Speaker 1 (00:05):
Welcome to another edition of in the booth. My name is Bridgette Cassety and I oversee our broker and consultant engagement here at Meritain Health. And I'm so pleased to be joined today by Stacey Meade and Stacey heads, our national sales here at Meritain and account management for our national team Dan day. Who's our head of middle market sales nationally as well. And it's so great to have both of you back today. We've had the opportunity to chat before, but to get both of you together into one conversation is, is wonderful. And I'm sure as our listeners that follow our podcast series know here at Meritain health, we talk a lot about reducing the total cost of care. And we think about that in four pillars. You know, we talk about it in terms of access and cost avoidance and prevention, payment, integrity, and actionable data. But specifically today, Stacey and Dan, I'd like to really drill down into that payment integrity conversation. So, Dan, I thought I'd start with you just to, to dig into, you know, what does payment integrity mean? What is it our listeners should think about when we talk about payment, integrity,
Speaker 2 (01:04):
Well Bridgette at Meritain health, our payment integrity strategy really combines a couple of different moving parts that work in tandem to produce these best results. And as you pointed to reduce that total cost of care, it's a very comprehensive approach to bringing down that total cost of care by leveraging what we have with our network. But then the other pieces that come into play can be things such as a hospital bill audit, which I should know is very different than a hospital claim audit hospital. Bill audit actually looks at the UV 92 that has the itemized bill of a hospital. And we actually go through that for validity, make sure everything's coded properly. And we do pick up a lot there, but it's also claims editing it's looking at special investigation, our special investigation unit that looks at maybe peculiar claim practices that might be coming from a large medical practice segregation and of course out of network claims reduction.
Speaker 1 (02:02):
And so Dan, I think, you know, I think that's a great over you when we talk about payment and credit and payment integrity. But the question that I think people or the things that I hear from folks when I'm out in the market is yeah. Okay. But is it real, you know, how do you validate the results when you talk about payment integrity? So I'm just curious, how, how would you respond to that?
Speaker 2 (02:23):
Interestingly a little over a year ago, we were actually calculating the numbers that we, as an organization felt we were savings our saving our clients with our payment integrity programs. And what we were showing was that we were, we were driving very good results. They were improving year over year. However, they weren't really validated by an outside firm. And why that's important is because when you communicate these programs to the public, they essentially will challenge. Hey, did we essentially do our own math? We're calculating things using our own statistics, or instead you have independent different set of eyes churning through the data to make sure they're truly valid. And that's where we decided to hire the spring consulting group outta Boston, who specializes in these things to go through our data. And interestingly enough, what it pointed to is that their results validated were actually better than the ones we were calculating. So it just reaffirmed that we’re moving in the right direction and doing the right things. But now that good housekeeping seal of approval by an actuarial firm really validates it to the general public.
Speaker 1 (03:34):
Yeah. And I think that's putting good words, Dan, when you say, you know that good housekeeping seal of approval and Stacy, I think it would be a great time to, to bring you into the conversation. And based on that actuarial work that Dan just described, what, you know, what were the key findings that you think our brokers and consultants should really take away from that work when they're out talking with our customers and plan sponsors?
Speaker 3 (03:55):
Yeah, let's start with the big one, which is the actuarial study indicated that merit a pay produced growth savings of 4% of bill claim dollars specific to our cost ma management and payment integrity strategy. So that's not network savings. That is truly our unique approach saved an additional 4% of bill charges. When we calculate that out, that's additional savings of $102 per employee per month, which is well more than any of the admin fees we could ever possibly charge. So it's, it's outstanding results there. And something, we are just really proud of. One of the other notes in the study that I would make a point to mention is that they actually analyzed our data over a couple of years to make sure this wasn't an anomaly and, you know, understand that we've got an impact from COVID years. And their data actually showed that our cost savings changed year over year. They actually improved it from, it was 3.6% in the first year to the 4% in the second year, which is something that I think I'm, I'm really proud of, I think is a big item to pay attention to because this is such a dynamic space. It's important to be thinking about this as a changing marketplace
Speaker 1 (05:19):
And Stacey, I think you're right. When you think about that kind of savings in the, in the type of environment that we're in, that is significant when we're talking about driving down the total cost of care and showing that over a period of time for sustainable savings, those are the words that I wrote down when you were talking, but, you know, can you talk a little bit more about, you know, How is Meritain able to not only sustain that, but accomplish this long term for their clients? What, what would you speak to typically around the, how we do it?
Speaker 3 (05:49):
Yeah, I think this is the definition of the best of both worlds, getting a TPA with national carrier backing. So if you think about the, the legacy of being a TPA, we had to find every dollar in cost savings possible. And when we were acquired by Aetna many, many years ago, we didn't lose those skills. We actually kept them and continued growing them because we saw the benefit that they could provide. And so we had had still that philosophy of no claim left behind. For those of you who have been around a while, you might have seen Matt Logan you know, we've got lots of different ways we do it, but that's just part of our culture. We constantly are looking for, you know, ways to do things that drive down claim dollars. Then you add to that, the resources that we have available through, through our ownership by Aetna, CVS, they've got claim editing tools, you know, our Meritain special investigations unit will often work with the Aetna special investigations unit on questionable billing or potential fraud. So this is a situation where you can take that TPA DNA, add to our carrier sources. And I think you end up with a better than better outcome than either would have a loan. And I think you see that through the, the savings, you know, generated documented by spring consulting and 4% reduction fees. I mean, think about that in context of network discounts, 4% is a meaningful. And so if Meritain can make that for our customers, we're very proud to do so.
Speaker 1 (07:26):
And Stacy, I think that you know, when we think, think about this conversation is advocates for healthier living. Certainly we wanna lean into reducing the total cost of care. And when you share this type of insight where we can document and validate, validate externally savings of this magnitude, there's no doubt. And there's no question why payment integrity is one of our key pillars in accomplishing this for our customers. So I wanna thank Dan and Stacey for joining us today and taking a drill down into the one pillars that drive total cost of care here at Meritain. And we look forward to joining us again in another podcast series. Thank you.
