City of Fort Worth and SmartLight Analytics Form Partnership to Reduce Healthcare Costs
Could save the city millions per year with continued partnership
By: SmartLight Analytics
Given the estimate that 1 in 3 healthcare dollars in the US are spent on fraud, waste, or abuse, the City of Fort Worth was eager to find an independent partner with the required expertise to reduce unnecessary costs for employees, retirees, and taxpayers. The City of Fort Worth Human Resources department engaged SmartLight Analytics to review a subset of past paid claims in a pilot program. Initial findings showed that an ongoing partnership would give the City additional tools to continue to proactively fight against wasteful healthcare spending and decrease its overall healthcare costs.
SmartLight CEO, Asha George, said its "singular objective is to meaningfully reduce the City of Fort Worth's per member per month (PMPM) cost by identifying and removing wasteful spending from its annual health plan dollars."
"The intended outcome of this examination was to report significant findings to Fort Worth on its health plan spend and also provide solutions for reducing potential wasteful spend in future payments," SmartLight stated in its first report to the City.
Some examples of what SmartLight Analytics was able to identify include:
§ pass-through billing schemes
§ medically unnecessary screening and testing
§ identifying claims that violate the anti-kickback laws
§ overuse of ER
Given the success of the initial engagement, SmartLight Analytics will now enter into an on-going partnership with the City. Once a wasteful claim is identified, SmartLight will pass that information on to the City's current medical and prescription providers and work with them to get the money back for the City. Additionally, the medical or prescription providers may report these findings to authorities to help curb the abuse throughout the healthcare system. SmartLight Analytics anticipates the City could save up to $2-$3 million per year in reduced wasteful claim costs.
"We anticipate that SmartLight Analytics will identify claims with fraud, waste, or abuse. Then, they will work with our claims administrator to recover the costs for the City, and have them credited back to us," said Brian Dickerson, Fort Worth's Human Resources Director. "This will be a win for our employees, our retirees, and the taxpayers of the City of Fort Worth."
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