Payment Integrity Perspectives: how health plans innovate
How do health plans use technology to overcome specific payment integrity challenges? Each season, ClarisHealth experts follow a health plan on their “hero’s journey” as they work through a knotty problem to arrive at an innovative solution. Through these relatable stories, you will find the inspiration in your own health plan’s day-to-day and understand how to achieve transformation with the right technology.
New episodes added weekly.
Introducing Payment Integrity Perspectives, A New Podcast from ClarisHealth
January 25, 2021
Season 1 Trailer - In this teaser, host Amanda Bair (ClarisHealth) features insights from company leaders to offer a unique perspective on payment accuracy by looking at the problems modern health plans are facing.
Why ClarisHealth? Telling the story about how health plans innovate.
February 1, 2021
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.
The Value of Transparency for Health Plan Technology
February 8, 2021
Season 1: Episode 2 - How exactly does advanced technology help health plans innovate? In this episode, ClarisHealth payment integrity experts Jim Weathersby, Michael Gilbertson and Jason Medlin discuss the value of transparency. How sharing information between health plan internal payment integrity functions, third-party services vendors and other stakeholders fosters a free flow of ideas. As a result, payers experience greater returns and can more easily capitalize on other opportunities for innovation.
Technology to Answer Your Innovation Goals
February 15, 2021
Season 1: Episode 3 - With your health plan’s goals around digital transformation and the increasing number of technology choices available to you, you may start to ask yourself: Are you doing enough to innovate? Healthcare is only increasing in complexity, so the longer you wait to start, the more out of reach success can seem.
Reduce Your Health Plan’s Risk When Selecting Advanced Technology
March 2, 2021
Season 1: Episode 4 - How can health plans evaluate the increasing number of technology choices available to them and find a partner to match their vision - without taking on unnecessary risk? In this episode, experienced payment integrity leader Ben Roberts explains how transparency, flexibility and comprehensive solution offerings set some vendors apart.
How Can Technology Help Health Plans Navigate Complexity?
March 8, 2021
Season 1: Episode 5 - Technology solutions are often the cornerstone of a health plan’s innovation journey. But, as you build your technology stack, ask yourself: Is it simplifying your existing burden? Or, adding even more complexity to your organization and processes? Every step along the way, technology can either pave the way for innovation or split your focus. In this episode ClarisHealth experts Stacey Parker, Tanner Plauche and Misty Ganguly explore how a payment integrity platform’s architecture, development and implementation can help you better navigate complexity.
The Importance of Partnership When Adopting Technology
March 15, 2021
Season 1: Episode 6 - How your technology solution is delivered, and by whom, is a large factor when considering how successful a technology project will be. In this episode, ClarisHealth experts Kenya Adams, Mattie Stremic, Stacey Parker and Christie Hill explore how partnering with clients throughout the relationship can make all the difference.
How Highmark Uses Pareo for an Integrated Approach to Claims Cost Containment
March 30, 2021
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.
Introducing L.A. Care Health Plan
October 11, 2021
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.
Building Payment Integrity from the Ground Up
October 15, 2021
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.
Scaling Payment Integrity to Accelerate ROI
October 20, 2021
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.
Harnessing the Innovation of Payment Integrity Services Vendors
October 29, 2021
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.
Measuring the Value of Payment Integrity
November 5, 2021
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.
3 Elements Needed to Internalize Payment Integrity
November 12, 2021
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.
A Vision for Payment Integrity
November 23, 2021
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.