Simeon Kohl Photograph

The US Healthcare sector has been one of the fastest-growing industries, and the recent pandemic has shown how vital the efficient development of this sector is. The cost of healthcare in the United States has grown to over $4 trillion dollars per annum and it’s estimated that nearly $1 trillion of that spend is attributed to fraud, waste and abuse.

There are very few companies that specialize in helping healthcare payers contain costs, and Performant is one of the biggest names in the industry. Established in 1976, Performant has a long history of helping commercial and government healthcare payers contain costs by identifying, preventing, and recovering improperly billed or paid claims. Performant’s innovative payment accuracy solutions allow payers to focus on what matters most – Affordable, quality care and healthier lives.

As one of the leading recovery agents for the US Department of the Treasury in the early 2000s, Performant realized a significant portion of its work was being completed on behalf of the Centers for Medicare & Medicaid Services (CMS). This was the Company’s first significant benchmark in the market, and led to subsequent success on a CMS pilot program that served as a precursor to the Recovery Audit Contracts that exist today. Shortly after entering the government healthcare space, Performant secured its first national commercial healthcare client, and has grown its commercial footprint significantly over the past decade.

Simeon Kohl, President of Performant, was with the CEOViews team to share some details about Performant’s journey of making the healthcare industry more revenue efficient.

How it all started?

Having proven their legacy “recovery” capabilities applicable to the healthcare industry, Performant was awarded one of the first CMS Recovery Audit Contractor (RAC) regions. CMS has since awarded Performant 2 of the 4 RAC fee for service regions as well as the sole national region for DME, Home Health and Hospice claimsAdditionally, Performant is the sole national vendor for CMS’ Medicare Secondary Payer Commercial Repayment Center (MSP CRC) and the sole vendor for medical record review on behalf of the US Department of Health and Human Services Office of the Inspector General (HHS OIG).

Making a name for themselves

Further speaking about how they were able to make a name for themselves in this market, Simeon said, “These journeys are never straight lines. Not every RFP bid is a win, and not every new product launch is a success. But, by building on our core capabilities and instilling a clear dedication to our clients through all areas of our operations, we have grown to become a known and respected brand in our industry. In a market flooded by competitors associated with major healthcare payers or those infused with private equity capital, it can be difficult to get your client footprint and performance reputation established.”

Differentiating factor

Performant follows a simple but effective strategy that is based on four key pillars to keep themselves at the forefront of a competitive market. One of these strategic pillars is customer centricity, which is at the heart of everything they do – how they communicate, invest resources, and prioritize efforts. In all things, Performant aligns around their client’s needs. Performant’s mission statement is quite clear and compelling: Innovative payment accuracy solutions that allow customers to focus on what matters most – affordable, quality care and healthier lives. This simple organizing principle gives focus and motivation to the entire company.

Trends in the industry

There are at least two mega-trends that are shaping the payment integrity marketplace:

Prepayment vs. Post-payment: For the last 20 years, payment integrity has focused on the recovery of improper payments. Ideally, however, it is far more efficient to stop an improper payment than chase down a recovery. Performant has embraced this and delivers prepayment and cost avoidance solutions for most of their products. Yet, unlike many other payment integrity firms, they are unashamed to acknowledge that there will always be a place for post-payment and recovery services.

Simplification and Integration: In the early and mid-2000s, many payers pursued, and even perfected, outsourcing of payment integrity services to vendors. For larger payers, this even featured stacking multiple vendors in “pass order”, meaning the successive opportunity for a lead vendor, then a secondary sweep by another, and potentially more sweeps by successive vendors. Today, plans are maturing to demand simplification of managing that sprawling vendor footprint. They need technology and trusted partners who can help “insource” more of the workflow and reduce dependence on outside vendors. Performant, with its proprietary platform, proven library of payment integrity analytics, and workflow technology, is perfectly positioned to help health plans navigate this monumental change of operations.

Work culture & service delivery

One of Performant’s four strategic pillars of is customer centricity. The Company does not identify this as a goal for attainment but more as a recognition of a common thread in the fabric of culture. They noted that Performant thrives on solving clients’ needs or challenges. This manifests in many ways. The company’s client-centric focus is on full display through its extensive offering of customized and tailored solutions. Performant’s Customer Service team, which supports provider interaction, has obtained independent industry rankings that are 2 to 3 times ahead of competitors. There is a lot a company like them can build to encourage this intensive customer focus, but having it woven into the heart of their culture ultimately requires the embrace of every team member.

Having proven their legacy “recovery” capabilities applicable to the healthcare industry, Performant was awarded one of the first CMS Recovery Audit Contractor (RAC) regions.

Roadmap for the future

Performant is already a national brand. They boast status as the national vendor for CMS RAC Region 5, the CMS MSPCRC, and the HHS OIG and serve major national payers and regional “Blues” plans. To further their growth, Performant is focusing on delivering excellent service and value to their existing clients. In a connected industry, word of mouth referrals from satisfied clients is the surest path to growth. Judging from Performant’s robust pipeline of new accounts, it looks like the strategy is working.

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