Almost $1 trillion is lost every year in the U.S. healthcare market due to waste and inefficiency, with about half of that in administration.
Payors have reduced fee-for-service (FFS) reimbursement rates, and at the same time are shifting to value-based care reimbursement models. These changes bring additional complexity to an already complex environment and uncertainty that could be better managed using data analytics.
The U.S. healthcare system has invested billions of dollars in upgrading its systems, and with over half of the committed of planned conversions of Electronic Health Records and Patient Accounting Systems completed, vast of amounts of additional data are now being generated in clinical, financial, and operational functions.
Lack of interoperability between healthcare data systems prevents efficient and effective use of data including the capabilities to compile and derive analytical insight. Government and commercial payors are setting standards and providing incentives for providers improve their business processes. There are a number of large BPO firms that are investing and embracing continuous improvement methodologies. In any re-engineering of business process projects it is not unusual to see the most innovation occur with the smaller more nimble companies that don’t have the constraints to change the larger first have. Certive Health believes that its Tier One team of leadership can capture a significant share of the market using a strategy of innovation and speed coupled with knowledge and experience with more established firms. It is Certive Health’s belief that with our capabilities and a toehold in the revenue integrity segment of the industry, there is an opportunity to identify areas to deploy our resources and solve the problems one at a time by working closely with partners, systems, and agencies.