Reduce Denials with These Four Tips to Uncover Hidden Coverage
A recent report by The Kaiser Family Foundation showed that claim denials are on the rise, with some plans reaching up to 80% in denials. Based on...
Healthcare continues to become increasingly complex. Member health outcomes and financial measures are managed by disparate systems that trap information in silos, causing inefficiency, introducing human error, and causing friction between members, healthcare providers, and health plans. New technology, however, offers ways to minimize these challenges. With the right technology tool set, health plans can bring less friction and more harmony to their member experiences.
What does this look like in practice? Read on for five quick tips for using emerging technology to accelerate health plan/healthcare collaboration, support members throughout their healthcare journey, and gain new insights into the whole member, powered by data.
5 quick tips for solving health plans’ top challenges
- Pain point 1: Inefficient data management processes
Health plans exist to distribute risk across a population to reduce overall costs. To provide the best services at the most affordable costs, a streamlined data management process is essential. This can be difficult to do, especially when information is siloed, disparate, or not well managed.
Quick tip: Put comprehensive data management strategies in place. Be sure the data you’re using is industry-leading and comes from a trusted, accurate source. Invest in the right tools and technology to enhance your strategies. - Pain point 2: Lack of trust
There are 900+ health plans with different rules in our healthcare market today. Not only does this make it confusing to navigate from a benefits and payment standpoint, but it can make it hard to build trust with members and healthcare providers. Despite the narrative positioning insurance companies as highly profitable organizations, a mandated 80% must be spent on care and quality improvements. When profits exceed these numbers, funds must be returned to the subscribers paying the premium.
Quick tip: Transparent pricing—including information on the payer-specific negotiated rate—helps remove any confusion about rates and costs. When members and healthcare providers can easily view and understand their payment responsibilities, it makes for a more positive experience. - Pain point 3: Low healthcare literacy
Navigating the healthcare system can be confusing for members, as they often don’t know where to go for the best level of care, how much their payment responsibility will be, and/or if the services rendered will be covered by insurance. Without a better understanding of these factors, overall satisfaction can suffer. Health plans, in many cases, are the best source of information on costs and coverage, but they’re often not consulted.
Quick tip: Find the best way to proactively reach out to members (via their preferred method) about their care and its costs. Just as consistent communication with members is important, it’s equally important to maintain positive relationships with healthcare providers. By collaborating with both groups, health plans can better support healthcare consumers to feel more engaged and empowered in their care decisions. - Pain point 4: Understanding social determinants of health
Unmet social needs can affect member health and drive higher costs and utilization of healthcare services. Socioeconomic data at the individual and community-level can help inform innovative wellness programs and interventions, and improve organizational efficiencies. With affordable care being top of mind for members and healthcare providers, social determinants of health (SDOH) have become a worthwhile strategy for health plans to more carefully consider and implement.
Quick tip: Consider identifying a technology partner that specializes in socioeconomic data aggregation. This will help produce strong risk mitigation strategies and ultimately improve overall health outcomes. - Pain point 5: Inadequate member engagement
For actionable insights to be possible, it’s imperative to have accurate member identity information available. With accurate member engagement, you can reach the right person on the first attempt via their preferred method (phone, mail or electronically), improving member safety and engagement while also reducing the cost of unnecessary visits.
Quick tip: Implement a member matching and/or identity solution to ensure you're using the most up-to-date member information. A good starting point for ensuring data hygiene is to update duplicate or mismatched contact information.
At FinThrive, we are proud to offer innovative solutions that help health plans implement these tips and more. Explore how we help health plans improve member outcomes and engagement with technology you can trust.
