Innovative context-aware fraud, waste, abuse and error detection powered by leading-edge AI to prevent low-value care in real-time and drive higher quality, safety and affordability for health plan members
Health at Scale, a leading provider of machine intelligence for value-based care delivery and management, today announced a partnership with ATRIO Health Plans, Inc., a top provider of Medicare Advantage plans serving approximately 30,000 members in Oregon and Nevada. The partnership will leverage Health at Scale’s state-of-the-art AI and machine learning technologies to prevent low-value care corresponding to fraud, waste, abuse and errors in real-time; and drive greater quality, safety and affordability for plan members in support of ATRIO Health Plan’s mission of delivering high quality health insurance at a reasonable price for Medicare Advantage beneficiaries.
With the increasing prevalence and continuously evolving patterns of fraud, waste, abuse and errors in the healthcare industry, the use of AI-powered technology has become an essential tool to help health plans identify and eliminate wasteful and often unsafe spending. Over $345 billion in healthcare spend is wasted annually to low-value care services. These services provide little or no benefit, incur unnecessary costs, waste limited resources, and have the potential to cause harm. Eliminating fraud, waste, abuse and errors is critical to optimizing healthcare outcomes and spending for payers, providers, employers and TPAs, but has traditionally been difficult to accomplish using rules-based payment integrity 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 smart AI-powered fraud, waste, abuse and error detection technology goes beyond traditional rules-based payment integrity systems and identifies low-value care by using a clinically-nuanced, deeply context-aware and hyper-personalized understanding of the patient, the provider, the time and the care setting. By factoring in a 360-view of every healthcare service and transaction, Health at Scale’s AI reduces false positives and false negatives while continuously self-learning new patterns of low-value care as they emerge, flagging fraud, waste, abuse and errors with unprecedented accuracy and actionability.
“We are excited to partner with ATRIO Health Plans around our industry-leading capabilities to reduce fraud, waste, abuse and errors,” said Zeeshan Syed, CEO of Health at Scale. “Our technology has been able to meaningfully reduce low-value care for health plans – something that has been a hard problem to solve for decades and continues to drive up costs. We look forward to working with ATRIO Health Plans to bring this innovative capability to their Medicare Advantage plans and to support their mission of providing high-quality, cost-effective healthcare to their members.”
“After completing substantial due diligence of the market landscape, we have found that the tools and technology that Health at Scale offers health plans is best-in-class based on what we have seen, and look forward to working with Health at Scale across our entire book of business,” said Jennifer Callahan, Chief Operating Officer of ATRIO Health Plans.
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