| Page 72 | Kisaco Research

Exclusive – Payment Integrity Savings PMPM Benchmarks

(45 min – 15 min presentation, 30 min open discussion)

No payment integrity savings benchmarks currently exist. Each health plan varies in payment integrity complexity – making it difficult to create industry standards. For the first time, HPRI has collaborated with payment integrity thought leaders to start to tackle this challenging but critical initiative. In this working session, hear how leaders are defining and calculating savings PMPMs across different programs, and share feedback to help health plans compare performance and optimize savings. Attendees will receive a post-event report with benchmarking insights.

Payment Integrity

Author:

Dr Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE

VP Payment Integrity

Blue Cross NC

Dr. Priscilla Alfaro is a seasoned healthcare professional with extensive experience in executive medical management, fraud prevention, and healthcare analytics. A certified medical coder, fraud examiner, and auditor, she has a proven track record of improving healthcare efficiency and preventing fraud, waste, and abuse across various roles and affiliations, including the Texas HHS and Anthem.

Author:

Monique Pierce

Payment Solutions & Operations

Cohere Health

Monique started her Payment Integrity career in COB at Oxford HealthPlans. After the merger with UnitedHealthcare, she led multiple teams and was responsible for creating innovative programs. Monique joined SCIO Health Analytics in 2014 and was responsible for system and process improvements before being promoted to VP of client engagement and business optimization In 2020, Monique joined start-up Devoted Health and created a full suite of programs from the ground up. Based on a passion for metrics and measuring performance, she centralized and standardized all programs reducing implementation time and maximizing savings. Today, Monique is driving opportunities to improve claim payment by designing and developing new prior auth and claim reconciliation products at Cohere Health.