Innovative, context-aware fraud, waste, abuse and error detection powered by cutting-edge AI to prevent low-value care in real time and improve quality, safety and affordability for health planners Let
San Jose, California, February 27, 2023 /PRNewswire/ — Health at Scale, a leading provider of machine intelligence for the delivery and management of value-based care, today announced a partnership with ATRIO Health Plans, Inc. Oregon and NevadaThe partnership leverages Health at Scale’s cutting-edge AI and machine learning technology to prevent low-value care by responding to fraud, waste, abuse and error in real time. It also promotes quality, safety, and affordability for plan members in support of ATRIO Health Plan’s mission to provide quality health coverage at affordable prices to Medicare Advantage beneficiaries.
With prevalent and continuously evolving patterns of fraud, waste, abuse and error in the healthcare industry, the use of AI-powered technology will help healthcare plans identify and eliminate spending that is often wasteful and unsafe. has become an indispensable tool forthat’s all $345 billion of healthcare costs are wasted on low-value care services each year. These services provide little or no benefit, incur unnecessary costs, waste limited resources, and can cause harm. Eliminating fraud, waste, abuse, and error is critical to optimizing health care outcomes and spending for payers, providers, employers, and TPAs, but manual efforts to develop and maintain has traditionally been difficult to achieve using a rules-based payment integrity system. Detects obvious and known patterns of low-value care and is subject to 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 to provide deep clinical nuances, contextual awareness, and advanced Use personalized patient understanding to identify low-value care. , providers, hours, and care settings. By taking into account a 360-degree view of all healthcare services and transactions, Health at Scale’s AI reduces false positives and false negatives while continuously self-learning as new patterns of low-value care emerge. , flag fraud, waste, abuse and errors in an unprecedented way. Accuracy and practicality.
“We are pleased to partner with ATRIO Health Plans on industry-leading capabilities to reduce fraud, waste, abuse and error.” Zeeshan Side, CEO of Health at Scale. “Our technology has been able to significantly reduce low-value care for health insurance, a problem that has been intractable and driving up costs for decades. We look forward to working with Plans to bring this innovative capability to the world in support of Medicare Advantage plans and their mission to provide high-quality, cost-effective care to their members. ”
“After completing sufficient due diligence of the market environment, we found the tools and technology offered by Health at Scale to be best in class based on what we have seen so far across the business’s full books,” he said. rice field Jennifer CallahanChief Operating Officer of ATRIO Health Plans.
About Health at Scale
Health at Scale uses advanced AI to drive smart, highly personalized and situational care delivery and management. Founded by machine learning and clinical faculty at . MIT, harvard, Stanford and the University of Michigan, the company brings precision to healthcare across a wide range of use cases. This includes fraud, waste and abuse prevention, medical and drug error reduction, provider navigation and network curation, early and targeted prediction and prevention of adverse outcomes. For more information, visit healthatscale.com.
About Atrio Health Insurance
ATRIO Health Plans are Medicare Advantage (MA) plans established in 2004 that offer Preferred Provider Organization (PPO) options and Health Maintenance Organization (HMO) Special Needs Plans for dual eligible individuals. Health plans are supported by trusted physicians who care for Medicare beneficiaries. Oregon and NevadaFor more information, please visit atriohp.com.
Source Health at Scale Corporation
