2.27.18 | Burgess cited in Gartner research report entitled, “U.S. Healthcare Payer CIOs Must Adopt Prospective Payment Integrity to Thwart Improper Claims Payment and Fraud”
ALEXANDRIA, Va. – Burgess, an innovator in healthcare payment operations for over 20 years, announced that the company has been mentioned in Gartner’s report: U.S. Healthcare Payer CIOs Must Adopt Prospective Payment Integrity to Thwart Improper Claims Payment and Fraud.1
In the report, Gartner addresses the issue of payment integrity within the healthcare payment sphere. Gartner states that “CIOs can significantly improve the financial returns from payment integrity programs. By expanding solution capabilities to incorporate prospective — even pre-emptive — processes, CIOs can exponentially increase financial performance and improve provider relationships.” It adds that “with payer CIOs under pressure from CFOs to contain medical claims costs, the payment integrity program represents an immediate opportunity to deliver substantial financial improvement. Furthermore, CIOs can choose from a plethora of mature prospective payment solutions.”1
The report also states that “2018 is ripe for a payment integrity renaissance. Rising claims volume and complexity threaten the viability of current fragmented, manual clawback processes that alienate providers and network management executives, alike. Meanwhile, schemers and fraudsters continue to innovate ways to take advantage of payers’ trusting inclinations. Stacking solutions, a popular practice with Gartner clients, offer diminishing financial returns as operational cost increases with each vendor integration. Business stakeholders across the organization have competing and often conflicting interests. Something has to change.”1
The issue of payment integrity within the payer sphere was discussed by Burgess Chief Experience Officer Jared Lorinsky in his America’s Health Insurance Plans (AHIP) webinar entitled, “Eliminate Payment Integrity Challenges” on Dec. 6. During his presentation on solving payment integrity issues, Lorinsky recommended implementing a cloud-based integrated system based on a plan that emphasizes design thinking. Likewise, he suggested choosing a business partner not just based on attributes and cost, but on cultural considerations. We feel that Lorinsky’s views align with the Gartner report, in particular his emphasis on getting away from point solutions as a crucial step in addressing payment integrity concerns.
Waste that comes about in claims payment operations has become a significant issue in the healthcare industry. According to a Harvard Business Review study2, the health care industry would save $130 billion if administrative complexity was reduced to same level as other industries, such as the various consumer or automotive industries. Gartner’s report states “It’s no secret that healthcare in the U.S. has an expensive payment integrity problem, and that no line of business or payer segment is immune. In a testimony to Congress in 2016, Assistant Inspector General Ann Maxwell estimated improper payments by Medicare and Medicaid to exceed $88 billion annually.”1
Burgess was mentioned in the Gartner report among other vendors under the header, “Issue an RFP to Evaluate Vendor Capabilities.”
The company’s latest innovation, Burgess Source™, introduces a new workflow solution to address healthcare payment inaccuracies, compliance, and rework. Designed from the ground up as a sole-source platform to natively manage and deliver claims editing, pricing, analytics, transaction audits, and bi-weekly regulatory data updates, Burgess Source provides health plans a next-generation approach to simultaneously improve both their bottom line and provider relations.
For more information on Burgess Source and to discover how its unified approach can streamline payment operations in your organization, visit burgessgroup.com.
1 Gartner, U.S. Healthcare Payer CIOs Must Adopt Prospective Payment Integrity to Thwart Improper Claims Payment and Fraud, Analyst(s): Mandi Bishop, Bryan Cole, Published: 13 February 2018 ID: G00350050.
2 Sahni, N. R., Chigurupati, A., Kocher, B., Cutler, D. M. (2015) How the US can reduce waste in health care spending by $1 trillion. Harvard Business Review. Retrieved from https://hbr.org/2015/10/how-the-u-s- can-reduce-waste-in-health-care-spending-by-1-trillion
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After 20 years, Burgess continues to design and build innovative and scalable solutions for healthcare payment operations. With headquarters in Alexandria, Va., and an office in West Hartford, Conn., the company serves many of the nation’s top health plans, including multiple BCBS, national, and regional payers.
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