Alivia Analytics Acquires SourcEdge to Expand Healthcare Claims Lifecycle Capabilities for Commercial and Government Payers
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The acquisition of SourcEdge by Alivia represents a strategic move in the healthcare technology sector, aimed at enhancing the capabilities of healthcare payers in managing claims efficiently. The integration of SourcEdge's expertise in claims system modernization with Alivia's AI-powered payment integrity platform has the potential to streamline operations and reduce the incidence of fraud, waste and abuse (FWA) in healthcare transactions.
From a technology standpoint, the consolidation of these services under the Alivia brand could lead to improved data handling and security, particularly concerning protected health information (PHI). The adoption of advanced AI and analytics is expected to bolster the value-based care strategies, which are increasingly important as the industry shifts towards outcomes-based reimbursement models.
Furthermore, the tech-enabled services practice that is being formed could provide additional revenue streams for Alivia while also offering comprehensive solutions for payers. This could translate into better financial performance for the company and potentially, for the healthcare payers who are their clients.
The undisclosed financial details of the transaction do not provide direct indicators for market impact analysis. However, the involvement of healthcare-focused private equity firms Council Capital and Health Enterprise Partners (HEP) suggests confidence in the combined entity's future growth potential. The healthcare payment integrity market is poised for growth, driven by the increasing need for cost containment in healthcare expenditure.
Alivia's enhanced end-to-end claims solution could position the company as a leader in a niche market, which may attract investor interest in the healthcare technology space. The addition of Mark McAdoo as President of Alivia and a member of the Board of Directors is likely to bring valuable experience and leadership, potentially influencing the company's strategic direction and market performance.
The merger's emphasis on AI and technology in improving healthcare affordability aligns with current policy trends that encourage innovation in the healthcare sector. Policymakers and regulators are increasingly supportive of technologies that promise to enhance the effectiveness and efficiency of healthcare delivery.
By potentially reducing the costs associated with FWA, the combined capabilities of Alivia and SourcEdge could have a positive impact on the overall healthcare system. This could lead to broader policy implications, such as influencing the development of regulations surrounding AI in healthcare and the management of PHI.
It is also significant that the transaction has been financed by private equity firms with a focus on healthcare, indicating a trend towards private investment in healthcare technology solutions that address systemic challenges.
The unified organization combines SourcEdge's claims system technology optimization expertise with Alivia's AI-powered payment integrity / FWA data and analytics platform
Alivia and SourcEdge have worked collaboratively for more than two years, resulting in a solution combining expert professional services with purpose-built healthcare technology. The combined entity will operate under the Alivia brand.
"Our platform and its modules are even more effective when our clients' claims and business systems are optimized to achieve financial and operational returns, says Michael Taylor, MD, Alivia CEO. "We are thrilled to incorporate this exceptional, well-respected team of experts we know and trust."
SourcEdge brings unique expertise to assist health plan CIOs and VPs in modernizing and maintaining their critical healthcare claim systems. This includes protected health information (PHI) security, value-based care strategy accelerators, and claims payment data consolidation.
"Alivia's SaaS platform combined with SourcEdge's data transformation services provides a unique combination for end-to-end claims management," adds Mark McAdoo, SourcEdge CEO who will become President of Alivia and member of the Board of Directors. "Combining products and services demonstrates the efficiency of modern healthcare technology and digital transformation."
Fusing these capabilities also includes the formation of a tech-enabled services practice that uses the platform to provide outsourced SIU / investigative resources, pre-pay clinical reviews, post-pay recovery audits, and end-stage renal disease (ESRD) premium protection.
Bill Lucia, former Chairman, President & CEO of HMS (NASDAQ: HMSY) and Alivia Board Member, comments, "Finding solutions to improve the effectiveness of our nation's healthcare system will continue to dominate headlines and remain top-of-mind for policymakers and regulators. Embracing technologies that truly unlock this potential through use of advanced artificial intelligence are critical tools in addressing healthcare challenges and will improve affordability and change the status quo for patients, providers, and payors."
Healthcare-focused private equity firms Council Capital and Health Enterprise Partners ("HEP") financed the transaction.
The financial details of the transaction were not made public.
About SourcEdge
SourcEdge Solutions, LLC (known as SourcEdge) is a trusted technology solutions partner helping health plan CIOs and VPs modernize and maintain their claims and business systems. This unique expertise includes protected health information (PHI) security, value-based care strategy accelerators, and claims payment data consolidation. We help our clients achieve financial and operational returns by working closely with world-class software, database, and cloud providers. Our talented people bring the most modern tools and proven best practices to each project to help health plans efficiently serve their members, patients, and providers.
About Alivia
Alivia Analytics, LLC (known as Alivia) provides a revolutionary, AI-powered payment integrity platform for cost containment, serving commercial and government health plans, auditors, and fraud investigators. The platform offers speed, accuracy, and adaptability with powerful data and analytics. It includes a pre-pay accuracy module to prevent improper payments, Alivia FWA Finder™ for post-pay fraud detection and recovery, and Alivia Case Manager™ that works seamlessly with our modules or can be independently used with any system. Our tech-enabled services leverage the platform to provide outsourced SIU / investigative resources, pre-pay clinical reviews, post-pay recovery audits, and ESRD premium protection.
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SOURCE Alivia Analytics
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