MIAMI, FL - September 5, 2024
A $3 billion merger of three closely held health technology firms aims to use artificial intelligence to help health plans police their payments to doctors and hospitals.
New Mountain Capital LLC is forming the new company by combining three in its portfolio: the Rawlings Group, the payment-integrity business of Apixio, and a recently acquired firm called Varis. The deal values the combination at more than $3 billion, according to people familiar with the matter who asked not to be named discussing private information.
The US health-care industry is plagued by payment errors, with an estimated $100 billion in improper payments in government health programs alone last year. That’s led to the rise of a group of payment integrity firms that promise to reduce insurers’ erroneous outlays.
Often operating behind the scenes, payment-integrity companies have taken on a growing role within the $5 trillion US health-care system by helping insurers make accurate reimbursements and recover dollars that are paid in error. McKinsey estimates the annual market for such services at $9 billion. However, David Pierre, who will lead the New Mountain-backed business as chief executive officer, said the total market is about twice that when counting the value of insurers’ internal efforts.
Private equity firms have been pouring money into businesses that operate in the middle layers of the health-care payments system. R1 RCM Inc., which helps hospitals optimize billing and other payment functions, is set to go private in an $8.9 billion deal led by TowerBrook Capital Partners and Clayton, Dubilier & Rice.
Cotiviti, a payment-integrity firm that helps health plans save money, was recently backed by private equity giant KKR in a deal valuing the company at $10.5 billion, Bloomberg News reported in February. UnitedHealth Group Inc.’s Optum Insight division is another major player.
New Mountain’s new company aims to marry artificial intelligence and other digital tools with large health-care data sets to make the payment system more efficient, said Matt Holt, the firm’s president of private equity.
“The overarching trend is absolutely toward the reduction of administrative cost,” he said in an interview.
Founded in 1977, Rawlings helps health insurers determine when another party is responsible for medical claims. Apixio, previously owned by Centene Corp., uses artificial intelligence to review medical bills and patient charts. Varis provides auditing services for health plans.
Layers of Approvals
Medical providers are frequently frustrated by the layers of approvals, reviews and audits they face from insurance companies when trying to collect payment. The new company aims to remove errors from the payment process and accelerate accurate reimbursements to providers, said Pierre, the CEO of the combined venture.
“We can make these payments simpler,” said Pierre, who was previously chief operating officer of Signify Health, a New Mountain company that went public and was later acquired by CVS Health Corp. for $7 billion.
AI can accelerate the work of sifting through voluminous data to find patterns that may signal a payment problem. For example, Pierre said, a medical record for an emergency visit with head trauma and shards of glass could indicate an injury in a car crash. That claim might be the responsibility of an auto insurer rather than a medical plan.
The new company is yet to be named and will employ close to 2,000 people, including experts in medical coding, clinicians and attorneys. It will have more than 60 client health plans covering 160 million people, according to New Mountain.
About Eir Partners
Eir Partners is a health technology private equity company. Eir has completed or partnered on over $5 billion in healthcare technology transactions since inception in 2015 and has been involved in large scale health tech companies including Apixio, Capta Health Partners, GIftHealth, CloudMed, Equian, Millennia, ReviveHealth, and Convey amongst others. Visit www.eirpartners.com.
About Rawlings
Rawlings, founded in 1977 and based in La Grange, Kentucky, is a leading technology-enabled coverage analytics provider that delivers savings for its health insurance clients by identifying third parties responsible for paying medical claims across its subrogation, coordination of benefits, and drug claim payment integrity offerings. For more information on Rawlings, please visit https://www.rawlingsgroup.com.
About Apixio
Apixio is the Connected Care Platform at the intersection of health plans and providers. The company’s actionable AI technology, flexible services, and seamless workflows power accurate payments and high-quality patient care so that healthcare organizations can thrive as the industry moves toward value-based reimbursement models. Learn more at www.apixio.com.
About VARIS
VARIS, LLC was founded by a team of healthcare professionals with more than 100 years of combined experience in the healthcare industry. VARIS specializes in overpayment identification solutions including DRG and APC. VARIS serves clients who are commercial payers, Medicare Advantage contractors, Medicaid Managed Care contractors, Administrative Service Organizations, and State/Federal programs throughout the country. Learn more at http://www.varis1.com.
###
Contact
Eir Partners Capital
Brett Carlson, Founder and CEO
830 Brickell Plaza
Suite 3203
Miami, FL 33131
