While wellness programs and other long-term cost containment strategies have their place in healthca...

1. Healthcare Cost Management Through Technology And
Expertise
While wellness programs and other long-term cost containment strategies have their place in
healthcare cost management, most organizations require cost reduction now. Current or recent
increases in health plan claims are what most often drive companies to search for healthcare cost
containment companies. That's where technology and expertise become most important. So what
should corporations be looking for to contain health plan claims right now? Let's have a look.
Analytic technology and tools that are ahead of the curve. Superior software that delves deep into
claims billing is a critical step required by companies aiming to reduce unnecessary health plan
claims. Industry experience is certainly necessary to understanding the requirements for this
software, but superior software that delivers clear, meaningful reports is crucial to helping
companies understand their health care costs. Some of the things that superior software can
perform would include detection of irregularities, rich editing and auditing of claims, and claims
trend analysis, among other things. When a healthcare cost management company can provide truly
meaningful data that can integrate with that of any corporation this reduces lag time in
implementation and can provide more immediate cost reductions. State-of-the-art software that
audits every claim down to the last detail is critical to cost reduction.
Expertise in Auditing and Clinical Bill Review. This begins with people, starting at the top of any
healthcare claims management provider. The company's experience in auditing claims,
understanding the industry, detecting fraud (among other things) must be deep and rich. This must
extend through its entire staff of claims auditors who must provide medical, analytical and
negotiating expertise. This is critical to helping companies identify opportunities for improvements
and to reduce unnecessary health plan benefits claims and costs.
Well established PPO Networks. The establishment of preferred provider organizations comes with
experience and expertise of course, but a rich, wide understanding of network availability and
integrity is critical to reducing healthcare costs. That quest for experience extends into the provider
networks as well, so that cost management companies ensure that healthcare providers are aware of
cost reduction opportunities and avoid waste or mismanagement.
These are only a few aspects that form part of effective healthcare cost management but these are
some of the most critical in immediately reducing healthcare claims, especially those due to
unnecessary errors, abusive impropriety or fraudulent claims. Look for superior technology,
experience and expertise when you want to immediately reduce healthcare costs due to undue
health plan claims.