Rising costs, legal and regulatory mandates, fewer resources, growing enrollments, are just a few of the challenges that Government Health Agencies and Programs face every day. Current budget crises and intensified scrutiny of Health programs result in the need to improve efficiency and quality of health care with cost-effective solutions. More and more, government initiatives focus on innovative and advanced services as the vehicle for achieving significant and measurable improvements.
ACCURATE can help government agencies improve the efficiency of health services while enhancing the quality of their programs. Our breadth of experience affords us a unique perspective on the Greek health care market and an unmatched ability to address the particular requirements of government.
An example of how ACCCURATE was able to deliver substantial savings to a Government Agency includes:
Case Study
A large National Public Health Insurance Fund, OPAD, avoids €2 million in overpayments with Medical Case Management Auditing by ACCURATE
Challenge
OPAD, a National Public Health Insurance Fund for Public Servants, needed assistance analyzing its claims data, in order to manage its Health Care program more efficiently and hold down costs.
By applying retrospective knowledge to front-end processes, the health plan could avoid making unnecessary overpayments to private clinics. But isolating the root causes for overpayments, quantifying them, and then employing viable solutions required time and expertise. OPAD wanted to:
- determine what elements of the program drove the costs,
- eliminate fraud and abuse,
- ensure payment integrity, and finally
- develop a plan to implement the solution.
Solution
OPAD entered into a pilot short-term consulting agreement with ACCURATE to examine and enhance payment processes and improve payment accuracy. This marked the first time that a Public Insurance Fund outsourced this service to an Independent Third Party Administrator. Working in collaboration with the client, ACCURATE generated a detailed project plan that included key dates and benchmarks. Next, the project team assessed and defined metrics to create standards that would be used to measure root causes and impacts on the final report card.
ACCURATE used its systems and analytical expertise to discover immediate cost savings and provided recommendations for corrective measures. Upon completion, a final review detailing the project’s successes and lessons learned was prepared and delivered to OPAD.
Results
Within weeks of the contract execution, ACCURATE yielded more than €2 million in savings for OPAD.
Once ACCURATE audited 1,200 Medical Claims, submitted by the network of private clinics, its experts discovered that of the €12 million the plan needed to pay out, more than €2 million could be cut as overpayments. This represented over 18% of total cost savings, and a Cost vs. Savings ratio of 1/37.5. Clearly the results were impressive, when considering that OPAD internal audits conducted in previous years had only averaged 3% of cost savings.
In addition, ACCURATE pointed out that if the audits had been performed real-time, as is customary in the Private Sector, then the savings that OPAD could have realized, would have been much greater. Already OPAD’s private clinic network providers fully accepted the report findings, and will not seek to recover these claims.
To learn how ACCURATE can help your organization, visit ACCURATE Services.
