“The holy grail of health care management is to strike the perfect balance between quality and cost.”
David Wolpaw, M.D., author of “Denying Medical Claims Is Not Always Bad”Overspending on claims goes further than monitoring fraud, waste and abuse. It also extends to cost-containment on claim items, such as unnecessary medical services or above-market prices. For each health plan, the opportunity to maximize return on claim spend can be different depending on their service lines, enrollment numbers, and other factors. Unfortunately, these opportunities are often only uncovered once comprehensive technology is in place to shine a light on the big picture (we term this total payment integrity). Here are some areas that payers can address (with the help of Pareo®) in order to improve ROI on claim spend and contain costs:
Reduce administrative costs, which amount to nearly 20% of claim spend.
Continue to address fraud in-depth by leveraging innovative technology.
Streamline by looking at too-high prices, unnecessary services, inefficiencies and missed prevention opportunities.
Actively track your ROI on healthcare claims.
Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.
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