CASE STUDYIntelligent Subrogation

Community health plan saves more than $2 million in less than a year with cloud-based coordination of benefits and subrogation solutions

BACKGROUNDThis 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:

INSIGHT

Improve insight into inventory of cases to forecast expected recoveries and use that data in corporate planning.

AUTOMATIONACTIVE PURSUIT

Simplify the current manual effort and paper-based processes to rapidly identify cases, manage them more efficiently, and track savings.

More aggressively pursue potential COB and subrogation cases. Client had only been tracking known, referred cases.

SOLUTIONFull-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

Eligibility

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COB

COBCOBCOBSubro

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OUTCOMES

COORDINATION OF BENEFITS

$2.3 millionincremental savings in first

year of service

SUBROGATION

$2.2 millionadditional savings in first

year of service

Health plan sees boost of more than $5 million in savings across Medicare, Medicaid, commercial and ASO plans.

1 2

WHY IT WORKEDProprietary 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

Discovery Health PartnersIntelligent Cost Containment Platform

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.

Information analytics deliver critical case-level detail and high-level trending information any time, anywhere

Expertise –experts in healthcare regulations and government systems advocate for client, delivering higher recoveries faster

“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.dicoveryhealthpartners.com

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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