Artificial intelligence-powered payer intelligence startup Anomaly Insights launched a new tool aimed at providing managed care executives with evidence to bring to payer negotiations.
Anomaly Insights seeks to take on what Anomaly CEO Mike Desjadon told Fierce Healthcare is an “adversarial payment system” in the U.S. healthcare industry. He added there is also a “fundamental asymmetry” in data between insurance companies and health systems.
“It's that asymmetry that allows an insurance company to basically make the health care system chase its tail with denials and all the things that they do with data,” Desjadon said.
Anomaly seeks to change that.
The Manage solution examines all claims across every payer in a health system’s contract, identifying patterns and synthesizing complex data from contracts to claims. With the solution, providers can see when each payer denies a claim that should be pai or downcodes services to lower-reimbursement codes.
“The whole goal of Manage is to provide a data-driven mechanism repeatedly, reliably and with as little labor as possible to get an insurance company to change their behavior proactively,” Desjadon said.
The new offering is the latest solution within Anomaly’s platform. Founded in 2020, it uses machine learning to search for irregularities in medical billing to prevent overpayments and billing errors. The platform also includes detection, prediction and recovery solutions.
Anomaly Chief Product Officer Dan Unger told Fierce Healthcare the company has received “really positive” feedback from systems using the solution, adding that Anomaly built the tool “hand in hand” with clients.
“We have tangible success stories where we have helped payers to stop doing things, change their behaviors that have led to millions and millions of dollars of outcomes that are validated,” Unger said. “That's the part that I'm excited about. That our clients have seen something change.”
Four customers are currently using the Manage solution, with several others in the pipeline, executives said. Desjadon said the solution will likely be available to all customers by the end of the year.
Anomaly works with “more than 20 organizations,” roughly reaching “tens of millions” of patients, Desjadon said.
“We've started with our biggest health systems,” Desjadon said. “They're the ones that have this particular issue to the most disproportionate level.”
The company says an early deployment of Manage at a major U.S. health system identified two payer patterns that made up more than $110 million in annual financial impact. When data was presented to the payer, a settlement was reached and the underlying issue was resolved.
“Our goal is to be balanced and be able to sift through the noise,” Unger said. “And start marching towards more frictionless transactions.”