Solutions


Approach

In more than 12 years of delivering managed care services, Paladin has developed an effective process for combining the workflow requirements of our clients with Paladin's well-tested best practices. We help clients incorporate one or more of our managed care services using the following approach:

Define

In the definition phase, we determine how to adapt our services to client processes and workflows, such as data exchange for medical bill reviews, the referral process for case management files, whether bills are paid per claim, in bulk, electronically, and so on. We work with client teams to:

  • Identify current and future business goals so that Paladin services will scale to accommodate the client's business growth and change.
  • Interview functional experts in the client's Claims, IT, Finance, and/or other departments to understand how Paladin services can enhance existing workflows.
  • Identify the workflow steps, benefits, staff involved, and opportunities for streamlining tasks.

Measure

We believe that performance measurement is the foundation of high-value managed care services, so we establish a baseline for continuous improvement and hold ourselves accountable for performance results. We work with client teams to:

  • Gather the latest data on the company's outcomes, such as turnaround times for bill and utilization reviews, medical cost savings, and headcount for workflow tasks.
  • Create a set of benchmarks against which to measure future outcomes.
  • Obtain agreement for the benchmarks, which become the basis of our program evaluation.

Analyze

By analyzing "what is" versus "what's possible," we produce realistic goals for exceeding benchmarks, while respecting staff work styles and preferences. Specifically, the Paladin team will:

  • Compare benchmarks to composite outcomes for Paladin services nationwide.
  • Specify the future outcome levels we expect to achieve for each workflow.
  • Forecast the potential impact of our services, translating planned improvements into actual cost savings and other quantifiable results.

Implement

Implementation typically involves streamlining existing workflows by incorporating Paladin best practices to improve upon the benchmarks. Specifically, the Paladin team will:

  • Develop a comprehensive program plan that describes workflow enhancements and how we plan to achieve the goals on time and on budget.
  • Test each enhanced workflow in a test environment until it's ready to implement without disrupting business.
  • Work with the client team to begin implementation as a pilot project or companywide launch, depending on the client's resources and requirements.
  • Begin evaluating results the very first day, in a continual cycle of review and incremental refinements.

Control

For Paladin, reaching the program goals is only a beginning — our ultimate challenge is to keep our clients out in front of industry performance trends:

  • Once we achieve the baseline outcome levels, we put controls in place to maintain them.
  • We introduce a continuous quality improvement (CQI) plan that raises the bar on the original outcomes — realistically.

 

Results

utilization review ROI, fast turnarounds, and other performance results. Read more...

Case Studies

Insurance carrier saves 95% after Paladin's medical bill review.
Read more...

Leadership

Meet the executives and doctors who oversee our services.
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