Examining claim spend cost at health plans, and what kind of ROI can be expected.
Controlling claim spend is nearly impossible without system visibility. By that, we simply refer to the access that some technology gives health plans and payers into payment integrity programs which includes measuring how much is spent on claims.
Some health plans we speak to lack this type of total visibility and therefore settle for 1-2% rate of return on claim spend rather than the nearly 10% that is achievable with Pareo®. Considering that healthcare overspending is on the rise, it has never been more important to contain claim costs.
Controlling Healthcare Claim Overspending
Overspending on healthcare claims payments is estimated to total $1 trillion of total annual healthcare expenditures in the United States. Generally, we identify overspending to occur in three categories: fraud, waste and abuse. You may think that a fraud program is catching overspending at your health plan – it’s not. Even a full FWA program will have gaps if it isn’t paired with total system visibility.
“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.
Improve Your Return on Claim Spend
Don’t settle for the industry standard. Aim for a better solution to contain costs at your health plan. You can tighten margins, proactively control claim spend, and contain costs across the healthcare continuum with the power of Pareo®.
Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.
Now’s the time for total payment integrity
See the ClarisHealth 360-degree solution for total payment integrity in action.