June 23, 2024
Well being at Scale and ATRIO Well being Plans Accomplice on Sensible AI-Powered Cost Integrity

Revolutionary context-aware fraud, waste, abuse and error detection powered by modern AI to stop low-value care in real-time and drive larger high quality, security and affordability for well being plan members

SAN JOSE, Calif., Feb. 27, 2023 /PRNewswire/ — Well being at Scale, a number one supplier of machine intelligence for value-based care supply and administration, as we speak introduced a partnership with ATRIO Well being Plans, Inc., a high supplier of Medicare Benefit plans serving roughly 30,000 members in Oregon and Nevada. The partnership will leverage Well being at Scale’s state-of-the-art AI and machine studying applied sciences to stop low-value care comparable to fraud, waste, abuse and errors in real-time; and drive higher high quality, security and affordability for plan members in help of ATRIO Well being Plan’s mission of delivering prime quality medical insurance at an inexpensive worth for Medicare Benefit beneficiaries.

With the growing prevalence and repeatedly evolving patterns of fraud, waste, abuse and errors within the healthcare {industry}, using AI-powered expertise has grow to be an important device to assist well being plans determine and remove wasteful and infrequently unsafe spending. Over $345 billion in healthcare spend is wasted yearly to low-value care providers. These providers present little or no profit, incur pointless prices, waste restricted assets, and have the potential to trigger hurt. Eliminating fraud, waste, abuse and errors is crucial to optimizing healthcare outcomes and spending for payers, suppliers, employers and TPAs, however has historically been tough to perform utilizing rules-based cost integrity programs which might be manually intensive to develop and keep, restricted to detecting patterns of low-value care which might be apparent and recognized, and affected by excessive charges of false positives and false negatives.

Well being at Scale’s good AI-powered fraud, waste, abuse and error detection expertise goes past conventional rules-based cost integrity programs and identifies low-value care through the use of a clinically-nuanced, deeply context-aware and hyper-personalized understanding of the affected person, the supplier, the time and the care setting. By factoring in a 360-view of each healthcare service and transaction, Well being at Scale’s AI reduces false positives and false negatives whereas repeatedly self-learning new patterns of low-value care as they emerge, flagging fraud, waste, abuse and errors with unprecedented accuracy and actionability.

“We’re excited to companion with ATRIO Well being Plans round our industry-leading capabilities to cut back fraud, waste, abuse and errors,” stated Zeeshan Syed, CEO of Well being at Scale. “Our expertise has been capable of meaningfully scale back low-value look after well being plans – one thing that has been a tough downside to unravel for many years and continues to drive up prices. We look ahead to working with ATRIO Well being Plans to deliver this modern functionality to their Medicare Benefit plans and to help their mission of offering high-quality, cost-effective healthcare to their members.”

“After finishing substantial due diligence of the market panorama, we have now discovered that the instruments and expertise that Well being at Scale affords well being plans is best-in-class based mostly on what we have now seen, and look ahead to working with Well being at Scale throughout our whole guide of enterprise,” stated Jennifer Callahan, Chief Working Officer of ATRIO Well being Plans.

About Well being at Scale
Well being at Scale makes use of superior AI to drive good, hyper-personalized, context-aware care supply and administration. Based by machine studying and scientific school from MIT, Harvard, Stanford and the College of Michigan, the corporate brings precision to healthcare throughout a broad vary of use circumstances, together with: fraud, waste and abuse prevention, discount of medical and drug errors, supplier navigation and community curation, and early focused prediction and prevention of opposed outcomes. For extra data, please go to healthatscale.com.

About ATRIO Well being Plans
ATRIO Well being Plans is a Medicare Benefit (MA) plan established in 2004 that provides Most popular Supplier Group (PPO) choices in addition to a Well being Upkeep Group (HMO) Particular Wants Plans for Twin Eligible. The well being plan is supported by the trusted physicians who look after Medicare beneficiaries in Oregon and Nevada. For extra data, go to atriohp.com.

SOURCE Well being at Scale Company

Well being at Scale and ATRIO Well being Plans Accomplice on Sensible AI-Powered Cost Integrity