Transforming Benefits Data to Improve Health Outcomes
Discover in this case study see how BenInsights unified fragmented health data across carriers, resulting in targeted cancer screening initiatives with extraordinary results for one employer.
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Revenue Revival: A Rural Hospital’s Path to Sustainable Success
Claritev's Provider Strategy and Data Insight Services helped a rural healthcare organization overcome mounting financial pressures, care and access hurdles, competitive disadvantages, and fragmented data systems.
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Broker Case Study: Early Risk Prediction Improves Effectiveness of a Musculoskeletal Point Solution
A case study for brokers that highlights the transformative potential of early risk prediction for improving financial outcomes and ensuring a healthier, more productive workplace.
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Stabilizing the Unsustainable: A Look at the Healthcare Market in 2022 and the Stabilizing Power of Reference-Based Pricing
When employees and employers think of healthcare, adjectives like, “expensive” and “costly” may come to mind. Health systems, policy analysts, and other healthcare experts agree. They’ve labeled the rising costs in U.S. healthcare as unsustainable.
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Case Study: Strategic negotiations
A large carrier offering plans with an aggressive Medicare-based benefit limit sought: to satisfy clients seeking greater protections from balance billing for their plan members; to preserve the underlying cost benefits of the out-of-network reimbursement methodology
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Case Study: Retaining important business
Claritev analysis helped a third-party administrator defend against a competitor’s push to implement Medicare pricing by: significantly improving savings for the employer and its members; engaging important providers in the new process; and preserving the community’s provider-patient relationships.
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Case Study: Navigating a challenging environment
An auto medical services provider wanted to distinguish its network-based cost management program to sensitive auto insurance carriers by demonstrating: minimal provider noise through the use of network contracts to reduce medical cost; effective dispute resolution processing.
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Case Study: Meeting a specific need quickly
A full-risk plan looking to expand into adjacent counties needed: assistance with provider network access to meet a looming filing deadline; selective access to providers post-filing, as needed to meet network adequacy requirements.
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Case Study: Fixing vs. paying improper charges
Claritev analysis uncovered opportunities for a third-party administrator using a variety of PPO networks to: improve payment accuracy – too much was being missed in the existing editing process; gain control over clinical billing waste and abuse; and minimize provider abrasion to preserve leased network relationships.
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Case Study: Partnering to achieve certification
A workers’ comp services provider needed help maintaining State Certified Managed Care programs by: eliminating provider coverage gaps in geographies not addressed by its proprietary network; strengthening coverage for key medical specialties.