THE 'EDGE REPORT BLOG

How this Health Plan Cut Costs and Maximized Efficiency

To remain competitive in today’s market, health plans must invest in critical areas such as member satisfaction, care coordination, and adding new lines of business. Still, many have limited resources and tight budgets. Transitioning manual processes—like processing claims, which can have a considerable cost impact for health plans—to electronic, can save plans and providers billions of dollars.

Headquartered in Brooklyn, New York, Elderplan is an established, not-for-profit health plan organization, serving 27,000 members and meeting the needs of Medicare, Medicaid, and Dual-Eligible individuals at every stage. For nearly 30 years, Elderplan has offered a wide range of innovative health plans. 

In 2015, Elderplan’s Medicare auto adjudication rate was 47 percent, and the HomeFirst auto adjudication rate for Managed Long-Term Care was 77 percent. 

More than half of the claims that came in were pending on the Medicare side, requiring significant time spent on manual adjudication of the claims and taking away from focusing on making continuous improvements and that attract and retain their members and drive success in their business. 

Given these challenges, Elderplan needed to maximize operational efficiency, control administrative costs, and embrace evolving business models.

As Diane Pascot noted, “for health plans, operational efficiency could be the first step in their approach to innovation. While it may not be the most exciting aspect of the business, achieving operational efficiency will enable them to remain competitive in the long-term.”

Prioritizing operational efficiency would result in critical savings and enable Elderplan to redeploy resources typically spent on routine administrative tasks and shift to transformative projects. The health plan knew it needed a core administration system that breaks down product design barriers, increases efficiency, and delivers real-time transparency.

Continue reading this case study to learn how next generation technology enabled Elderplan to cut costs and maximize efficiency, while providing the flexibility to respond to unforeseen circumstances such as the COVID-19 pandemic quickly. 

About the Author

Janet Barros

Janet Barros, Senior Business Development Manager, HealthEdge
LinkedIn
jbarros@healthedge.com 
Janet Barros is a seasoned healthcare business development executive with extensive sales and client management experience. Janet works closely with senior executives to identify their business objectives and provide the solutions and strategies that enable them to achieve their goals. She has an extensive background in digital health, payer, provider, and solution sectors. Prior to joining HealthEdge in 2018, Janet led successful revenue-generating initiatives at Influence Health, Premier Medical, and, most recently, Aptus Health.

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