Analytics firm tackles rising cost of healthcare
Working with City of Fort Worth and others to reduce healthcare spend
By: SmartLight Analytics
Asha George, CEO and co-founder of SmartLight Analytics, said her aim is to make a meaningful impact on the rising cost of healthcare for employers and employees. She has spent years working to build a team of data analytic specialists and clinical board-certified physicians to conduct systematic reviews that result in significant cost savings. Big employers – especially those with 10,000 or more employees – don't have the time or expertise to monitor claims, she said. Claims processors are consumed by just processing and paying the claims, which means there is usually no review happening.
Two such employers – Dean Foods and the City of Fort Worth – are diving deep into their employee medical claims to find savings from waste, duplication, errors and even fraud. Both employers are working with SmartLight Analytics to mine their healthcare claims data for things like unnecessary testing, billing two doctors for the same service and careless errors. Fraud can also be a significant find. In Fort Worth, an initial assessment of the city's employee healthcare claims data aims to further reduce healthcare spending costs, which in 2017 went $15.2 million over budget. Dean Foods began reviewing its claims in 2016 and is reaping the benefits now.
Mike Adams, Vice President of Benefits & HR systems of Dean Foods, a multi-billion-
"It's an extremely good investment of our corporate dollars," Adams said. "SmartLight established a good working relationship with our medical claims processor. We are extremely happy with the results. They identified claims with waste and fraud, researched and recovered those costs and had it credited back to us."
"The City of Fort Worth is looking at ways to further reduce their employee healthcare spend because they have a finite budget and, when it comes to managing the rising cost of healthcare, they have to continue to look for ways to contain those costs," George said.
George said SmartLight's role will be to analyze two to three years of healthcare claims from the city to find waste -- such as duplication of services, unintentional billing errors, and intentional fraud, waste or abuse -- and take action to eliminate this unnecessary spend from the city's employee healthcare costs. Continue reading at https://www.tworoadscommunications.com/