be the most vocal, offering input through whatever channels are available. We call this group “first movers.”

Being a first mover on exciting tech means that you often get to shape overall platform direction. As we’ve said before, some of our best ideas are born from our user ideas and expertise. Connecting with those early adopters of Pareo was an experience that continues to drive our passion for disrupting the industry. We learned early on from our users that our solution was unique.

Of course, we know not everyone can be a first mover. We term the second subset in a user group “fast followers.” Being a fast follower means that you get to benefit from the work first movers put in while still providing input as part of iterative software development. Our user groups today are a mix of first movers and fast followers, and we couldn’t be more grateful for their efforts to help us make Pareo even better. However, we aren’t the only one benefitting from the diverse group who leverage Pareo.

How You Benefit from a Community of Users

There are professional and personal benefits when you join a community of users. Because Pareo solves such a specific market niche, we think the shared expertise our users gain access to is unique to the market. It’s easy to see how a business benefits from uncovering solutions to industry problems, but there are other, softer benefits to be gleaned from being part of a community of users.

Professionally, employees engaging with a community of users are actively sharpening their problem solving skills while also networking with other industry professionals. This level of engagement grants you the opportunity to check you’re staying on the same page as other health plans. Payment integrity is such a focused skill set that networking opportunities are small, albeit mighty.

Still, sometimes these payment integrity efforts are so siloed at organizations that it can be difficult to connect with others facing the same problems. The more out of touch you feel with the industry, the greater the impact aggregated communal knowledge can have.

That’s why many believe the benefits of community extend to the workplace. But engaging with a user group isn’t just a professional box to check off. There are meaningful personal benefits to be had when you’re part of a community.

For example, we speak with some PI staff that find themselves burned out after trying and trying (and failing) to move the needle on recoveries. We find that they respond particularly well to the community of users within Pareo; they’re finally able to engage with those that not only understand their struggles but also appreciate their triumphs. That kind of energy may just be the invigorating force that helps you through the next work slump.

 

Talk to ClarisHealth about how Pareo®advanced payment integrity technology is helping health plans take advantage of collective insights from across the industry. Join our weekly demo: