Anomaly announces $ 17 million in funding to address a $ 300 billion health issue

Anomaly, a company seeking to alleviate hospital costs, announced $ 12 million in Series A Tuesday. Anomaly is a growing company – it was only founded in 2020. But it has its eyes on the old guaranteed problem: waste in the U.S. health care system.

The anomaly platform was designed to detect inaccuracies in medical bills. The AI-based approach comes as a result of dealing with the “high cost” of data disclosure from insurance companies and healthcare systems, says Jacob Shiff, Anomaly’s founder, president, and COO. The training allows the software to deliberately define claims that do not always exist or to determine the billing process that ultimately results in free spending.

“Our overall goal in our work with insurance companies and providers is to use in-depth technology and healthcare professionals to resolve the dispute between employers and insurers so that we can pay the appropriate amount upfront,” Shiff told TechCrunch.

The round comes as the previously announced $ 5 million profit closed earlier this year, bringing the company’s total revenue to $ 17 million. RRE Ventures led the A process and included input from Link Ventures. Existing investors also include Madrona Venture Group, Declaration Partners, and Redesign Health.

Anomaly will use the money to develop a team (the company now has 12 employees) and then boost its business by partnering with insurance companies and healthcare systems.

“Traditional solutions focus on exit and response mechanisms to deal with unpaid bills,” said Kyle Tatz, CEO of Redesign Health. “We believe Anomaly’s day one approach to working with payers and service providers is reasonably priced and, first and foremost, embodies the industry standard.”

While there is a job shortage in-hospital care that costs another dollar, large amounts of costs, at least according to the 2019 JAMA survey, do not happen at the bedside. An analysis of more than 54 books suggested more than $ 300 billion in lost labor costs. The study was conducted by a team of economists, but William Shrank, chief medical officer at Humana, an insurance company, led the article.

Most of the waste is the “management complex”; in other words, the weight of the paper is unnecessary.

Tatz called that $ 300 billion “an indication of how much room there is in the market for better solutions.”

“Imagine that, on your credit card, every month you receive your statement along with 10% of your false accusations,” says Shiff.

But questions about how to solve the paper problem have led to a blind spot in the medical examination. The paper could not find any study that revealed a viable way to save money by reducing administrative complexity.

When the paper was published, some argued that turning to a payroll healthcare system was the best way to follow this trend. Others argue that other countries with private health care systems still spend less on administration costs than the United States.

For example, take a March 2018 JAMA study of health spending in the US and eleven other major countries, including the UK, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark. The United States spends about 8% of its GDP on “administration and government.” Other countries accounted for an average of 3% in the sector.

Anomaly calls his approach to acquire a blind spot an expensive “full-payment” doctor. When a service provider files a complaint with the insurer, Anomaly can review the statement and make sure there are no errors. If so, the supplier will receive an immediate response stating the error (that’s the idea behind one of the company’s products: Anomaly Prevent).

The company’s product, Anomaly, is on the mend, identifying past transfer costs that may not have been seen.

Shiff won’t name the insurance company or healthcare system Anomaly currently operates, but the company does have a relationship with the CEO of the game and the company. The president of the company is Jeff Alter, former president of the commercial division of United Healthcare and current president of IngenioRx and Anthem Health Solutions.

Shiff said Anomaly is working with “local taxpayers in the Northeast” and “the health care system in Florida.” He also won’t show any metrics on how Anomaly has saved these systems funds or simplified disclosure. Instead, he described the consequences.

“We are satisfied with the results. This result is very valuable, in terms of dollars and cents, in and of itself,” he said.

The fact that hospital bills are so confusing and full of errors is not a generalized story. Tatz argues that now is the time to solve the problem because “overcrowding between healthcare providers” and AI can be reduced for free and, due to healthcare costs, pushed to the limit. “

“We have identified vendors and service providers are increasingly looking for solutions like Anomaly that reduce administrative waste and conflict, which is a relatively low cost to reduce in the healthcare environment,” he said.