Artificial intelligence-powered payer intelligence startup Anomaly Insights has launched a new tool aimed at providing managed care executives with evidence to bring to payer negotiations.
Anomaly Insights is looking to counter what Anomaly CEO Mike Desjadon described Fierce Healthcare as a “hostile payment system” in the U.S. healthcare industry. He added that there are also “fundamental asymmetries” in data between insurers and health systems.
“This asymmetry allows the insurance companies to essentially have the health system chase their tail with deniability and everything they do with the data,” Deshaddon said.
Anomaly is trying to change that.
Management solutions examine all claims across all payers in a health system’s contracts, identify patterns, and integrate complex data from contract to claims. With this solution, providers can see when each payer denies a claim that should be paid or downcodes a service to a lower reimbursement code.
“The overall goal of Manage is to provide data-driven mechanisms iteratively, reliably, and with as little effort as possible to force insurers to proactively change their behavior,” Desjadon said.
The new product is the latest solution within the Anomaly platform. Founded in 2020, the company uses machine learning to search for medical billing fraud and prevent overpayments and billing errors. The platform also includes detection, prediction, and recovery solutions.
Dan Unger, Anomaly’s chief product officer, told Fierce Healthcare that the company has received “very positive” feedback from systems using the solution, adding that Anomaly built the tool “in collaboration” with clients.
“We have concrete success stories of helping payers stop and change their behavior, and that has been validated and resulted in millions of dollars in outcomes,” Unger said. “That’s the part that excites me: that our clients have seen some change.”
Executives say four customers are currently using the management solution, and several others are developing it. Desjadon said the solution will be available to all customers by the end of the year.
Deschadon said the anomaly is working with “more than 20 organizations” and affects approximately “tens of millions” of patients.
“We started with the largest health systems,” Deshaddon said. “They are the ones who have this particular problem at the most disproportionate levels.”
According to the company, Manage’s initial implementation at a large U.S. health system identified two payer patterns with annual financial impact of more than $110 million. Once the data was presented to the payer, a settlement was reached and the underlying issue was resolved.
“Our goal is to maintain balance and be able to filter through the noise,” Unger said. “And start moving towards smoother transactions.”
