Shift Technology, a provider of AI-driven decision automation and optimization solutions for the global insurance industry today announced the formation of the company’s Healthcare Advisory Board and the appointment of Seema Verma, the former administrator for Center for Medicare and Medicaid Services (CMS), as a strategic advisor to the company and the inaugural member of the Healthcare Advisory Board. The Shift Healthcare Advisory Board will help the company address the key issues facing the healthcare payor system, and support the continued development of the technology solutions required to solve these complex challenges.
According to the National Health Care Anti-Fraud Association (NHCAA), the impact of healthcare fraud in the United States could be close to $300 billion. When considering other forms of waste and abuse, the total is estimated to be over $1.5 trillion. Through the company’s Healthcare Improper Payment Detection solution, Shift is working to mitigate the impact of FWA in both private and public healthcare payor organizations. Shift’s AI-native improper payment detection platform leverages advanced data science techniques to allow for the discovery of a significantly higher percentage of FWA, with greater accuracy and efficiency. The platform leverages sophisticated AI and ML healthcare models, built on internal and external data, and a comprehensive health plan data model to spot hidden FWA.
“There is an amazing opportunity to drive significant bottom-line improvement for health plans and we are thrilled to collaborate with one of the best minds in the industry to help us realize our vision,” said Salil Punalekar, head of U.S. healthcare, Shift Technology. “Traditional static rule-based decision models are outdated and insufficient to identify the wide scope of improper payments plaguing payors. There is a clear need for comprehensive data driven approaches and technologies to help payors dramatically reduce the impact of FWA on their organizations and their members.”
“What Shift brings to the fight against health insurance FWA is truly exceptional and could help the industry save billions of dollars in improper payments,” continued Verma, Healthcare Advisory Board member, Shift Technology. “I am proud to share what I have learned throughout my career with this industry pioneer to help make health insurance better for everyone involved in the process.”
Verma is a national health policy expert and was the longest serving Centers for Medicare and Medicaid (CMS) Administrator in modern history. At CMS, she oversaw health insurance programs for over 140 million Americans; managed a budget of $1.3 trillion, which represents almost a third of the federal budget; and led over 6,000 employees. Further, she spearheaded the implementation of more than sixteen strategic initiatives aimed at transforming the American health care system to lower costs, improve quality, and increase access. Her leadership of federal government efforts to infuse market competition, empower patients, and unleash innovation – including efforts to require price and quality transparency while ensuring patients have ownership over their portable medical records – produced historic reforms across CSM.
“Seema’s belief in the Shift platform, its ability to drive intelligent decisioning throughout payor organizations, and its potential to drive meaningful impact to our customers makes her an ideal member of our advisory board,” said Jeremy Jawish, CEO and co-founder, Shift Technology. “That she decided to participate is further validation of our value proposition and the hard work that has gone into building our products.”
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