ACA Emphasizes Importance Of Costs Of Care Management
By Christine Kern, contributing writer
As more people sign up for insurance, medical groups and health plans need to improve their efficiency in predicting costs of care.
With the implementation of the ACA and the swelling of Medicare rolls, increasing numbers of individuals are coming under the umbrella of insurance coverage. As a result, medical groups and health plans have an ever-more pressing need to predict the costs of care.
San Mateo, CA-based Apixio wants to fill that need by crunching a lot of existing clinical data, providing healthcare organizations with the information they need to accurately estimate patient risk. That enables providers to more accurately (and profitably) bill for their services. Bain Capital Ventures and a group of Silicon Valley angel investors are getting behind the concept by infusing Apixio with $13.5 million in new capital. The new capital brings Apixio’s investment total up to $22.6 million.
“We are very excited about our new partnership with Bain Capital Ventures and the continued support from our current angel investors,” said Shawn Dastmalchi, CEO and Co-founder of Apixio in a press release. “The proceeds will be used to ramp up our sales and operations in support of the strong growth we are experiencing in our Risk Adjustment business. We also intend to further develop our Big Data technology and to build on our vision to provide analytic solutions that power value-based care.”
“Apixio’s solutions are gaining terrific customer traction, and we are thrilled to partner with their team to help meet a pressing need in the healthcare analytics market,” said Jared Kesselheim, Partner at Bain Capital Ventures “An effective Risk Adjustment process is becoming essential to an increasing portion of the payor-provider landscape, and Apixio’s technology platform has the power to deliver unprecedented accuracy and automation.”
The steady acceleration in Medicare Advantage plan enrollments, combined with increasing audit pressure from the Centers for Medicare and Medicaid Services (CMS), is creating growing need for accurate and efficient reporting of member risk scores. In addition, the ACA requires commercial health insurance plans to maintain accurate Risk Adjustment data for their small group and individual plan members, further expanding the demand for Risk Adjustment solutions. Ultimately, as value-based payment models gain broader adoption, Risk Adjustment solutions will become the foundation for both how payment is determined and how patient care outcomes are tracked.