FORT WORTH, TX – The Dallas-based health care analytics firm, SmartLight Analytics, will soon begin an initial assessment of the City of Fort Worth’s employee health care claims data in an effort to further reduce the city’s health care spending costs, which in 2017 went $15.2 million over budget.
“The City of Fort Worth is looking at ways to further reduce their employee health care spend because they have a finite budget and, when it comes to managing the rising cost of health care, they have to continue to look for ways to contain those costs,” said Asha George, CEO and co-founder of SmartLight Analytics. “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 health care costs by identifying wasteful spending and errors currently occurring in their employee health care claims.”
The city’s budget saw a dramatic turn-around in 2018 when the cost for providing health care 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 health care 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 health care 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 will review the claims identified by analytic models as either having waste, duplications, errors or other issues that could be costing the city unnecessary dollars. The initial report to the city will show officials exactly where there was wasteful spending or other errors or claims issues. SmartLight’s clinical team would then work with the city’s insurance carrier to eliminate the wasteful claims before they are paid again.
George said she expects SmartLight to identify as much as a 5% savings on the health care spend through its analytical analysis. The process will take rough 8-10 weeks to complete once SmartLight receives the data, both medical and pharmacy claims. The city could see its first reports 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.”
SmartLight was recommended to the Fort Worth Human Resources leadership by another customer, Dean Foods, which has worked with SmartLight since 2016. Dean Foods executives said the process worked for the company in reducing health care costs for their 16,000 employees.
“The process of working with SmartLight Analytics was easy for us,” said Mike Adams, Vice President of Benefits & HR systems of Dean Foods, a multi-billion-dollar food and beverage company. “Asha George, CEO of 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.”