Sagility Acquires BirchAI, a GenAI Company in the Healthcare Space

Sagility to transform member, patient and provider interactions using BirchAI’s SaaS platform

DENVER, COLO. – March 26, 2024 – Sagility LLC, one of the leading technology-enabled services providers in the healthcare services space, announced its acquisition of Seattle-based BirchAI. BirchAI is a healthcare technology company offering cloud-based, GenAI call technology built by experts in transformer-based natural language processing. BirchAI enables clients to reduce operational costs by providing various AI-powered real-time customer support solutions to manage complex healthcare transactions. 

Ramesh Gopalan, Sagility’s Group CEO noted, “We’re thrilled to announce this acquisition of BirchAI, which enables Sagility to build on our healthcare domain expertise and demonstrates our commitment to technology enabled transformation of the healthcare value chain. BirchAI’s generative AI capabilities will help us deliver significantly more impactful ROI to our clients.” 

With this acquisition, Sagility broadens its analytics and automation backed healthcare engagement services that it provides to large national payers, Blues plans, regional payers, health systems, medical devices and other healthcare providers. 

BirchAI will further propel Sagility’s delivery of healthcare operations, enhance the member and provider experience, and improve quality of care. “Sagility brings strong domain expertise and a renowned healthcare presence to complement our generative AI solutions,” noted Kevin Terrell, Cofounder and CEO, BirchAI.

Sherman & Company served as BirchAI’s financial advisor on the transaction. 

About Sagility

Sagility combines technology and transformation-driven healthcare services with decades of healthcare domain expertise to help clients draw closer to their customers. The company optimizes the entire member/patient experience through service offerings for clinical operations, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 34,000 employees across 5 countries.

Visit www.Sagilityhealth.com to learn more. 

About BirchAI

BirchAI is a GenAI company founded in 2020 by Kevin Terrell, Sumant Kawale and Yinhan Liu. The concept was developed through Seattle’s AI2 Incubator, one of the world’s leading supporters of AI-first startups.

BirchAI helps their clients reduce average handle time by up to 35% by automating complex healthcare interactions using proprietary speech-to-text and Large Language Models that efficiently integrate with most commonly used CCaaS and CRM solutions. 

Visit https://birch.ai to learn more. 

Media Contact
Christopher Morrison
Head of Marketing,
Sagility
[email protected]
770.298.5830

BPO, Supercharged: Business Process as a Service Drives Scale, Savings While Exponentially Enhancing Outcomes

October 5, 2023 – (Healthcare Business Today)

Discover how BPO is no longer just about cost-cutting; it’s a supercharged strategy that drives scalability, savings, and, most importantly, unprecedented outcomes. Find out more in our blog/article, “BPO, Supercharged: Business Process As A Service Drives Scale, Savings While Exponentially Enhancing Outcomes,” by Sagility team members Srikanth Lakshminarayanan, Umesh Chandorkar and Nikki Henck.

Article originally published by Healthcare Business Today

Press Release: Sagility LLC Acquires Devlin Consulting, Inc.

DENVER, April 25, 2023 08:00 AM Eastern Daylight Time – (BUSINESS WIRE) – Sagility LLC, a leading provider of technology-enabled business process management (BPM) services, announced today their acquisition of Chandler, Arizona-based Devlin Consulting, Inc. (DCI). For the past 28+ years, DCI has made a name for itself as a healthcare technology services company providing payment integrity services to several of the country’s leading health plans.

With this acquisition, Sagility broadens the 360-degree precision payment integrity solution offering they provide to five leading US health plans and regional Blue plans. Sagility’s payment integrity services are backed by 18+ years of payer and claims expertise with certified coders/credentialed clinicians, data scientists, claims examiners, and auditors.

This union combines Sagility’s payment integrity solutions and advanced analytics with DCI’s robust contract central technology platform. Through this relationship, Sagility will now offer market-leading payment integrity solutions suite that focuses on pre-pay cost avoidance, enhanced post pay recoveries, and improved provider-payer relations. These features will help clients achieve the new levels of efficiency required to thrive in today’s marketplace.

“Sagility has outlined a strong growth trajectory, and one of the key strategies fueling this is the acquisition of credible companies that further strengthen and complement our capabilities,” said Ramesh Gopalan, Group CEO of Sagility. “With the integration of DCI’s expertise, we will further enhance our payment integrity offering while remaining committed to all areas of client service excellence.”

About Sagility

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical operations, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Colorado-based Sagility has more than 30,000 employees across 5 countries and revenues of over $500 million.

About Devlin Consulting, Inc

Devlin Consulting Inc. (DCI) is a payment integrity firm which utilizes specialized technology to shorten the time horizon from overpaying a claim to the time it is identified and client systems can be updated to help avoid future payment errors. Founded in 1995, DCI’s payment integrity services provide millions of dollars of post payment overpayment identifications for clients. DCI has extensive experience in the health care field with over 28 years of experience servicing managed care clients. Synergy Advisors acted as exclusive financial advisor to DCI in this transaction.

Transformative AI to Revamp Prior Authorizations

Tech enablement drives lower costs, lessened provider abrasion

Health plans are unnecessarily burdened by administrative tasks such as prior authorization—a costly bottleneck to optimized care and operational outcomes. Recent American Hospital Association (AHA) research states that that 95% of providers spend increasing time seeking prior authorization approval. An astounding 78% of hospitals and health systems said their relationship with commercial insurers is getting worse. What’s needed is relief at this high-impact payer-provider touchpoint. AI-enabled prior authorizations can help. According to McKinsey analysis, AI-enabled prior authorizations can automate up to 75% of manual tasks. This tech enablement solves for many of the inefficiencies while working to improve payer and provider synergy, reduce costs, improve case turnaround time, and, most importantly, drive better health outcomes for patients.

Drivers to Digital Utilization Management

The case has never been clearer for a straightforward, faster, and impactful PA process. High-impact PA ups the ante with an analytical approach to flag clinical decisions that need priority nurse review. The algorithmic decision support can identify high dollar clinical usage patterns, FWA patterns and CPT conversion/alternative treatment. Traditional, siloed UM programs are not adequate to meet current market conditions: a high-cost clinical resource pool and financially pressured payers and providers. Add to that this simple fact: our internal research shows that 80+% of authorizations reviewed are eventually approved without any modifications, and only a few of the cases need a detailed review for necessity. This leaves a lot of room for digital intervention in the provider interaction channel to instantly auto-approve and provide an outcome via digital assists for better member care.

Experts such as healthcare business process management partners have the combined digital solution and skillset: experienced clinicians supported by AI workflows to effectively manage the process and cost. Backed by process re-engineering, automation and digitization of the prior authorization process will ease provider burnout and change the perception of this process. Traditionally, the prior authorization step has been viewed as cumbersome, with high administrative costs running into billions of dollars across the US healthcare sector. BPM partners with experience across both payers and providers can collaborate and bridge gaps to improve the overall ecosystem of population health and give a better dollar accountability and visibility. As a result, transformed, high-value utilization reviews will drive to lower-cost per review using state specific/CMS guidelines and a 99%+ calibration with medical directors on review decisions.

UM Augmented with Transformation Levers

The front- and back-office digital suite of solutions use automated speech recognition (ASR), NLP of medical entities, contextual insights, computer vision, and machine learning feedback to evaluate prior authorization requests against automated guideline rules. The outcomes are provided via digital nurses on some channels and nurse assist flows on others, each with comprehensive criteria summary and recommendation on approval or referral to a medical director.

Outcomes and Future of Clinical Reviews

BPM partners with experienced clinical resources combined with AI workflows can manage the PA process cost effectively and find transformation with process effectiveness. For the first launch of the back-office solution for a top payer client, Sagility’s prior authorization medical record review automation leveraged in-house asset Intelligent Content Processing (ICP) for a 20% efficiency gain across the entire document review process, with a line item gain of 75% error reduction, in some cases. With the buildup of this platform to transform clinical data into intelligence to reduce process complexity, enhance accuracy, and speed TAT which is 7-10 minutes saved per case transaction. Through machine learning, these savings will compound over time, for up to 40% cost savings for identified scenarios. This powerful tool will also drive significant TAT improvements as well as enriched provider and member experience (potential Star and NPS ratings impact) from improvements on quality with reduction in nurse error and nurse glide path, enhanced productivity, decrease in regional medical director (RMD) routes, increase in identification of potential approvals for nurse to review and also decrease in number of cases referred to physician.

Transforming the front office with the voice assist and context bots results in auto-approvals for high volume procedures. This directly reduces call volume reduction by 10-15%. The next-best action and access to unified knowledge bases have driven a shortening of complex prior authorization calls, for 15-20% savings via handle time reduction. The continuous digital bot and agent monitoring metrics have also resulted in an internal training glide path reduction by 50%, ensuring the quality of outcome at above 99%+. Overall savings in the front office can be at least 20% as skilled resources need no longer work on administrative tasks anymore.

As next steps, any outcomes of clinical decision support that sources from a unified data lake of claims, medical records, and member profiles can be successfully linked with population health outcomes and patient profile stratification. This will result in insights on high risk population analysis, population trends and wellness management, and, finally, risk scoring of individuals and proactive population management. Weaving in provider profiles can also help provide in extension insights on the segmentation, scorecards, and comparative analytics to evaluate provider utilization and abuse, if any.

As published on Healthcare Dive

Challengers of the Status Quo In Billing and Claims — More Accurate and Fairer Payment

This coverage demonstrates Sagility’s thought leadership on the potential for dramatic change in an area that’s long been an issue for health insurance plans.


Article originally published by Managed Healthcare Executive

Author: Sohail Djariri, Chief Growth Officer, Sagility

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