Is focusing on the 80/20 rule limiting hospitals?

The Pareto Principle, or the 80/20 rule, is the idea that 20% of your activities are responsible for 80% of your results and addressing the top 20% of your organizational headaches would resolve 80% of overall causes. Good organizational process design should adhere to the 20% effort rule.

Claims from traditional health payers align to this rule and a small set of well-defined tasks result in a significant amount of hospital payments.

But is focusing on the 80/20 rule limiting hospitals?

Typically, close to 5% of total hospital emergency room claims are made up of complex claims such as workers’ compensation and motor vehicle accidents.


These claims are costly, time consuming and resource-intensive due to the high variability of the activities required to get the claim paid, placing additional stress on already strained hospital resources.

Following good organizational process design (80/20 Principle), hospitals don’t prioritize the resolution of complex claims and potentially leave millions of dollars on the table. There is a better answer:

Outsource these headaches to a partner who specializes in resolving complex claims.

By outsourcing challenging claims to a partner with resources and technology dedicated to processing complex claims, hospitals will realize the benefit of the partner's Pareto Principle and put millions of dollars back into their revenue stream while still focusing on their core business.


To learn more about how Kemberton can help relieve your complex claims induced headache, contact us today!