Why we focus on the problem, not the health care solution

Oct 31, 2019

ClarisHealth CEO Jeff McNeese shares how our tech company created a solution born directly out of the frustrations with the healthcare industry, by experienced healthcare workers.

A major health plan client came to us recently and asked “Can you partner with us on this healthcare solution?” And it’s honestly one of the best compliments our organization can receive. Why? They know we understand their challenges as if we were working alongside them, and that puts us in a position of solving problems, allowing us to hit the ground running. This unique knowledge of health plan challenges proves useful when you’re evaluating potential technology partners. 

Consider a recent conversation we had with a health plan leader regarding advanced technology. The leader shared with us a frustration they had when approached by technology vendors who claimed to have a health care solution. But, this leader told us, when it came down to serious discussions, he often uncovered that the technology vendor knew a lot about tech but next to nothing about the industry, much less the problems facing it. 

Instead, the vendors in question wanted the health plan to tell them how to solve their problems. “We aren’t in the technology business, we are in the healthcare business. I don’t have the solutions. That’s why I’m coming to you!” the health plan leader recounted to us. 

This perspective has opened up a lot of dialogue for us internally around what it takes to be a good problem solver and why our experience matters so much. How are we able to, as one client told us recently, “see the problem as if you’re working alongside us”? With so many technology companies entering the advanced technology space, how clearly are they able to see the acute pain points facing the industry without having much healthcare experience? 

Good question. We know the problems that plague health payers because we’ve been in your shoes. Our company is a well-curated collection of folks from various walks of healthcare life: payer, provider and, of course, members and patients. Some of our team members, those in the Services department, are even working as Auditors, Data Miners and Overpayments Specialists — just like you. 

It’s our history and our commitment to deriving insights from the pain points these front-line employees bring to us, that allows us to be more effective problem solvers. And it’s not far fetched to admit that we love the problems — because that better positions us to solve them. Here’s what keeps us motivated to redefine the vision of technology in the health payer space. 

Problem-solving Mindset

We’ve been where you are today: stymied by processes that don’t work, and stuck in a situation where you are asked to deliver more with fewer resources. And, while we actively follow industry updates, including changes in compliance and legislation that are sure to affect our clients, perhaps more importantly, we listen. We seek opportunities to hear directly from industry leaders what works and what doesn’t in terms of technology solutions for payers. 

We aren’t the only technology company offering a solution by digging into the problem. Waze confounder Uri Levine says, “Fall in love with the problem not the solution, and the rest will follow.” When we can place ourselves in our clients’ shoes, we can see more clearly the pain points — big and small — that prevent health plans from managing payment integrity in an effective way. Understanding and accepting that the nature of problem solving has many ups and downs is something we embrace. 

Where does this love of problem solving come from? It starts with how we came to be a technology company. ClarisHealth was initially a services vendor. We grew frustrated by tools that didn’t serve our purposes, even simple things like automated time and date stamping on claims. This frustration triggered the development of what would become known as Pareo, a “nerve center” technology that integrates the varied data and viewpoints into a single source of truth. 

Today, health plans who are weary of outdated processes, of promises to help that fell short, of hearing the same rhetoric thrown their way, suddenly see the power of Pareo. And they get excited. Excited about the potential for transformation — moving away from what has become acceptable in this industry to what is possible. That excitement is contagious. It’s what keeps us going.

Here to Transform the Industry

Not everything about Pareo is sexy or glamorous. Imagine you had the best house in the world but the plumbing was not well done. It would quickly become a place you would not want to live in. Similarly, it may be cooler to throw out buzzwords like AI or Blockchain or NLP, but Pareo focuses on solving the real-world practical issues that prevent health plans from scaling a PI organization. We see Pareo as the plumbing, that foundational set of solutions, enabling PI leaders to build a fully integrated ecosystem where they can drive scale and efficiency.

The use of a design-thinking process helps ClarisHealth dig in and understand the problem, quickly model and deploy a solution. Through the years we’ve realized that it’s vital to ensure we are solving a big enough problem. It’s not our goal to offer yet another technology solution that is destined to become siloed. Rather, we want to elevate the whole industry

Our clients see this vision and through them, we are changing the way payment integrity processes are run. It’s the friendliest sort of disruption — from those in the trenches with payers, seeking to find a way through.

Focusing on health plan challenges is why we envisioned and built Pareo as a platform. Not only does it integrate seamlessly with many other best-in-class solutions, it’s also developed in a way that allows it to be continually tweaked and customized. In other words, we haven’t built a software and stuck it on a shelf. Our team is, at every stage of a project, creating a solution that meets the specific needs of a health plan. And what’s more, the various modules in Pareo get better and smarter as more health plans use them – a benefit that all of our clients feel in the way of continual updates. 

For those of you new to Pareo, we are glad you’re open to learning more about our transformative vision. And to those who have believed in us, thank you for continuing to support us and allowing us to take this dream of a better payment integrity solution — Total Payment Integrity — all the way to the top.

Talk to ClarisHealth about how Pareo® advanced payment integrity technology is helping health plans deliver on their most advanced digital strategies.

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