While the healthcare industry continues to advance technologically, the same cannot be said about its availability and costs. The gap here is the accuracy of payments. If payers submit bills for payment that are correct, there are fewer administrative costs for both payers, physicians and hospitals and less abrasion between the parties.
However, due to the gap, insurers around the nation struggle with billing and payments made in error. With that, billions of dollars are at risk and currently, no industry best practices are found to be in place. The current software systems are fragmented, and practices only discover and recover a fraction of the total overpayments. As such, competitors identify less than one-thirds of these incorrect payments and charge millions of dollars in fees.
Recognizing such importance, we begin our quest, The 10 Most Innovative Companies to Watch in 2020, with 360 Health Systems, a Payment Integrity Technology Company focused on empowering Healthcare Payor Organizations with a unique, easy-to-use, feature-rich, and AI-driven SaaS solution.
The firm disrupts the $300+ billion industry with AI-driven technology and provides a claims payment integrity, Fraud, Waste, Abuse, and Recovery solutions. It allows Government Agencies, HealthPlan Organizations, Self-Insured and TPA’s to identify, reduce, and recover hundreds of millions of dollars in improper payments. Whether their objectives are Payment Integrity, Analytics & Reporting, FWA, Financial Recovery, Medical Record Validation, Contract Re-Pricing or Workflow Management, 360 Health System’s digital and non-conventional approach enables them to take full control over the Claims Cost Containment initiatives to meet and exceed the financial objectives.
Since its inception in 2013, the company has become a lean organization, providing a concierge service to its client and future clientele while increasing their efficiency, effectiveness, and financial bottom-line.
Meet the Innovator
Stanley Guilbaud, the Founder and CEO of 360 Health System, is an accomplished operation, financial, and analytics executive. He has over 25 years of experience in the healthcare industry within the payor and provider sectors. Throughout his career, he has led and implemented innovative solutions, reversing the loss of $750+ MM in operational dollars. He has also led Payment Integrity initiatives accomplishing over $2 BB in Financial Recoveries for fortune 500 organizations.
Mr. Guilbaud holds an MBA from NSU Graduate School of Business and a BS in Computer Science from Florida International University. With a global perspective and in-depth knowledge of the Healthcare industry, the entrepreneurial-minded Mr. Guilbaud is recognized as an expert in business processes engineering and optimization with a highlight on developing technology that intelligently manages and empowers the healthcare supply chain.
Under his able leadership, 360 Health System has become a prominent name in providing an AI-enabled end-to-end solution to payers with the opportunity to seamlessly reverse billions of dollars.
Leveraging game-changing technology, 360 Health Systems designed and developed an AI Software as a Service (SaaS) system called P.O.R.A. With machine learning capabilities, P.O.R.A allows payors to identify, prevent, reduce, and recover billions of dollars in improper Medical & Pharmacy claim payments, fraud, waste, and abuse. Using 360 Health Systems proprietary analytics, P.O.R.A. integrates health insurance payment integrity initiatives, contract configuration, and modeling into a centralized and user-friendly application.
PORA is a solution designed to help payers navigate through the complex healthcare billing and payment data from beginning to end:
- Continuously monitoring across more than 20,000 objective, primary, and public data sources
- Innovative technology that drives analytics and creates transparency while reducing operational costs associated with data management.
- A platform that unites all your payment integrity, fraud, waste and abuse efforts, streamlining internal and external processes through one solution.
- Generating reports on-demand without any bottlenecks.
- A calculation engine that analyzes 100% of paid claims retrospectively and prospectively, through a series of edit rules that are designed to find payment inaccuracies, fraud, waste and abuse on a variety of claims types.
Understanding the Model
360 Health System’s turn-key platform is built on a SaaS model with AI Technology. It allows Healthcare Organizations to unite and manage all of their payment integrity and FWA efforts, streamlining their internal, and external processes through one cost-effective automated solution.
The company offers health plans, TPA’s and Self-Insured in both government and private sectors an opportunity to seamlessly reverse billions of dollars that are paid incorrectly. “We help Healthcare Payor Organizations to minimize and reduce payments and billing errors to Hospitals, Physicians and Pharmacies,” says Mr. Guilbaud.
Consequently, 360 Health Systems’ solution being user-friendly has become a one-stop-shop application. Some of the features include Claim Repricing, Fee-Schedule lookups, claim scoring, Real-Time Financial and Operational reporting, Interactive dashboards, Workflow and Vendor Management, Advanced Analytics with hundreds of algorithms powered by an AI technology and automated recovery module.
The firm is poised to transform the Healthcare Payment Integrity with unprecedented access to the most cost-effective and innovative payment accuracy system available in the market today. “Our proprietary analytics system processes millions of claims per day, analyzing 100% of paid Medical and Pharmacy claims automatically with minimal human interaction,” he adds.
Why 360 Health Systems?
What makes the company unique is its unmatched accuracy, affordability, extensive analysis, coupled with its ability to increase productivity, providing advanced digital reporting, and root cause identification for better decision making. The automated overpayment recovery solution is positioned to provide its clients with an easy-to-use system to identify and recover wasteful billing errors and fraud while improving its clients’ ROI.
“The company is called 360 Health Systems for a reason as we designed our software to review pre and post payments, a 360-degree payment accuracy review,” says the CEO. Further, he adds, “We run the organization with the mindset of the strength of the team is each individual member and the strength of each member is the team; additionally, we don’t go after what we think we can do, we go for something beyond what we think we can do. We also maintain clear and concise communication while promoting integrity and quality.”
P.O.R.A for Tomorrow
With AI-driven technology, SaaS-based, and highly secured HIPAA Compliant software, the company will continue adding value proposition for all healthcare payers. “360 Health Systems’ team is comprised of the nation’s leading payment integrity experts and data scientists. Their contribution to refining the powerful real-time reporting with actionable insights has fueled the innovation behind the unique machine learning capabilities, which powers our software called PORA (Payor Overpayment Recovery Application)”, concludes Mr. Guilbaud.
Word of Mouth
Let us see what the clients have to say about 360 Health systems:
“I want to say thank you so much to you and the whole team at 360 Health Systems for all your support – it has been a pleasure working with you and we look forward to continuing growing with you”
-Director Payment Integrity from a Southeast Healthplan
“Thank you for the work you’ve done. You’re a group of outstanding professionals with a kind and patient mindset. Rock on, 360HS Team!”
– Manager Cost Containment from a West Coast Healthplan
“Thanks for everything you do, you guys are an awesome partner, we have been able to surpass our financial goals by 17%!”
– Payment Integrity and Financial Recovery Team from a Healthplan
“Financial tools like PORA enable us to execute the kind of financial recovery service we’re looking for. It’s the kind of software that is taking our business to a different level!”
-CEO of a Financial Recovery Company
Visit www.360healthsystems.com to know more.