Transcript What is $2 million worth to your company?

CASE STUDY
Intelligent Subrogation
Community health plan saves
more than $2 million in less
than a year with cloud-based
coordination of benefits and
subrogation solutions
BACKGROUND
This community health plan manages health benefits for 207,000
members. The group had been managing Coordination of Benefits
(COB) and Subrogation cases internally, but suspected it could
simplify its current process and improve savings by:
ACTIVE PURSUIT
AUTOMATION
INSIGHT
More aggressively
pursue potential COB
and subrogation
cases. Client had only
been tracking known,
referred cases.
Simplify the current
manual effort and
paper-based processes
to rapidly identify cases,
manage them more
efficiently, and track
savings.
Improve insight into
inventory of cases to
forecast expected
recoveries and use
that data in corporate
planning.
Full-service outsourcing of COB and
Subrogation functions to Discovery Health
Partners’ Intelligent Cost Containment Platform
• Securely transfer claims and eligibility files
to Intelligent Cost Containment Platform each
month
• Run claims through cloud-based platform
with data mining and analytics technologies
to identify high-potential COB and Subrogation
cases
• Mobilize Discovery Health Partners’ case
managers to pursue and collect recoveries
on client’s behalf
• Incorporate multiple levels of security to
ensure HIPAA compliance
Administrative, physical, technical safeguards
SOLUTION
Intelligent Cost
Containment
Platform
COB
COB
COB
COB
COB
COB
COB
Subro
OUTCOMES
Health plan sees boost of more than $5 million in savings across
Medicare, Medicaid, commercial and ASO plans.
COORDINATION OF
BENEFITS
SUBROGATION
1
2
$2.3 million
$2.2 million
incremental savings in first
year of service
additional savings in first
year of service
WHY IT WORKED
Proprietary Intelligent Cost Containment Platform combines
adaptive analytics and data mining technologies with a business
rules engine to quickly and accurately identify high-opportunity
COB and Subrogation cases
Information analytics
deliver critical case-level
detail and high-level
trending information
any time, anywhere
Data mining helps
pinpoint the most
workable cases
rapidly and accurately,
eliminating false
positives
Business rules engine
includes content that
impacts business
processes and enables
automation. Makes
application more
adaptable to change.
Discovery Health Partners
Intelligent Cost Containment Platform
Expertise –experts in
healthcare regulations and
government systems
advocate for client,
delivering higher
recoveries faster
SOLUTION
“Discovery Health Partners has a case inventory
web tool and a dashboard that allow us not only
to see inventory at any point in time and review
specific individual cases when needed, but also
helps us predict future performance.”
- Senior Director, Claims Administration
READ THE FULL STORY
Find out more about how this healthcare
payer and others are saving money with
cloud solutions for healthcare cost
containment.
www.discoveryhealthpartners.com
Click here
HOW MUCH IS HIDING IN YOUR
ORGANIZATION?
Contact Discovery Health Partners to find out how
you can contain costs and increase your recoveries.
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Subrogation
Coordination of Benefits
Eligibility Services
Claims Review
Audit
www.discoveryhealthpartners.com