Responses from Matthew Hawley, EVP, payment integrity, Cotiviti.
Matthew Hawley leads operations and content development for Cotiviti’s prospective payment integrity and fraud, waste, and abuse solutions. He brings more than 30 years of healthcare experience to his role as executive vice president of payment integrity operations for Cotiviti and has been with the organization since 2004.
With the U.S. healthcare system constantly shifting and facing new challenges, it is critical for healthcare leaders to adapt to these changes and leverage proven, technological solutions to solve problems. Here, Hawley shares his insights on how taking a data-driven approach is vital to preventing fraud, waste, and abuse in the healthcare industry and how healthcare organizations can operate more efficiently to optimize patient care.
What are a few significant changes you expect to see in the year ahead, and how can data-driven approaches help healthcare organizations navigate these shifts?
The U.S. healthcare system has been experiencing a rapid evolution marked by new therapies, changing care sites, and fast-paced technological innovation. As healthcare leaders adapt and prepare for more shifts in 2024, forward-thinking, data-driven approaches will be key for supporting payment integrity while capitalizing on emergent new ways to optimize patient care. For example, analytics can identify areas at highest risk for fraudulent, wasteful, or abusive spending—such as billing for non-traditional care sites—and also uncover trends in utilization that could indicate unmet needs among certain populations.
Data-driven approaches will also become increasingly important to prevent inappropriate payments as more complex specialty drugs and gene therapies emerge with million-dollar price tags. Looking forward to 2024 and beyond, payers and providers must collaborate to ensure future innovations in medical technology and treatment are billed and delivered appropriately to improve patient health while protecting members’ plan benefits.