Payment Integrity Perspectives: how health plans innovate ClarisHealth

This season, as we have followed L.A. Care Health Plan's journey building a payment integrity function from the ground up, we've seen them go from a few thousand in unsolicited recoveries to $131 million in overpayment avoidance and recoveries in just a few short years. That's a triumph by any measure. But if you've learned anything from the L.A. Care team, you might have guessed that isn't the pinnacle of their ambition. As they look back on how far they've come and look forward to their next challenge, they still have their focus firmly planted on a vision for a fully mature payment integrity function.

In this episode, Shonnie Davis, Gladys Oswell and Erik Chase tell of how they’re incorporating more of the organization and sharing their insights in order to shift more to overpayment prevention.

Joined by Yaw Agyemang, Jeff McNeese, Dana Ryan and Andrew Walters of ClarisHealth who discuss the value of partnership, focused goals and starting small to achieve big gains.

Guests: 

L.A. Care Health Plan: Shonnie Davis, Gladys Oswell, Erik Chase

ClarisHealth: Yaw Agyemang, Jeff McNeese, Dana Ryan, Andrew Walters


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As we've followed L.A. Care Health Plan's story of payment integrity transformation, they have discussed how important third-party service vendors have been to that journey - especially when combined with the efficiencies, oversight and transparency enabled by the program optimization capabilities in Pareo. But their ultimate goal will be familiar to most health plans. How can they do more overpayment detection and prevention with their own resources?

In this episode, Erik Chase and Shonnie Davis tell of how they have combined technology, internal subject matter experts and outside analytics content to maximize the recoveries initiated by their own resources.

Joined by Jeff McNeese, Cassie Bishop, Coy Page and Andrew Walters of ClarisHealth who discuss the value of the “outsource to insource” strategy and how health plans can engage in a non-traditional vendor relationship focused on root-cause remediation.

Guests:

L.A. Care: Erik Chase, Shonnie Davis

ClarisHealth: Jeff McNeese, Cassie Bishop, Coy Page, Andrew Walters


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One of the primary reasons health plans seek digital transformation is for its potential as a more reliable source of information and insights. L.A. Care Health Plan was no different, but the stakes were even higher. Because the payment integrity function was relatively new, they were under arguably greater pressure to increase visibility and definitively prove their value and impact.

In this episode, Erik Chase, Gladys Oswell and Shonnie Davis tell of how their value and focus evolves over time as their function matures and how they’re collaborating cross-functionally to share those insights via Pareo.

Joined by Coy Page, Dana Ryan and Jeff McNeese of ClarisHealth who discuss the value of insights and analytics in a health plan’s ability to measure the success of their strategy – and move their payment integrity program forward.

Guests:

L.A. Care: Erik Chase, Gladys Oswell, Shonnie Davis

ClarisHealth: Coy Page, Dana Ryan, Jeff McNeese


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We can't tell the story of L.A. Care Health Plan's accelerated path to payment integrity results without talking about the efforts of services vendors. Even with their innovative strategies, this traditional approach has played a key role in allowing L.A. Care to quickly ramp up capacity.

In this episode, Erik Chase and Shonnie Davis tell of how they added vendors, stacked to greatest effectiveness, to jumpstart innovation. And how Pareo helps them manage these relationships efficiently, with an eye toward optimizing value. From their point of view, win-win vendor and health plan relationships are made possible through setting big goals and improving transparency.

Joined by Tara Dufrene of ClarisHealth as well as Jon Downie and Valerie Thompson of TREND Health Partners who provide a vendor perspective on this unique dynamic.

Guests: L.A. Care: Erik Chase, Shonnie Davis; ClarisHealth: Tara Dufrene; TREND Health Partners: Jon Downie, Valerie Thompson


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When the L.A. Care Health Plan payment integrity team looks at how far they’ve come in 4 short years, the differences are startling. Their early success made the case for the work they do. And the efficiencies created by Pareo allow them to go further, faster.

In this episode, Gladys Oswell, Erik Chase and Shonnie Davis tell of their experiences scaling payment integrity results across the organization. Joined by Andrew Walters, Cassie Bishop, Jeff McNeese and Yaw Agyemang of ClarisHealth who tell of collaborating on new opportunities to push overpayments identification, recovery and prevention forward at L.A. Care.

Guests:

L.A. Care: Erik Chase, Shonnie Davis, Gladys Oswell

ClarisHealth: Andrew Walters, Cassie Bishop, Jeff McNeese, Yaw Agyemang


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On their way to achieving an annual $131 million recovery rate, L.A. Care Health Plan had to build their team, onboard and manage vendors, and acquire a technology solution to enable their expansive vision.

In this episode, Erik Chase, Shonnie Davis and Gladys Oswell tell of their payment integrity function’s beginnings in 2017 and how they embraced the challenge by starting small to find early success. Joined by Jeff McNeese and Yaw Agyemang of ClarisHealth who tell of Pareo’s origins as a vendor management technology solution that caught L.A. Care at just the right time.

Guests:

L.A. Care: Erik Chase, Shonnie Davis, Gladys Oswell

ClarisHealth: Jeff McNeese, Yaw Agyemang


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Send in a voice message: https://podcasters.spotify.com/pod/show/payment-integrity-podcast/message