A long-time healthcare executive with deep data analytics experience, Steve oversees analytics vision and strategy operations for Discovery Health Partners. Discovery offers payment and revenue integrity solutions that help health payers improve revenue, avoid excess costs, and optimize their operations. Serving more than 60 healthcare clients, including five of the largest health payers in the nation, Discovery Health Partners was named the 100th fastest growing privately held company on Inc. Magazine’s 2014 Inc. 500 list and was 14th among healthcare firms.
As Vice President, Solutions Management & Analytics, Steve assesses opportunities, develops learning, and drives analytics adoption rates for Discovery Health Partners. Prior to joining Discovery, Steve served in senior management positions overseeing analytics and payment integrity operations at Change Healthcare (formerly Emdeon). During this time, he oversaw gains in revenue per case and managed the implementation of the productivity-improving medical-record search capability. He also drove double-digit performance improvements to the post-payment audit and recovery organization through the development of analytic-driven claim valuation techniques. Previously, Steve held various analytics leadership roles at MultiPlan, Inc. (formerly Viant), most recently as Vice President of Reporting & Analytics.
Clare Walker (CW), a principal researcher with Frost & Sullivan, had an opportunity to conduct a Movers & Shakers interview with Steve Forcash (SF), Vice President, Solutions Management & Analytics, Discovery Health Partners.
CW: Hello, Steve! Let me start by asking you to provide our readers an overview of your company and its role in the healthcare industry.
SF: Discovery Health Partners has been providing payment integrity solutions to healthcare payers for ten years. Healthcare is a $3T a year industry, and some estimates suggest as much as one-third of that is administrative waste; inefficiencies; and fraud, waste, and abuse. Companies like ours help payers improve the accuracy of the payment process and increase their efficiency as well, ensuring payers pay the correct amount for medical claims incurred by their members.
CW: Continued innovation is a key to success in this industry; how is the process of innovation managed at your company?
SF: This is a great point, and the truth is, healthcare has lagged many industries in innovation. A key to successful innovation is organizational commitment. At Discovery, we have built and continue to grow what we call our Pilot Factory, where we efficiently and objectively evaluate innovative ideas. This structured approach to idea evaluation allows us to “fail fast” on concepts that don’t pan out and more effectively push forward novel solutions that will help health plans reduce the waste in the medical claims for which they are paying.
CW: What do you see as your company’s greatest challenge(s), and what strategy(ies) do you employ to help overcome it?
SF: One of our most successful solutions to date has been our Medicare Secondary Payer Validation solution (MSP). We have helped over 50 Medicare Advantage plans—that’s over 60% of the Medicare Advantage plan market—restore over $300M in premium owed to them because they were primary insurer of their members but the Centers for Medicare and Medicaid Services (CMS) reimbursed them at the secondary-level premium rate. This success has resulted in many of our Medicare Advantage plans asking us “What else can you do for us?”
Our biggest challenge is staying true to the disciplined approach to innovation and solution development we have instilled at Discovery. True partnership with our clients requires that we communicate what we do well, what is on our development roadmap, and what is outside our core and, therefore, not something we plan to pursue.
Our Pilot Factory is the foundation for having these candid conversations with our clients. Having an approach to idea evaluation that (a) is efficient enough for you to get to answers quickly and (b) is trustworthy enough that the pilot results determine what we will and will not invest in, guide our one-year, three-year, and five-year strategies. We know that our ability to provide a full suite of best-of-breed payment integrity solutions relies on this disciplined approach to innovation.
CW: What do you want the company to accomplish in the next couple of years, and how would you define success for Discovery Health Partners?
SF: Our mission over the next couple of years is to continue to broaden the portfolio of solutions we offer to health plans so that the strong partnerships we have with our clients can deepen further. There are many nuanced aspects to identifying and eliminating waste in the healthcare payment process, and few companies offer a full suite of solutions for health plans. Discovery’s vision is to offer a full portfolio of solutions that generate unique and actionable analytic insights for payers. For us, success will be defined by our clients. When our clients continually come to Discovery Health Partners for payment integrity solutions, that’s when we know we’ve achieved success.
CW: What do you see as the critical success factors in establishing partnerships with your clients? Are there requirements on their end to implement your solutions?
SF: I can sum up what it takes to build successful partnerships with payer clients in two words: Trust and Results. First, it’s paramount that we at Discovery respect the importance of the data we receive from our clients. Healthcare data is among the most sensitive data that exists, and health plans must know that we have the appropriate respect for this data. At Discovery, we have invested heavily in data security, and we recently received HITRUST certification for our technology platform, which demonstrates that we have stringent controls in place.
But no matter how well you secure the data, the payment integrity industry has always been, and will continue to be, a results-driven business. It is a very competitive space, and if we don’t deliver results in the form of savings back to the health plan, they will certainly find someone else who will. We pride ourselves on our ability to deliver more savings back to health plans than our competition for the solutions we offer.
The requirements to implement our solutions are similar to all vendors in this space. It depends on the solution, or solutions, for which we partner on, but we typically need some combination of claims data (medical and/or pharmacy), member eligibility data, and provider data. We use this data, in conjunction with our proprietary algorithms, to identify claims most likely paid in error and then incorporate them into our workflows that are designed to help return dollars to the health plan.
CW: What are trends are on the horizon (on the industry-level and/or in new enabling technologies) that will affect how you and your clients do business?
SF: As I mentioned, healthcare has lagged many other industries in its appetite for innovation. As such, in our space, use of advanced analytics, machine learning, AI, etc., are still much more sizzle than they are steak. Those techniques have one major requirement: data—gobs and gobs of data. It wasn’t that long ago that doctors’ offices had giant shelving units filled with paper medical records for their patients. Legislation has brought us a long way in the digitization of healthcare data, and now companies are becoming more and more ready to use that data to derive better insights. We continue to invest in our Analytics R&D lab so that we are among the industry leaders in converting healthcare data into actionable insights so that health plans can ensure that they pay what they owe and only what they owe for the members they manage.
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