PAI and Health at Scale Team up to Defend Employer Dollars From Inappropriate Healthcare Payments

Planned Administrators, Inc. (PAI) is partnering with Health at Scale to identify inappropriate healthcare claims before they are paid. Through the partnership, PAI will use Health at Scale’s breakthrough technology for real-time screening of claims in a pre-payment setting, to detect inappropriate claims and surface them for review before the dollars are paid out.

“Employers are working hard to fulfill their mandate of using plan dollars wisely” said George Stiles, PAI President and COO. “This deployment represents a big step forward in PAI’s ongoing commitment to help them fulfill their fiduciary duty and provide employees with the best care at the lowest cost.”

An estimated 25-30% of all US healthcare spend is estimated to be lost to spending that is waste, abuse or fraud, which equates to almost $1,700 per member per year. This cost burden directly impacts the ability of employers to continue providing high-quality, affordable health benefits to their employees. Though the problem is widespread, limited progress has been made by traditional payment integrity systems with manually-crafted rules, which are subject to high rates of false positives and false negatives. In contrast, Health at Scale delivers industry-leading accuracy through smart, context-aware and clinically-nuanced analysis of each claim in real-time with a deep understanding of the patient, the provider, the time and the setting of care.

In addition to saving crucial dollars for employers, the technology will also play a role in improving employee well-being. With the financial incentive to perform wasteful procedures removed, fewer employees will receive care that is unnecessary, or even cause harm or health complications.

"We are delighted to be part of PAI’s leading solution for employers," said Health at Scale CEO Zeeshan Syed. "Wasteful services are a burden for employers and their members, and continue to propagate healthcare inequity with employees and dependents in underserved geographies or those challenged by social determinants of health disproportionately impacted. We’re excited to play a positive role in helping reduce this burden.”

Health at Scale's Precision Fraud, Waste, and Abuse Detection™ is highly differentiated as the only solution developed by a leading technology team with widespread recognition for pioneering contributions to healthcare AI advances. Health at Scale’s technologies have been used for millions of lives in pre-pay and post-pay settings, with proven results in deployments for employers, third-party administrators and insurers.

About Planned Administrators, Inc.

PAI is a nationally licensed TPA, delivering flexible solutions across group health plans, ancillary products, and P&C programs, and offering innovative approaches to support client partners. We currently provide administrative services for both traditional self-funded accounts, as well as providing business process outsourcing solutions for regional and national businesses.

About Health at Scale

Health at Scale uses advanced AI to drive smart, hyper-personalized, context-aware care delivery and management. Founded by machine learning and clinical faculty from MIT, Harvard, Stanford and the University of Michigan, the company brings precision to healthcare across a broad range of use cases, including: waste, abuse and fraud prevention, reduction of medical and drug errors, provider navigation and network curation, and early targeted prediction and prevention of adverse outcomes. For more information, please visit healthatscale.com or contact us.