Reveleer, a cloud-based platform helping payers analyze member and provider data, has landed $65 million in fresh capital.
The company allows government-sponsored payers to manage risk adjustment and quality improvement in-house, using machine learning to simplify the process of collecting member data and improving outcomes.
Oak HC/FT led the round, joined by previous investors Upfront Ventures and Boston Millenia Partners.
The process of payers collecting clinical data from providers, which often involves multiple payers all asking a single provider for the same member information, is “inefficient, redundant, and creates a lot of friction for providers,” said Jay Ackerman, president and CEO of Reveleer, in an interview with Fierce Healthcare.
“The solution set today doesn’t solve that, and there’s no impetus to solve it. We’re trying to take the opportunity to do that in-house and to do it faster, cheaper, and better, allowing more time to work on improving member outcomes,” he said.
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Reveleer’s artificial-intelligence-enabled platform aims to simplify the process of capturing and reviewing member data, analyzing over 40 million pages of clinical data in 2020, Ackerman said.
“We’re able to scan and identify 86% of that inbound, the member and the provider related to the medical record. Previously, none of that was read,” he said.
In addition, the platform’s natural language processing (NLP) tools help identify and validate compliance across the 11 specific quality measures that health plans report on, according to Ackerman—“and we can do that at a really high performance level,” he said.
The AI and NLP capabilities attempt to ease the burden on payers prompted by the shift to value-based care with an “ever-evolving” federal performance bar for quality improvement and risk adjustment, Ackerman said.
“What you have to do this year to be a four-star plan is harder than what you had to do in the prior year. They keep raising the bar,” he said, adding that Reveleer’s technologies can accelerate that work for payers.
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While the funding will allow the company to accelerate its product development, Ackerman said, it also empowers Reveleer to pursue potential acquisitions or partnerships.
“We are actively talking to over 158 companies that have interesting solutions that could extend value to the payers we work with,” he said.
He noted that the company is specifically looking at point solutions focused on interoperability, NLP in value-based care and analytics.
In a statement about the round, Andrew Adams, co-founder and managing partner at Oak HC/FT, said Reveleer’s use of technology to guide payers through increasingly complicated regulation and reimbursement models gets at one of healthcare’s most critical issues.
“At Oak HC/FT, we’re always seeking to partner with companies that are addressing the leading challenges in healthcare, and there’s an urgent need for automation to reduce inefficiencies and unnecessary costs,” Adams said. “We’re looking forward to supporting Reveleer as it continues to expand its capabilities and reach as the industry increasingly shifts to value-based care.”
The company has spent five years developing its software tools in response to payer demand, Ackerman said.
“We’ve believed for a long time that there was a unique opportunity to accelerate how this process functions to put more energy into caring for members, and the Oak investment validates that,” he said.