Discovery Health Partners delivers significant ROI to health plan clients using Premium Restoration solutions

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Flexible approach, ongoing investments in analytics, and deep relationship with CMS drive tremendous results

Discovery ESRD Premium Restoration

"With our combination of advanced analytics, relationships with dialysis clinics and other ESRD care providers, and deep expertise working with CMS, Discovery can deliver tremendous premium restoration results that health plans alone can’t achieve.”

Discovery Health Partners announces it recently restored over $61 million in underpaid CMS premiums for a regional Blue Cross and Blue Shield health plan client with 36,000 Medicare Advantage members. The market leader in the premium restoration space, Discovery offers a robust and growing Premium Restoration solution set—including Medicare Secondary Payer (MSP) Validation, End-Stage Renal Disease (ESRD) Premium Restoration, and Part D OHI services—that has delivered large, quick, ongoing ROI to more than half of the Medicare Advantage plans across the U.S.        

“Many plans don’t realize how much revenue they lose in underpaid premiums,” said Jeff Martin, Discovery’s VP of Payment Integrity Operations. “Because CMS allows plans to look back 7 years to determine if premiums were underpaid, that can add up to a significant amount of dollars coming back to the health plan. With our combination of advanced analytics, relationships with dialysis clinics and other ESRD care providers, and deep expertise working with CMS, Discovery can deliver tremendous premium restoration results that health plans alone can’t achieve.”

Discovery’s Premium Restoration services require very little data lift from health plans, are offered with no-risk contingency pricing, and can be implemented in less than 90 days to deliver value back very quickly to the health plan. In one case, a 1M+ member national health plan with an extensive inhouse team chose Discovery to supplement their MSP operations; working behind the internal team, Discovery was able to restore $36 million in premiums in the first year of the engagement.

Another national health plan outsourced their entire MSP operations to Discovery; to date, Discovery has restored over $137 million on behalf of this client.

MA plans are also experiencing significant value from Discovery’s recently launched ESRD solution. Incorrect premium adjustments for Medicare Advantage members with ESRD are common due to the complexity of the process. Discovery’s analytics engine accurately finds “needle in the haystack” records for members with ESRD for which the plan is not receiving a higher premium and then works with ESRD care providers and Centers for Medicare and Medicaid Services (CMS) to correct those members’ records and restore the additional premium dollars back to the health plan. Discovery has helped over 30 Medicare Advantage plans restore millions in ESRD premiums—a 165,000-member Medicare Advantage plan recovered $8.4 million in underpaid premiums; a 230,000-MA member plan saw $5.9 million in restored premiums; and a 100,000-member Medicare Advantage plan restored $6.5 million in premiums all in the first 18 months of starting the program.

As part of Discovery’s Premium Restoration services, Discovery performs over 15,000 updates to CMS’ records every year to correct member eligibility information, resulting in accurate premium payments to health plans. To date, Discovery has completed over 500,000 MSP validations on behalf of its health payer clients.

Ensuring accurate premium payments from CMS continues to plague healthcare payers; innovations from Discovery are easing the administrative burden for its payer customers and driving bottom-line value.

For more information on the value of premium restoration for health plans, see Discovery’s blog post Success with MSP and ESRD Premium Restoration.

About Discovery Health Partners
Discovery Health Partners’ mission is to deliver unique, actionable analytic insights and technology-powered solutions to help healthcare payers improve payment integrity, increase revenue optimization, and maximize efficiencies. Serving more than 80 health plans across the U.S., including nine of the 10 largest U.S. health plans, Discovery has been recognized consistently for its growth and innovation—earning a spot on the Inc. 5000 list seven years in a row, the Crain’s Fast 50 four times, and a prestigious FutureEdge 50 Award from IDG for innovations in machine learning. For more information on Discovery Health Partners, please visit http://www.DiscoveryHealthPartners.com.

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Mary Dalton
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