Payment Integrity Perspectives: how health plans innovate

Season 1: Episode 1 - Why is ClarisHealth telling the story about how health plans innovate? In this episode Jeff McNeese, Tara Dufrene and Ryan Nowers tell about the origins and early days at the company. How they started helping health plans solve their biggest challenges with payment integrity technology and what the future looks like for healthcare innovation.

Season 1: Bonus Episode - How has Highmark Blue Cross Blue Shield achieved an industry-leading 27:1 ROI on their payment accuracy and FWA operations? Listen as Kurt Spear, VP Financial Investigation and Provider Review for Highmark, reveals the role Pareo has played in their success.

Season 2: Trailer - This season, we’re following L.A. Care Health Plan who built a payment integrity function from the ground up – with a little help from advanced technology platform Pareo – and found incredible success in the process.

Season 2: Episode 1 - On their way to achieving an annual $131 million recovery rate, L.A. Care Health Plan had to build their team, onboard and manage vendors, and acquire a technology solution to enable their expansive vision. In this episode, Erik Chase, Shonnie Davis and Gladys Oswell tell of their payment integrity function’s beginnings in 2017 and how they embraced the challenge by starting small to find early success. Joined by Jeff McNeese and Yaw Agyemang of ClarisHealth.

Season 2: Episode 2 - When the L.A. Care Health Plan payment integrity team looks at how far they’ve come in 4 short years, the differences are startling. Their early success made the case for the work they do. And the efficiencies created by Pareo allow them to go further, faster scaling results across the organization.

Season 2: Episode 3 - We can't tell the story of L.A. Care Health Plan's accelerated path to payment integrity results without talking about the efforts of services vendors. Even with their innovative strategies, this traditional approach has played a key role in allowing L.A. Care to quickly ramp up capacity. From their point of view, win-win relationships between payment integrity vendors and health plans are made possible through setting big goals and improving transparency.

Season 2: Episode 4 - One of the primary reasons health plans seek digital transformation is for its potential as a more reliable source of information and insights. L.A. Care Health Plan was no different, but the stakes were even higher. Because the payment integrity function was relatively new, they were under arguably greater pressure to increase visibility and definitively prove their value and impact. In this episode they tell of the insights they receive from Pareo and how transparency helps them continue to grow their program.

Season 2: Episode 5 - Third-party services vendors have been important to L.A. Care Health Plan's journey of payment integrity transformation. But their ultimate goal will be familiar to most health plans. How can they do more overpayment detection and prevention with their own resources? In this episode they tell of how they have combined technology, internal subject matter experts and outside analytics content to maximize the recoveries initiated by their own auditors and analysts.

Season 2: Episode 6 - This season, as we have followed L.A. Care Health Plan's journey building a payment integrity function from the ground up, we've seen them go from a few thousand in unsolicited recoveries to $131 million in overpayment avoidance and recoveries in just a few short years. That's a triumph by any measure. But if you've learned anything from the L.A. Care team, you might have guessed that isn't the pinnacle of their ambition. As they look back on how far they've come and look forward to their next challenge, they still have their focus firmly planted on a vision for a fully mature payment integrity function.