Is provider abrasion undoing all your best member satisfaction initiatives? After a recent medical appointment, I visited the front desk on the way out where the office manager/claims specialist let me know I had an outstanding balance from my preventive care visit six months ago. “That can’t be correct,” I said. “We’ve resubmitted and done all we can do. They’re so difficult to deal with. Maybe you’ll have better luck,” they replied. What followed was hours of my own time on the phone with half a dozen different health plan representatives. All of them very nice and – through no fault of their own – completely unable to help me. You see, my situation was a result of department silos. Different teams using and accessing different systems, and my claim had fallen into the gaps between. Nobody was in the wrong, exactly, but because my health plan lacked a comprehensive technology system, my claim was denied and my provider passed their frustration along to me. This situation got me thinking: How much of the provider abrasion that can result from the usual claims administration processes is being passed along to your members, and why should you care? Member Satisfaction Here’s why passing along provider abrasion to your health plan members should matter: Member satisfaction. Surveys increasingly suggest that keeping members happy is top of mind for health plans. And what keeps a member happy and loyal? You guessed it – customer service satisfaction. “When customer service leaves members feeling valued and appreciated, nearly 87 percent of health plan beneficiaries will advocate for the health plan’s brand and 74 percent will retain their membership. Conversely, only 11 percent of customers who feel annoyed or dismissed by health plan customer service interactions will promote the brand on their own, and just 28 percent will stick with their carrier,” reports Health Payer Intelligence. Typically, we see health plans address customer satisfaction through a myriad of consumer-focused technology solutions, like wellness apps, online access to claims data, 24/7 chat support, and offering easy payment portals. These initiatives are right in line with the focus on value-based care, as many consumers who’ve grown used to shopping health plans on the ACA marketplace are looking for a better experience. But something’s missing, and that something is the effect that middle- and back-office administrative processes have on your members.

Provider Abrasion Creates Poor Member Experience

Commercial health plan customer satisfaction rates have remained stable in the last years, but emerging consumer demands hold the key to growth. In particular, health plan members are struggling to understand the administrative processes that make their plan work (according to the JD Power 2018 Commercial Member Health Plan Study). And as I’ve already illustrated, it’s very often the case that a provider’s own abrasion with a health plan means that the consumer directly deals with claims process inefficiencies themselves. We speak frequently on the negative consequences of siloed data, and how Pareo® answers this issue by connecting a health plan’s entire ecosystem, creating transparency to benefit staff members. But what if we told you that total visibility benefits your plan’s members, too? All by improving or preventing provider abrasion, which creates poor member experiences for health plans.

See What Pareo Can Do For You

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

The Solution

Pareo is a Total Payment Integrity™ platform, aimed at transforming a health plan’s claims recovery processes. But housed within Pareo are modules that seek to improve or prevent provider abrasion. And since we’ve established that it’s important to health plans to keep members happy, and that members are decidedly unhappy when they have to deal with the administrative consequences of provider abrasion, we think it’s important to look at how Pareo can help. Pareo offers three core benefits that prevent or reduce provider abrasion: Vendor Overlap Management, Smart Work Queues, and Medical Record Image Capture and Storage. Let’s address each one:

Vendor Overlap Management

Our vendor management module allows a health plan to maximize recoveries and optimize costs, and it contains a feature we call overlap control. This feature eliminates unnecessary audits automatically. It prevents audits that are outside of vendor contractual requirements and if over-payment already exists, then it is prevented from loading into the audit review system. By streamlining vendors, your health plan will clean up any audit processes that are redundant or unnecessary on providers.

Smart Work Queues

Each payer has a unique audit and validation process, so Pareo customizes the entire lifecycle of an audit. Our streamlined workflows, which we call Smart Work Queues, increase analyst production by 3x. This smarter approach for health plans mean that data silos are shattered, and that providers (and members) will benefit from improved administrative processes that are intuitive and helpful (instead of redundant and frustrating).

Medical Record Image Capture and Storage

Process inefficiency is eliminated with Pareo’s payment error prevention program (PEPP). Digitizing medical records and storing them for our clients expedites otherwise slow processes. And, this module includes a drag-and-drop feature so that medical records are stored with a claim, making it much easier for them to access good data. With Pareo, medical records are easily shared between internal teams, allowing claim questions to be answered quickly

Streamline Your Processes

Provider abrasion undoubtedly trickles down to your plan’s members but improving communication through Pareo’s features can make all the difference in member satisfaction. Learn more about the ClarisHealth Total Payment Integrity approach for health plans.