Transforming Healthcare with AI managed care

Campaign Healthcare is a pioneering company that leverages our patent-pending managed care platform and artificial intelligence (AI) agents to scale how payers, providers and suppliers deliver and measure value.  We focus on several key areas:

1. Network composition, competitive rates and market dynamics
2. Medical spend to identify high cost populations and interventions
3. Vendor performance to measure efficacy across cost, quality and utilization targets
4. Revenue cycle to ensure payments are accurate and timely 
5. Data management across functional domains

There are many unrealized opportunities when it comes to building, operating and measuring a network of vendors, both clinical and non-clinical. Unrealized opportunities are cross domain in nature, need disparate data, and lack capabilities to guide workflows which can be automated based on machine learning models and rules.  These scenarios are ideal candidates to leverage our AI agents, machine learning and data management platform through an organized, time-boxed set of actions to achieve a goal (i.e., campaigns).  

Our campaigns address questions like:

• What are relative rates across payers or providers benchmarked to Medicare? Are you expanding into new geographies? Do you want to evaluate your relevancy as a vendor but find public transparency data unwieldy?
• What type of reimbursement model makes the most sense for a vendor?
• Which members or patients would benefit from different care management programs?
• What vendors offer the most impactful services considering cost, quality and outcome targets across functional areas?
• What blend of services will get the optimal outcomes for a member or patient?
• What charge entry functions can be automated? Do you manage different rules for different payer contracts? Are denials impacting receivables?
• Are quarterly business reviews frustrating?  Are my vendors performing against forecast and are we using the real-time operational data to measure their efficacy?

and the list goes on and on.  We partner with your functional leaders to define the appropriate goals and measurement criteria which, once defined, get updated in near real-time, so your teams can focus on optimizing outcomes, creating value and holding vendors accountable instead of trying to keep up with firefighting activities.

When vendor sourced work crosses financial, clinical, administrative and quality domains, opportunities can be missed, duplication of effort occurs and measurement criteria to determine returns or efficacy are more difficult to evaluate on time through the perspective of the various stakeholders.

With our years of healthcare experience, massive data lake, disparate data source integrations, machine learning models and next generation vendor management platform, we are changing how Insurance companies, physician networks and care management vendors work together to achieve optimal clinical outcomes and financial goals for their members and patients.