Concept: American healthcare technology startup Reveleer has launched an end-to-end cloud-based platform called Reveleer for Risk 2.0 (Risk 2.0) for clinical data gathering and coding for health plans. It is powered by AI-driven capabilities that allow health plans to reliably plan and execute risk adjustment programs with the essential support to automate the collection, analysis, review, and submission of risk adjustment data.

Nature of Disruption: The platform’s AI-driven evidence validation engine can process about 500 million pages of data annually, measuring quality and cost performance. It combines natural language processing (NLP), optical character recognition (OCR), and ML models to automate chart verification, validate administrative claims data, identify net-new encounters, diagnose, and hierarchical condition categories (HCCs). The platform’s AI-assisted coding in combination with broad match technology and confidence scoring can reduce false positives and provide first-pass ideal HCC discovery accuracy. The information from medical records is then returned to the coders to assist them with faster and more accurate reviews, which could increase productivity by up to 45%. Health plans can add their own plan-specific rule sets within the platform using customizable coding rules. Risk 2.0 offer contemporary risk adjustment capabilities which include several workflow improvements like rapid scan thumbnails and protected health information (PHI). Reviewers can quickly scan only the pages that contain evidence, cutting down the amount of manual reading. By enabling split-screen medical record review and data entry simultaneously, screen synchronization significantly reduces the need to scroll. Together, these improved features offer a smooth and effective coding experience, enhancing accuracy and efficiency.

Outlook: AI in healthcare is becoming more important for delivering high-quality, predictive patient care and improved results. Reveleer’s Risk 2.0 offers a road to transformation as health plans and providers are under pressure to do more with less. The startup intends to empower health plans across various business lines with control over their quality improvement and risk adjustment initiatives. The Reveleer platform enables plans to execute independently and manage every aspect of provider outreach and data retrieval, coding, abstraction, and reporting. It can offer comprehensive record retrieval and review services using unique technology, substantial data sets, and subject matter experience. In December 2021, the startup raised $65 million in funding led by Oak HC/FT. It intends to utilize these funds to expand its platform capabilities and improve the quality and accuracy of data-driven programs.

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