5 Common & Costly Gaps in Coordination of Benefits

Innovations in data, analytics and technology are transforming healthcare coordination benefits (COB). What was once a time and paper-intensive process is becoming increasingly streamlined and, in many cases, can now be managed in real time. However, given the complexity of today’s healthcare and insurance ecosystem, it is important to identify the gaps that may be hiding in your COB program in order to understand how these innovations can be applied strategically to drive value.

Here are five common COB gaps that could be costing your organization and that could benefit from a new, more efficient approach.

1. Data Limitations & Insufficient Matching Methods

Today’s COB is driven by data. From false positives to low match rates, drawing from a limited data source can inhibit savings and recoveries while also putting protected health information at risk. Qualified COB partners overcome these limitations by forging data use agreements with payers across all different plan types. This creates a comprehensive set of claims and eligibility data that not only enables the identification of all coverage sources, but also informs algorithms that drive continuous improvement in match logic and overall COB accuracy.

2. A Principally Retroactive Focus

Factors like mandatory pay and chase requirements and retroactive eligibility mean that post-payment recovery will continue to play an important role in COB for the foreseeable future. However, counterbalancing recovery efforts with pre-payment cost avoidance creates a cohesive and high-performing cost containment system — helping to prevent payment inaccuracies and alleviate administrative headache. For the best results, pre-payment and post-payment COB components should be complementary and integrated to avoid costly and otherwise harmful gaps.

3. Missing Benchmarks and KPIs

A common misconception about COB — and third-party liability, in particular — is that program maintenance and monitoring are not essential. Healthcare organizations have both a right and responsibility to understand how their investments are driving value. Without adequate benchmarks and mechanisms for reporting on performance, things like processing issues can go unrealized, which can have negative and long-term implications for an organization’s bottom line.

4. Data & Operational Silos

Fragmentation in COB processes, and across healthcare as a whole, is a barrier to progress, inhibiting efforts to create a more efficient, value-based environment. The integration of patient health data across various systems and settings is necessary to uncover all available health benefits and properly coordinate care. This makes widespread coordination, communication and data exchange vital components of a robust COB program. Solutions that are interoperable and stakeholder-friendly are best equipped to overcome silos and maximize COB efforts, driving value across the care continuum.

5. Lack of Integration & Strategic Partnership

COB plays an important role in the healthcare ecosystem, maximizing healthcare dollars and protecting the integrity of our nation’s healthcare system. There are many COB products on the market, but few strategic partners offering a comprehensive, integrated solution — and even fewer that are working to fundamentally transform COB through innovation, advocacy and influence.  

In a recent white paper, HMS, a trusted COB partner to Medicaid, Medicare, commercial health plans, marketplaces and exchanges, details a number of strategic approaches to improve COB for the benefit of all healthcare stakeholders. Download the white paper, Reinventing Coordination of Benefits: 6 Strategic Approaches to COB Innovation, here.

This article was created in collaboration with the sponsoring company and our sales and marketing team. The editorial team does not contribute.