What You Should Know:
– Anomaly, a precision payments platform using artificial intelligence (AI) to improve payment accuracy in the healthcare industry, today announced $17M in series A and seed funding. The series A was led by RRE Ventures and included participation from Link Ventures and existing investors Madrona Venture Group, Declaration Partners, and Redesign Health.
– Anomaly plans to use today’s funding to grow its team, invest further in product development, and expand its market presence. As part of the investment, Jason Black from RRE Ventures will join the Anomaly Board of Directors.
Ensuring Healthcare Payment Accuracy in Value-Based Care Era
Improper healthcare payments and related costs represent one of the most challenging problems in the U.S. healthcare system, contributing more than $300 billion, or one in every $10 spent, in unnecessary costs annually. Ensuring payment accuracy in healthcare has become more complex in the value-based care era, as payers often have unique contractual relationships with each provider that increasingly include reimbursement tied to value.
When errors or disputes occur, the resulting conflicts often exacerbate many of the existing challenges that plague the healthcare system, including provider burnout and abrasive clawback disputes. Both can have significant effects on patients, as provider burnout is proven to affect care quality, and reimbursement disputes can result in providers leaving insurers’ networks.
Anomaly works with healthcare payers, claims clearinghouses and providers to integrate at key points in the claims lifecycle, identifying and preventing payment and billing errors before they occur. Using advanced machine learning that analyzes billions of medical and pharmacy claims across one of the largest and most diverse datasets, Anomaly streamlines the claims payment experience between payers and providers, reducing friction and ensuring trust and integrity in the process.
“Overpayments, billing errors, and the resulting administrative rework creates completely unnecessary conflict and adds costs to the healthcare system that ultimately the consumer is responsible for paying. Anomaly works to ensure that the right amount is paid the first time, so payers can feel confident about every single payment, and providers know they are compensated correctly,” said Jacob Shiff, Anomaly’s Co-Founder, President and Chief Operating Officer. “We’ve brought together some of the best minds in healthcare and technology to solve this massive problem, because when there is less conflict, providers are happier, and patients are healthier.”
Anomaly Leadership Team
Anomaly’s leadership includes a cross-section of top data science engineers, healthcare industry veterans, payment integrity experts, and leading investors that bring unmatched insight into solving the payments problem. The team includes the former CEO of UnitedHealthcare’s commercial business, Head of Engineering of Foursquare and Redesign Health, Founder of payment analytics company Discovery Health Partners (acquired by MultiPlan), and alumni from top health and tech companies like Google and Flatiron Health.
“Health insurers are under immense pressure to both control costs and maintain great working relationships with providers, but nothing complicates those relationships more than conflicts over reimbursement,” said Jeff Alter, Anomaly Chairman and current CEO of Summit Health, who previously served as CEO of UnitedHealthcare commercial and EVP at Anthem. “The improper payments issue is constantly evolving and requires continuously learning AI to solve, which is why Anomaly is best positioned to make a difference in the market.”