SOUTHBOROUGH, Mass.--(BUSINESS WIRE)--With the Baby Boomer generation aging into Medicare and the increasing average lifespan due to modern medicine, the total number of Medicare-eligible Americans is growing. This means that having cost-effective and high-quality Medicare plans is becoming even more important. To meet this growing demand, nirvanaHealth launches Medicare Advantage-in-a-box, Aria Medicare, on Amazon Web Services (AWS).
The success and existence of MA plans play an increasingly crucial role in the Medicare program. MA plans, which are administered by private health insurers, are better equipped to reduce Medicare spending and result in better health outcomes compared to Original Medicare. However, MA plans only account for about 42% of the Medicare population. Of those who enroll in MA plans, around 80% choose plans with quality ratings of 4 stars or higher. To accommodate the growing Medicare-eligible population, there needs to be more high-quality MA plans.
However, launching and administering a successful MA plan is no simple task. Subject to stringent regulatory guidelines and scrutiny, even established MA plans struggle to offer a compliant, cost-effective, and highly rated plan. MA plans must comply with the strict marketing, sales, administrative, clinical, utilization, financial, quality, and risk score management functional requirements, lest face financial penalties. To do so, MA plans utilize multiple legacy vendors and rely on Independent Practice Associations (IPAs) and Management Services Organizations (MSOs) to distribute and manage risk. Without the right platforms, this results in extremely fragmented processes, which make it even more difficult to adapt to the ever-evolving Medicare risk models. These challenges can be overcome by having platform-driven operations and intelligence-driven risk management. However, there is a lack of comprehensive platforms for successful Medicare Advantage administration.
nirvanaHealth launches Aria Medicare, a Medicare Advantage-in-a-box solution that runs on AWS. “By leveraging our cloud-native Aria platform, we can simplify Medicare Advantage operations end-to-end for any health plan, whether it be a newcomer to Medicare Advantage or a large carrier. The architecture facilitates flawless onboarding,” says Ravi Ika, CEO and Founder of nirvanaHealth. The platform is designed to improve operational efficiency, eliminating the need to utilize multiple vendors and platforms. Aria Medicare is specifically designed to enable MA plans to manage Sales, General, & Administrative costs at under 8% of the total premium collected. Additionally, this platform empowers MA plans to creatively distribute and manage risk with risk partners, such as IPAs and MSOs. Aria Medicare shares actionable intelligence directly into workflows, including gaps in care, continuity of care, and accurate risk-adjustment. This leads to improved quality ratings and ensures appropriate care to the patient.
“This truly is Medicare Advantage-in-a-box,” says John Sculley, Chairman of nirvanaHealth and former CEO of Apple and PepsiCo. “No other singular platform in the market today is capable of managing Medicare Advantage as comprehensively or intelligently as Aria.” Comprised of several different robotic process automation (RPA) modules, Aria deploys hundreds of bots to automate and manage various marketing, sales, administrative, financial, clinical, medical, utilization, care management, quality, and risk contracting & management functions with built-in compliance. This comprehensive automation creates a digital workforce that allows MA plans to have lean resource management for all transactional tasks. “Empowered by platform-driven intelligence, MA plans can allocate human capital more wisely to focus on things that require human touch, such as member healthcare experience, social determinants of health, wellness regimens, care management, quality rating & risk management, and total cost-of-care. Since Aria is built on artificial intelligence (AI) and machine learning (ML), even these manual operations are more intelligent. By simplifying decision making and operations, Aria leads to higher quality outcomes and reduced operating costs,” Sculley says.
nirvanaHealth is an innovative Payer and pharmacy benefit manager (PBM) platform provider that leverages their robotic process automation (RPA) cloud platforms to manage integrated medical, pharmacy and behavioral services that reduce overall administrative and medical costs and improve quality. nirvanaHealth offers the first cloud-native Payer and PBM integrated platform in the industry. nirvanaHealth pioneers healthcare automation by uniquely combining deep healthcare domain expertise with proven platform-building experience to deploy RPA across the Payer and PBM industries.