As payers continue to be plagued by rising medical loss ratios (MLR) and seek to control costs without negatively impacting member benefits, they often turn to their own claims payment data to control improper spending. While this is a vital strategy, it fails to answer the question: What procedures and codes are driving higher utilization and spending across the entire market we serve?
There’s where cross-payer analytics become valuable to the health plan. With authoritative benchmarks derived from blinded claims data spanning multiple payers, plans can make more informed decisions about payment policy. For one large payer that was failing to meet its targeted MLR, Cotiviti’s payment integrity analytics team proactively delivered reports on key Medicare utilization and unit cost trends, top CPT-level spend drivers in each spend category, geo-mapping of regions with the strongest trends, and more.
Read our new case study and learn how the payer benefited from:
- Contextualized insights that go beyond internal data
- Intelligence to inform payment integrity decisions
- Benchmark-backed medical cost savings opportunities
Beyond providing these insights, Cotiviti helped pinpoint specific payment policies to help mitigate rising costs—supported by contextual data showing that other payers in the same market were already implementing those policies.
With an unparalleled data set spanning nearly two-thirds of the U.S. insured population, Cotiviti is well-positioned to confidently help your organization make more informed payment policy decisions. Don’t miss this opportunity to learn how it works.
