Finding New Ways to Enhance Client Savings
In mid-November, Claritev Negotiation Services implemented its second machine learning initiative to drive automation and increased savings (read about the first initiative here). The additional savings will be driven by intelligent offer automation on specific subsets of claims, which will give negotiators more time to negotiate with providers on other claims of value to our clients. As part of this new initiative, initial offers are automatically sent to providers without involvement from our negotiators for two specific types of claims:
- Difficult Claims. These represent up to 5% of claims routed to Negotiation Services
- High-Performance Claims. These represent up to 1% of claims routed to Negotiation Services
Using historic data for both of these claim types, our team of data scientists created a machine learning model that generates optimal offers for each claim in these categories, which are then submitted to the providers. The auto-generated offers use models that are expected to produce the greatest overall return on the claim, increasing savings.
Gaining deeper understanding into negotiation opportunities
The “difficult claims” category includes claims from providers who typically decline to negotiate. The success rate on these claims averages less than 1%, and total savings add up to only $173,000 annually. Despite the low success rate and low savings on these claims, they are resource-intensive, requiring an investment of significant time from our best negotiators.
Because the providers in this category generally won’t engage with us, we are automating the process. This allows us to reassign the negotiators who were previously working on these claims to ones with a greater likelihood of being successfully negotiated and generating more savings for our clients. We understand the value of driving savings for our clients so we will analyze the results from this process to see if we can understand why the providers won’t negotiate and to determine when and if it’s appropriate to transition some of them back to live negotiations.
Maintaining strong provider relationships while delivering savings
The “high-performance claims” category includes claims from providers who positively respond to our negotiations. The success rate for these claims averages more than 80%, and annual savings is approximately $200 million. Through the years, we’ve established and built a solid relationship with these providers. Because the relationships are so strong, we no longer have a need for constant discussions with them regarding their claims and can send automated offers. The automated offers will free up our negotiators to engage with providers who require more attention before agreeing to a negotiated amount.
To ensure we continue to maintain strong relationships with providers in this group, a negotiator will contact the provider if we don’t hear back or if they provide feedback on our initial automated offer.
Our Data Science and Negotiation Services teams will continually review performance in this subset and identify new opportunities, including options to attempt on a subset of providers with a slightly lower success rate in the future.
Claritev Challenges the Status Quo
We are excited about this new initiative because it offers a new way to engage with providers while increasing the opportunity for us to negotiate with others and generate higher savings for our clients.
Learn more about Claritev’s innovation and Negotiation Services.
