One of the most common questions we get from health plans is: "which FWA vendor (technology) would you choose?" But, the answer is not always simple or easy. Check out Integrity Advantage's President, Jala Attia, break down the things that your health plan should keep in mind when considering FWA solutions in the RFP process.

More often than not, when you are going to RFP, you’re looking for a vendor that has fraud, waste, and abuse analytics. But, there are other things that are involved besides just analytics. There’s case management. Do you need a case management tool? Do you need advanced analytics? Do you need a rules engine? What are you looking for? What do you need? And that’s driven by how big is your FWA program? Are you a very small SIU or a small compliance team with 200,000 lives? If so, you may not need the same thing that a health plan that has 2 million lives is going to need.

So, keep that in mind as you are out there looking at vendors in this space, because on of the things that I know very well is that the vendors are going to show you everything that they have the capability to do. And there are so many benefits to that because you may find in another part of the business that there’s something that the vendor offers that you could use in med management, or in pre auth, or wherever. But, from an SIU perspective and an FWA perspective, you want to think about what is important to you so that you can control costs and you can have a focused solution on what it is that you really need.

So, think about what you need. Do you need analytics? Do you need case management? Do you need both? Think about how big your plan is. If you are a very small plan, I would argue you may not even need analytics, depending on your size and what lines of business you’re in. But, if you go out to RFP for a vendor, I can guarantee you there’s going to be a vendor that’s going to want to sell you their entire technology platform, whether you need it or not. So, keep that in mind.

The last thing is what is your appetite? Are you going to recover on things you identify? Are you just going to educate providers? Are you really more focused on meeting compliance expectations and not so much on the ROI? That also should be a factor in whether or not you decide to choose a very robust analytics solution or a solution that’s going to get you what you need, but maybe not all the bells and whistles.

So, things to keep in mind as you’re going to RFP. Because we’ve had a lot of people come to us and ask the question: who would you pick, what do we need, what’s the best solution out there? And, it’s not a straightforward answer.

Integrity Advantage is the way healthcare payers reimagine the value of their fraud, waste and abuse program.

We provide FWA services to payers around the country. If you need a program assessment, program growth strategy, investigations, medical reviews or training support -- reach out today.

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