Analytics firm tackles rising cost of healthcare

DALLAS, TX – As executives across the country are looking for ways to reverse the trend of ever-increasing employee healthcare costs and the government is pushing for more transparency in billing, a Dallas-based analytics firm is providing a new way to accomplish both.

Asha George, CEO and co-founder of SmartLight Analytics, said her aim is to make a meaningful impact on the rising cost of healthcare for employers and employees. She has spent years working to build a team of data analytic specialists and clinical board-certified physicians to conduct systematic reviews that result in significant cost savings. Big employers – especially those with 10,000 or more employees – don’t have the time or expertise to monitor claims, she said. And, claims processors are consumed by just processing and paying the claims, which means there is usually no review happening.

Two such employers – Dean Foods and the City of Fort Worth – are diving deep into their employee medical claims to find savings from waste, duplication, errors and even fraud. Both employers are working with SmartLight Analytics to mine their healthcare claims data for things like unnecessary testing, billing two doctors for the same service and careless errors. Fraud can also be a significant find. In Fort Worth, an initial assessment of the city’s employee healthcare claims data aims to further reduce healthcare spending costs, which in 2017 went $15.2 million overbudget. Dean Foods began reviewing its claims in 2016 and is reaping the benefits now.

Mike Adams, Vice President of Benefits & HR systems of Dean Foods, a multi-billion-dollar food and beverage company, said the process worked in reducing healthcare costs for their 16,000 employees.

“It’s an extremely good investment of our corporate dollars,” Adams said. “SmartLight established a good working relationship with our medical claims processor. We are extremely happy with the results. They identified claims with waste and fraud, researched and recovered those costs and had it credited back to us.”      

Fort Worth could also see similar results.

“The City of Fort Worth is looking at ways to further reduce their employee healthcare spend because they have a finite budget and, when it comes to managing the rising cost of healthcare,  they have to continue to look for ways to contain those costs,” George said. “The city has reduced spending in the last year and gotten costs under control with some innovative initiatives such as on-site clinics. We will work to help them realize further savings on healthcare costs by identifying wasteful spending and errors currently occurring in their employee healthcare claims.”

The city’s budget saw a dramatic turn-around in 2018 when the cost for providing healthcare for more than 6,000 employees plus dependents came in under budget. As the city, like many other municipalities and businesses, continue to face the uphill battle of rising healthcare costs, officials engaged with SmartLight Analytics to look at additional innovative means to keep costs under control moving forward.

George said SmartLight’s role will be to analyze two to three years of healthcare claims from the city to find waste — such as duplication of services, unintentional billing errors, and intentional fraud, waste or abuse — and take action to eliminate this unnecessary spend from the city’s employee healthcare costs.

“We’re in the process of getting historical data to run through our inferential analytical models now,” George explained.

The SmartLight Analytics clinical team of medical coding specialists, led by board-certified physicians, reviews claims identified by analytic models as either having waste, duplications, errors or other issues that could be costing the city unnecessary dollars. They then report those findings to executives to show exactly where there was wasteful spending or other errors or claims issues. SmartLight’s clinical team takes it to the next level by working with insurance carriers to eliminate the wasteful claims before they are paid again on similar claims in the future.

George said she expects SmartLight to identify as much as a 5% savings on the healthcare spend through its analytical analysis for each client. The initial process takes rough 8-10 weeks to complete once SmartLight receives the data, both medical and pharmacy claims. Fort Worth should see its first report sometime in late September.

 “In the end, if we’ve done our job, as we have for other customers,” George said, “we can reduce the city’s spending, and eventually, the out of pocket expenses for employees without reducing benefits.”

George said SmartLight is focused solely on reducing year-over-year medical spend for self-funded employers.

“I headed up the Payment Integrity departments inside various large insurance carriers for decades before starting SmartLight Analytics. SmartLight was created because we saw the need for more independent, pro-active intervention in reducing unnecessary healthcare spend,” George said. “Our goal is to deliver our insider expertise to self-funded employers to lower healthcare costs for everyone – employer and employee.”

“I’m passionate about making a meaningful impact in this space,” she said. “Insurance carriers, in the role of third-party administrators, do their best to manage the waste in the system while processing claims, but we have, without exception, reduced spend by an additional 3-5% for our customers.”