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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