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Health at Scale and HealthComp Partner to Prevent Low-Value Care for Employers

CISION PR NEWSWIRE

Collaboration to prevent low-value care in real-time and drive optimal use of care services for HealthComp employer clients powered by Health at Scale’s best-in-class machine intelligence


SAN JOSE, Calif., Oct. 28, 2021 /PRNewswire/ — Health at Scale, the market leader in machine intelligence for value-based care delivery, today announced a partnership with HealthComp, the nation’s largest independent health plan administrator for self-funded employer groups, to protect against low-value care and drive optimal use of health care resources. Through the partnership, HealthComp’s employer clients will have access to Health at Scale’s industry-leading artificial intelligence and machine learning-powered fraud, waste and abuse detection platform to identify low-value services during prior authorization and pre-pay before they are delivered or paid.

Low-value care services contribute to over $345 billion annually in wasteful health spending. These services provide little or no benefit, incur unnecessary costs, waste limited resources and have the potential to cause harm. Eliminating low-value care is critical to optimizing health care outcomes and spend but has traditionally been difficult to accomplish using rules-based systems that are manually intensive to develop and maintain, limited to detecting patterns of low-value care that are obvious and known, and affected by high rates of false positives and false negatives.

Health at Scale’s machine intelligence goes beyond rules-based systems and identifies low-value care with a deep, clinically-nuanced understanding of the patient, provider, time and setting of care for each service – flagging fraud, waste and abuse with unprecedented accuracy and actionability in real-time, and self-learning new patterns of low-value care as they emerge.

“Low-value care is an existential challenge for the health care industry,” said Zeeshan Syed, CEO of Health at Scale. “With access to care increasingly limited, costs continuing to rise, and members being asked to pay more out-of-pocket, health plans are right to be concerned about wasting resources on unnecessary services that provide no benefit and often pose harm. Our technology has shown the ability to solve what has been a hard problem for decades, through breakthrough advances in machine intelligence. We are delighted to be working with HealthComp to bring this innovative capability to its employers and to support its mission of transforming benefits and changing lives for the members it serves.”

“Our in-house Fraud, Waste, and Abuse (FW&A) team has long been seeking a partner that goes beyond traditional rules- and outlier-based analytics” Justin Tran, SVP of Medical Cost Management at HealthComp. “Better predictive analytics means higher hit rates, improved provider experience, and increased capacity for us to review long-tail claims. Our work with Health at Scale showed us we could do exactly that. The AI looks at exhaustive provider behavior patterns with member longitudinal context. HealthComp’s multi-disciplinary team of clinicians, coders, benefits experts, and special investigators create water-tight cases with every savings approach on the table. The client sees results: hard dollar savings ahead of industry.”

About Health at Scale

Health at Scale is a health care machine intelligence company that uses proprietary advances in artificial intelligence and machine learning to match individuals to the next best action in real-time and when needed most: whether it’s the ideal choice of treatment, an early intervention, or the right provider. Founded by machine learning and clinical faculty from MIT, Harvard, Stanford, and the University of Michigan, the company’s mission is to bring precision delivery to healthcare, learning from thousands of health variables from over a hundred million lives to generate personalized and precise insights for individual patients. Health at Scale’s machine intelligence is deployed at scale in real operational settings–including with some of the largest payers in the country, driving better health outcomes and affordability for its customers. The company’s software solutions service a broad range of use cases: provider navigation and network design, early targeted prediction and prevention of adverse outcomes, optimized treatment planning; and fraud, waste and abuse prevention. For more information, please visit https://healthatscale.com/.

About HealthComp

HealthComp, a New Mountain Capital company, is the nation’s largest independent health plan administrator for self-funded employer groups, serving over 700,000 medical members and 1.3 million total members. Our solution brings together concierge-level service, best-in-class operations, powerful analytics and expert medical cost management and integrates seamlessly with any benefit ecosystem. The result is an industry-leading experience that delivers better clinical outcomes for our members and higher savings for our book of business. For more information about HealthComp, visit https://healthcomp.com/.

SOURCE Health at Scale Corporation

Related Links

https://healthatscale.com

Chad Harris

Chief Executive Officer

 

Chad Harris serves as the CEO of HealthComp and is a values-driven healthcare leader with over twenty years of experience running business process and information technology businesses as a senior executive. Chad has a reputation for creating and controlling rapid growth by focusing on the intersection of customers, market dynamics, and the new digital world.

 

Chad has held many senior executive positions and led global teams of more than 10,000 people across dozens of counties. Chad has grown both large and small businesses, from those with less than $100M of revenue to those producing multiple billions of revenue, focusing on delivery, customer satisfaction, and innovation to create market leadership.

 

Chad's philosophy is to inspire change by doing what comes naturally, putting the needs of others before his own, working incredibly hard, and focusing on "how" to accomplish things, never "if they can be accomplished."

Thomas Martel

Chief Growth Officer

 

Tom serves as the Chief Growth Officer at HealthComp. In this role, Tom focuses on strategic initiatives aimed at accelerating HealthComp’s growth nationwide. His passion lies in assessing market and enterprise structures and creating efficiencies that enable teams to deliver best-in-class performance.

 

Previously, Tom led Cigna’s largest employer segment, largest region which was comprised of several health plans including the two largest health plans. He worked closely with Market Presidents and their leadership teams to develop and execute local market strategy and deliver growth for the enterprise. Tom earned his degree from Saint Anselm College and holds certifications from The Wharton School and the Darden School of Business at the University of Virginia. In his spare time, he enjoys sailing and holds a Master Captain’s license with the U.S. Coast Guard. He is also active in community outreach programs including local food bank and shelter services.

Sanoj Balakrishnan

Chief Technology Officer

 

Sanoj Balakrishnan serves as the Chief Technology Officer at HealthComp. In this role, he oversees the company’s overall technology strategy and architecture, building secure and highly scalable distributed systems.

 

Most recently, Sanoj served as Head of Healthcare Digital Business and Technology at Cognizant, working with payers and providers in developing solutions that reduced healthcare costs and provided a best-in-class experience for members. Earlier in his career, he worked at technology organizations in a variety of software engineering and architecture roles. Sanoj earned his B.S. from University of Mumbai and Computer Systems Management from National Institute of Information Technology.

Justin Tran

Executive Vice President, Product

 

Justin serves as the Executive Vice President of Product at HealthComp. He has 8 years of experience in developing and delivering solutions that reduce health care costs, improve quality, and provide a best-in-class experience for members. Most recently, Justin was an Associate Partner and business unit leader at McKinsey & Company where he helped large carriers and healthcare technology companies build new clinical services and solutions for fraud, waste, and abuse. Justin earned his B.S. in Accounting and Data Informatics from Indiana University, Bloomington.

Tucker Stein

Chief Financial Officer

 

Tucker serves as the Chief Financial Officer of HealthComp. Tucker previously worked for The Boeing Company in a number of finance and strategy roles, most recently as a finance lead for the Transactions and New Business Development group. In this role Tucker led investments and strategic partnerships for Boeing’s Space and Communications portfolio. Tucker earned his MBA at Stanford’s Graduate School of Business and his Bachelors of Science at the University of Redlands.

Tom Georgouses

General Counsel

 

Tom is involved in multiple areas of HealthComp including Operations, Compliance and Legal Affairs. Tom was admitted to the California Bar in 1990 and started his legal career with Stammer, McKnight, Barnum and Bailey, LLP. When he left the firm to join HealthComp in 2014, he was the Managing Partner (he had represented HealthComp since 2003). In private practice Tom’s areas of focus included healthcare and transactional work. Tom holds a Bachelor of Science Degree in Business Administration-Finance from California State University Fresno and received his Juris Doctorate from San Joaquin College of Law.

Rishab Bansal

Chief Transformation & Operations Officer

 

Rishab serves as the Chief Transformation & Operating Officer at HealthComp. Rishab focuses on transforming and modernizing HealthComp’s operations to provide delightful and distinctive experiences to its members, providers, and clients. His agenda includes integrating all entities towards a One HealthComp vision, driving profitable growth, and delivering value and business outcomes.

 

In his former work over the last 2 decades, he has helped clients across industries to transform themselves by bringing industry-leading practices and digital and data-led disruption. As the trusted advisor to the C-suite, Rishab helped his clients leapfrog on their transformation journey to accelerate business outcomes and helped them unlock new opportunities to drive profitable growth, profitability, and enhanced experience for their employees and clients.

EDI Information

If you are a healthcare provider and have the capability to submit healthcare claims electronically and use one of the clearinghouses listed below, please use the associated payor ID to submit claims destined for HealthComp.

Clearinghouse Medical Payor ID Dental Payor ID
Availity 85729
Capario HCOMP
CareVu 85729
Dental XChange DX029
Emdeon/WebMD 85729 85729
Claimant.com 85729
I-Plexus Solutions 85729
McKesson (RelayHealth) 85729
CPID:
HCFA - 3206
UB - 2934
NDC 85729
Office Ally 85729
OptumInsight (Formerly Ingenix) 85729
Tesia 85729

We strongly advise that you confirm our payor ID with your clearinghouse before you submit claims electronically to us.
For questions regarding our EDI capabilities, please contact our EDI Coordinator



Elaine Davis

Chief Human Resources Officer

 

Elaine Davis serves as CHRO for HealthComp. Elaine previously served as CHRO for Continuum Global Solutions and has served in executive leadership positions for Xerox and GlaxoSmithKline. Elaine holds Bachelor’s and Master’s degrees from the University of California at Berkeley.