By: David Ostrowsky

Unfortunately, there has long been a widely held perception that the healthcare industry is largely antiquated and riddled with inefficient processes. Perhaps that can explain why last week’s announcement – that Machinify, a provider of artificial intelligence (AI)-powered software for streamlining the healthcare claims lifecycle, will become an integral part of the company recently formed through the merger of The Rawlings Group (“Rawlings”), Apixio’s Payment Integrity business (“Apixio PI”), and VARIS – was deemed particularly newsworthy. That this new conglomerate, to be named Machinify, will be leveraging next generation technology and a wealth of data to further automate and enhance healthcare administration processes has apparently captured the imagination of healthcare stakeholders worldwide, and struck a chord with those that believe the healthcare industry must do more to leverage new technologies and catch up to other innovative industries.

While the industry embracing novel technologies is an encouraging sign of change, the reality is that, upon closer inspection, it is not a new development. Not even close. In fact, The Phia Group, as one of the country’s premier healthcare cost containment companies, has for years been a pioneer in channeling A/I-powered applications to optimize the healthcare claims lifecycle by enhancing automation and efficiency. This next generation technology is integrated into multiple aspects of the company's core products and services, from The Phia Ignite Repricing Engine, to SoPhia (™) - its proprietary A/I consulting tool. So, what exactly are The Phia Ignite Repricing Engine and SoPhia (™)? Let’s take a look at how Phia has been championing cutting-edge means for automating processes over the past couple of years . . .

Encompassing focused A/I, detailed quality metrics, multiple and defensible repricing datapoints, the Phia Ignite Repricing Engine is engineered to consistently calculate equitable and defensible claims payments. Indeed, Phia Ignite represents a means for revolutionizing the way self-funded plans approach cost containment as it empowers plans to take control of their healthcare spending by unwrapping the complex layers of medical billing and reimbursement. Not only does Phia Ignite have the unique ability to price claims for which benchmarks and rates would be otherwise unavailable but it also can be utilized for navigating patients towards the highest quality physicians who can provide services at the most equitable prices. In short, with the Phia Ignite Repricing Engine, the market’s most innovative technology has been harnessed to help healthcare consumers become more enlightened about their options for receiving care. Meanwhile, for their respective health plans, the benefits – whether they be realizing maximum savings, reducing risks, ensuring proper compliance – are immeasurable.

Speaking of compliance, The Phia Group has invested considerable time and effort in developing the aforementioned SoPhia (™) for our consulting department. Gone are the days when Phia’s unrivaled consultants would spend hundreds (thousands?) of hours combing through a bevy of internal and industry communication materials and deliverables. Now, with SoPhia (™), they are able to tap into the powers of A/I to acquire, organize, update, and deliver information at an exponentially faster rate, leveraging years of output produced by The Phia Group’s thought leaders. Clients are constantly presenting The Phia Group with compliance-related questions and they need answers as quickly as humanly possible. Seeking to do better than “humanly possible,” Phia’s consultants and developers collaborated to achieve an incorporation of artificial intelligence into the processes of gaining and disseminating internal, and sometimes proprietary, Phia knowledge. While A/I, like any new technology, needs to be closely monitored in its nascent stages, its immense potential for enhancing the timing and quality of deliverables is awe-inspiring – and something the industry wholeheartedly embraces.

Hopefully, the narrative surrounding the glacial pace of change in healthcare will start to change as stories such as New Mountain Capital’s acquisition of Machinify to form a multibillion-dollar medical payments powerhouse become more commonplace. But, as Phia’s track record suggests, the latest and greatest technology (i.e., artificial intelligence) is already well embedded in certain aspects of the healthcare administration industry.

Just ask us about it.