Why Alpha Health

Be a Better Steward of the Healthcare Dollar

CHALLENGES OF RCM

Challenges Continue in Curbing Costs

Current RCM processes make it virtually impossible to reduce administrative costs in healthcare or improve performance, and existing solutions often add complexity and costs.

Complexity in medical reimbursement in the United States drives up hidden costs that we all pay, both in terms of dollars and in the erosion of trust people have that our healthcare system will serve them well. The U.S. spent an estimated $500 billion on medical billing and insurance administrative costs in 2019 alone. Sixty-nine percent of Americans experienced financial hardship due to medical bills last year. Sadly, nearly 67% of all bankruptcies are tied to medical issues according to a study study published in the American Journal of Public Health.

 

People pay the price when the backend of reimbursement is broken:

  • 75% of medical bills have errors, according to Medical Billing Advocates of America
  • Success rates at overturning denials hover around 50%
  • 57% of Americans have been surprised by a medical bill according to a study by NORC at the University of Chicago
  • 43% of consumers have had a catastrophic financial hardship due to medical bills

Health systems struggle because:

  • Only 50% of claims initially denied by insurance are ultimately overturned according to a report by the Revenue Cycle Advancement Center of The Advisory Board
  • The cost to collect hovers around 3% of net patient revenue for hospitals and health systems according to the same Advisory Board report.

 

Existing solutions fail because:

  • Most existing solutions are based around staff augmentation; these gains have saturated and staff are burnt out from learning new tools.
  • Automation tools have largely focused on RPA which is rudimentary, blind, and brittle. The dynamic nature of healthcare far exceeds the capabilities of RPA.
ALPHA HEALTH SOLUTION

We’re Creating a New Category: Unified Automation™

Alpha Health has pioneered Unified Automation™ to provide health systems with a single solution to efficiently, accurately, and autonomously navigate the complex state of medical reimbursement in the United States, enabling health systems to decrease their cost of care and be better stewards of the healthcare dollar.

We evaluated modern automation approaches from some of the most complex domains in the world, and we derived core principles – like the best ways to monitor existing workflows, learn from workflows at scale and quickly adapt to change. We then built proprietary technology from the ground up to apply these core principles to the unique challenges of healthcare revenue cycle management.

Our solution lives and operates within the existing electronic health record (EHR) and billing systems of our clients. We can deploy entirely remotely and there is no new training required for existing staff.

 

Unified Automation™ consists of three complementary elements:

  1. Proprietary technology that captures actions related to specific tasks.
  2. Machine learning (algorithms) that learn to perform those tasks.
  3. Human decision support.

Unified Automation™ refers to unifying these elements into a single solution to comprehensively automate dynamic, complex tasks that also require human judgement and subject matter expertise.

Unified Automation™ offers revenue cycle leaders at health systems and providers of all sizes a powerful new tool for doing more with less. Unified Automation™ can help restore trust in healthcare, by bringing together the best of people, data and technology to address financial complexity in the U.S. healthcare system.

Our Company

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Bridging the Gap Between Technology and Healthcare

As a team, we’re here to do the best work of our lives by solving critical challenges in technology and healthcare. We’ve intentionally brought together the best machine learning talent in Silicon Valley with senior revenue cycle operations experts from the front lines of healthcare organizations across the country. By bridging these two industries, we’ve built a team uniquely qualified to tackle the challenges of revenue cycle management in healthcare in new ways, with new technologies.