Health at Scale, the market leader in machine intelligence for value-based care delivery, today announced a partnership with HealthComp, the nation’s largest independent health plan administrator for self-funded employer groups, to protect against low-value care and drive optimal use of health care resources. Through the partnership, HealthComp’s employer clients will have access to Health at Scale’s industry-leading artificial intelligence and machine learning-powered fraud, waste and abuse detection platform to identify low-value services during prior authorization and pre-pay before they are delivered or paid.
Low-value care services contribute to over $345 billion annually in wasteful health spending. These services provide little or no benefit, incur unnecessary costs, waste limited resources and have the potential to cause harm. Eliminating low-value care is critical to optimizing health care outcomes and spend but has traditionally been difficult to accomplish using rules-based systems that are manually intensive to develop and maintain, limited to detecting patterns of low-value care that are obvious and known, and affected by high rates of false positives and false negatives.
Health at Scale’s machine intelligence goes beyond rules-based systems and identifies low-value care with a deep, clinically-nuanced understanding of the patient, provider, time and setting of care for each service – flagging fraud, waste and abuse with unprecedented accuracy and actionability in real-time, and self-learning new patterns of low-value care as they emerge.
“Low-value care is an existential challenge for the health care industry,” said Zeeshan Syed, CEO of Health at Scale. “With access to care increasingly limited, costs continuing to rise, and members being asked to pay more out-of-pocket, health plans are right to be concerned about wasting resources on unnecessary services that provide no benefit and often pose harm. Our technology has shown the ability to solve what has been a hard problem for decades, through breakthrough advances in machine intelligence. We are delighted to be working with HealthComp to bring this innovative capability to its employers and to support its mission of transforming benefits and changing lives for the members it serves.”
“Our in-house Fraud, Waste, and Abuse (FW&A) team has long been seeking a partner that goes beyond traditional rules- and outlier-based analytics” Justin Tran, SVP of Medical Cost Management at HealthComp. “Better predictive analytics means higher hit rates, improved provider experience, and increased capacity for us to review long-tail claims. Our work with Health at Scale showed us we could do exactly that. The AI looks at exhaustive provider behavior patterns with member longitudinal context. HealthComp’s multi-disciplinary team of clinicians, coders, benefits experts, and special investigators create water-tight cases with every savings approach on the table. The client sees results: hard dollar savings ahead of industry.”
