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CASE STUDY

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.

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CASE STUDY

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  1. 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

  2. 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 simplifyits 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.

  3. SOLUTION Eligibility 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 Claims Intelligent Cost Containment Platform Administrative, physical, technical safeguards COB COB COB COB COB COB COB Subro $ $ $ $ $ $

  4. 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 incremental savings in first year of service $2.2 million additional savings in first year of service

  5. 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. Expertise–experts in healthcare regulations and government systems advocate for client, delivering higher recoveries faster Discovery Health Partners Intelligent Cost Containment Platform

  6. “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

  7. 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.dicoveryhealthpartners.com Click here

  8. HOW MUCH IS HIDING IN YOUR ORGANIZATION? Contact Discovery Health Partners to find out how you can contain costs and increase your recoveries.www.discoveryhealthpartners.com • Subrogation • Coordination of Benefits • Eligibility Services • Claims Review • Audit

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