3 practical steps you can take today if your health plan is feeling left behind on advanced payment integrity technology

A few weeks ago, a blog reader approached me about a recent article I wrote titled “Does Your Health Plan Even A.I.?” The reader, who also happens to be a director at a smaller health plan, said something to me that really struck a chord. She said, “Forget A.I. We’re still struggling to process all the requests that come in daily. There’s no way we can think about advanced technology like that right now.” And you know what? This reader isn’t alone. Her health plan isn’t the only one that, rather than facing a fear of missing out (FOMO, as my 8 year old tells me) they are fearful of falling behind.

Pareo® isn’t just for health plans who feel they are “ready” to be forward thinking. It was created to help you innovate, wherever you are in the payment integrity process. Imagine what plagues your PI processes the most, and that’s where we start. Just because something is labeled “advanced technology” or another industry buzzword doesn’t mean it is more difficult for you to use or implement.

You don’t have to be “caught up” when you seek out an advanced technology solution. Rather, you just have to know where to begin.

What’s really stopping you?

I’m going to detour for a moment, so stick with me. Have you ever put something off that’s beneficial because the time wasn’t right? “Sure,” you say, “I should go get that sleep study done, BUT I’ll wait until the kids are back in school or until this big project at work clears up.”

How often does the waiting actually pay off? Do you ever realize that if you’d just gotten the sleep study when your doctor recommended it, the help would’ve come sooner? Putting things off until the “time is right” very often just means that you have to wait longer for help to come.

We speak with health plans who have these same feelings, applied to payment integrity. They tell us “We’re too busy right now” or “We’re too behind” or even “We don’t need help.” And when it comes to advanced technology? “Sounds nice, but we’re struggling to use the technology we have,” they’ll say. But they also tell us that something isn’t working. It makes sense. Professionals all over feel like they’re falling behind, including athletes, marketers, and medical care providers.

 

“In what’s rapidly becoming a mobile-first business world, all manner of industries are being ‘shaken up’ by digital innovation.”

Bryan Kirschner, director of the Apigee Institute

 

Start Gaining Traction

All these buzzwords are flying around and while they’re exciting, they’re also a bit nebulous. This feels especially true for health plans that are facing change on multiple fronts: reform, technology, workforce shortages and other external stressors. It’s understandable that when we throw around terms like AI, ML, Big Data, and NLP that health plans may feel overwhelmed — the healthcare industry is in the process of being disrupted.

Let’s look at three things you can do right now to start gaining traction in your payment integrity efforts:

1. Find the Best Next Step (and Take It)

The best advice on taking action when you feel overwhelmed is simply to start small. It never hurts to seek advice on this front from a trusted resource (we are always happy to help). For instance, you may benefit by performing an “audit” of your current payment integrity operations.

2. Set a Goal for Advanced Technology Integration

Now is not the time for everyone to embrace artificial intelligence, machine learning, and more — and that’s ok. But change is on the horizon, and your best bet is to set a goal to implement some form of advanced technology into your payment integrity operations. Health plans need to continue to focus on data sharing and their ability to comply with regulations requiring interoperability. Pareo®, while equipped with advanced technology, seeks to support data sharing goals at organizations through comprehensive access to information.

3. Power Through Feeling “Stuck”

When you fear you’re falling behind, there’s no need to feel discouraged. If you get stuck along the way, ask yourself if what you are experiencing is physical or psychological (called “paralysis by analysis”). In addition to structural roadblocks like lack of resources, other common barriers to advancement are rooted in emotions like fear. (Symptoms include pesky internal dialogue featuring “should have done …” and “what if …”) Stepping outside of the problem to gain insight into what’s causing your PI operations to fall short is a powerful way to power through problems. Additionally, transparency can be a key tool for health plans that feel stuck.
ClarisHealth seeks to be your partner in total payment integrity, so remember: you don’t have to go it alone. And while we do offer an advanced technology solution, we aren’t robots. We’re real people, passionate about helping your health plan find its focus, increase recoveries, and get ahead of the curve in this increasingly complex industry.

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

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