Download Document

THE BENEFITS OF TRANSPARENCY
IN SUBROGATION
1
HOW INFORMATION
INTELLIGENCE DRIVES
GREATER VISIBILITY,
RECOVERIES AND
COMPLIANCE
What do you see?
2
“TRANSPARENCY”
3
Definition
A general quality that is implemented by a set of
policies, practices and procedures that allow citizens to
have accessibility, usability, understandability and
auditability of information and process held by centers
of authority (society or organizations). - Wikipedia
Implies openness, communication, and accountability.
1. Impact on banking crisis
2. Implications for HIPAA
Transparency: our view
4
WHAT IS IT?
The ability to easily (timely) and flexibly (diversely) access
information for decision making
WHO CARES?
Anybody who wants to improve and manage results
•
•
Measuring increases focus
Focus increases results
SHOULD YOU CARE?
Yes. But why?
•
•
Increased pressure on overall healthcare cost puts cost
containment on the executive map
More sophisticated self-funded organization are asking questions
Top trends of transparency
(business intelligence)
5
Source: MIT Sloan Management Review
10 Insights-A First Look at the New Intelligent Enterprise,
2010
Now about you
6
WHO NEEDS TO REPORT MONTHY
PERFORMANCE?
Ex: Plan versus Actual?
WHO HAS A VENDOR MANAGEMENT
ROLE AND WANDS TO COMPARE VENDOR
RESULTS?
Ex: identify if your vendor has backlog – are they
working your cases in a timely manner?
5 Reasons why you must care
7
Better
business
Track
business
performance
Forecast what’s
ahead
Set goals to
improve
Better
customer
service
Be a partner,
not a vendor
Compliance
Health reform
An easier life
ERISA
With constant
change, be
prepared
Less time
Sarbanes-Oxley
Empower with
insight
Answer
questions before
asked
Give options for
information
Medicare
reporting
Medicaid
reporting
Better
recoveries
improve your
solvency as a
Plan
Greater insight
Better
leadership
Self-service for
group reporting
How it can make us feel
8
EXPOSED
VULNERABLE
Transparency solves organizational
problems
9
 Provides ability to see business






processes from A to Z
Gives more control and accountability
Removes doubt and suspicion
Helps avert trouble
Drives improvement
Move from crisis management to
proactive management
Different ways to use information
to your advantage

In-house vs. vendor
What this looks like in the real world
•
Access to a dashboard to get answers
anytime, anywhere
•
Giving detailed case information to
customers if you choose
•
Self-service reporting for you and your
customers
•
Strengthen identification process
•
Identify and address backlogs
•
Improve member interaction
•
Ability to compare vendor results
Transparency doesn’t matter
without
action
10
Does transparency improve results?
1. Does it deliver better recoveries?
2. Does it improve ratios?
3. Does it reduce processing cost?
NO
Improvement starts with you
11
Does it empower you to improve results?
YES
1. Better recoveries
2. Improved ratios
3. Reduced processing cost
Change made
to data mining
process
reduced false
positives
dramatically
New Client
Taking action on insights can yield:
Be sure to know what you’re looking at
12
The multiple faces of transparency
13
 Trending
o
Recoveries by account/group for the last rolling 12 months



Recoveries by account for the last 12 months rolling
Recoveries by funding type for the last 12 months rolling
Recovery ratio for the last 12 months
 Exception reporting
o
Recoveries with a ratio less than 45% based on a business rule


List all FTEs with more than 500 cases pending
List all providers with outstanding COB retractions
 Benchmarking
o
Recoveries by reporting group related to high and low recoveries


Recovery funding type vs. high and low recoveries for all members
Letter count ratio for a specific group vs. high and midpoint of all groups
 Ranking
o
Top groups within a dimension 80/20 rule


Top FTEs ranked high to low of recoveries
Top recovery teams / states / vendors ranked high to low
Transparency impacts the entire subrogation
process (not just recoveries)
14
EDI
Streamlines data processing and identifies stoppages, forcing
issue resolution
Identification
Improves data mining, reducing false positives
Investigation
Reveals backlogs, forces analysis, improves investigation, and
moves more cases to pending
Pending
Tracks diaries, reallocates workloads, and reduces settlement
delays
Settlement
Recovery
Automates follow-up on outstanding settlement proceeds,
speeding total recoveries
Analyzes recovery trends to identify areas of weakness, yielding
increased recoveries
Real-world examples of transparency
in action
15
 An automated comparison of multiple vendors allowed a health plan to easily
compare results, create benchmarks, and create SLAs across vendors
 An audit of 18 months of historical data found 36% more recoverable claims
than what a company had identified
 An analysis of closed without collection reasons led to improved data mining,
eliminating unnecessary illness-related inquiries and thereby minimizing
member intrusion
 Self-service reporting enables a company to reallocate resources to higher
priority functions
EXAMPLES OF DATA VISUALIZATION
16
Transparency leads to fresh insights
17
Filters: (Examples)
Transparency leads to fresh insights
18
Transparency leads to fresh insights
19
Case Aging by FTE
Transparency leads to fresh insights
20
Transparency leads to fresh insights
21
Transparency leads to fresh insights
Change made to
data mining
process reduced
false positives
dramatically
New Client
22
Your path to improved transparency
and
results
23
What matters is changing
24
24
•
Companies say the ability
to visualize data differently
to support strategy and
decision-making will be
most valuable in 2 years
•
Analytics for business
processes will be more
important too
Source: MIT Sloan Management Review
10 Insights-A First Look at the New Intelligent Enterprise, 2010
Challenges and key considerations
25
Lack of
resources
The obstacles to adopting analytics
26
 Companies struggle to
understand how analytics
can help improve
business results – and
managers are too busy to
investigate
 Culturally, many
organizations have issues
with data ownership and
sharing
 Many organizations don’t
tap their talent for
leveraging analytics
Source: MIT Sloan Management Review
10 Insights-A First Look at the New Intelligent Enterprise, 2010
Transparency Assessment: are you ready
for the change?
27
How much do you really know about your recovery operations?
 Transparency Assessment lets you self-assess in three
major areas
1.
2.
Topline results by line of business, accident type, FTE, and other views
Operational insight into what is happening and why



3.
Pending/active status
Closed without collection cases
Recoveries by plan type, state, plan descriptions
Reporting and analysis



Drilldown and ad-hoc capability
Benchmarking performance
Management reporting
Above all else, strive to see the full picture
28
By Paul Vosters