It’s no surprise that US healthcare is one of the talked-about markets on the global stage. Set apart from many of its peers internationally by its seemingly intractable web of payer-system-provider-patient-employer-plan-pharma-etc-etc relationships, there are many places where even the most experienced insiders can get tripped up. Couple this web with a set of incentives that doesn’t always align with the best health outcomes for individuals and it’s hardly surprising that the system loses 10% of spend to fraud, waste and abuse.
It is more surprising, however, that 80% of wastage is unintentional. While there is certainly a non-trivial amount of intentional fraud, the overall causes of wastage have become endemic to the complexity of the healthcare system overall. As such, they’re hard to identify, which makes them hard to fix. That’s where Alaffia Health comes in.
Alaffia is a company with one purpose: to use data to optimize medical claim payments. Free from waste, free from overpayment, and ultimately free from human error.
Alaffia’s first move is their overcharge detection engine. By ingesting relevant provider and patient data, the company forensically reviews claims to understand the true underlying value of the treatment given, and in turn flags claims that require deeper analysis by its qualified payment integrity team. By ensuring that payment is only occurring in where that exact care has been provided, Alaffia is directly improving the bottom line for large healthcare entities such as public insurance agencies, self-insured employers and private health plans.
What’s exciting about Alaffia is that they are essentially allowing healthcare to work how it should. In this privatized, multi-payer system, it’s imperative that processes are clean and efficient, and that everyone plays by the rules. Intentional or not, over-billing is a direct violation of the trust that we put in doctors and hospitals in our most critical and emotionally-fraught moments. When a payer is victim to that, they’re passing on unnecessary cost and pain to both their shareholders and their covered members, and perhaps even financially incentivising the behaviour.
Alaffia founders (and siblings) TJ Ademiluyi and Adun Akanni know this from personal experience. Their family’s business, Healthcare Service Partners, is in the healthcare billing sector. Between this and the pair’s own professional experiences, you would struggle to find better founders for the job. The US health system is complex, involved, and at times alien and disorienting. It takes natives to the system to navigate its halls and clean it from the inside. TJ and Adun are exactly that, which is why we as Anthemis are proud to have invested in Alaffia Health. We look forward to watching this company thrive as it brings much-needed clarity and fairness to the often unclear and lopsided world of medical billing and payments.
Alaffia are hiring! If you’d like to work to make the healthcare system function fairly, check out the careers section on the Alaffia site.