Accelerating measurable business outcomes with over 150 years of collective expertise in healthcare
At EsperHealth, we are passionate about driving healthier outcomes with equitable and affordable access to healthcare for all.
We combine extensive industry expertise with our cutting-edge eXplainable AI (XAI) platform to achieve impactful business outcomes in the healthcare sector including payers, providers, pharmacies, and Pharmacy Benefit Managers (PBMs).
Ensuring responsible, evidence based solutions for the healthcare sector
Leveraging over 150 years of collective expertise to drive impactful business results
Increase in Medicare Advantage enrollment, Medicaid state-reassements triggering coverage complexities, Payer/Provider cost pressures resulting in plan limitations requiring supplemental coverages; all lead to complexities in coordination of benefits causing delays, potentially leading to reduced quality and gaps in care.
Employer cost optimizations, shrinking retiree coverage benefits, increased cost of care are some of the leading factors driving disparities in access to care in a growing underinsured, uninsured population. This leads to increased risk of reduced quality of care and eventually leading to gaps in care.
Complexities of healthcare regulations, continued consolidation within the healthcare industry creating technical debt and data silos, varying levels of standards adoption, and persistent shortages of skilled labor are significantly contributing to patient experience challenges, which in turn lead to adherence issues.
Innovation in medicine is increasing complexities in Care Pathways, changes in regulations require constant revisions to process and technology, high expectations from technology savvy patients, caregivers and providers; all leading to patient churn and adverse impact to effectiveness of care.
Our passion to disrupt healthcare, coupled with our industry expertise and proven technology capabilities, enables organizations to address their business challenges with these four themes and beyond
Ensure optimal care and improve outcomes with a holistic and interconnected approach for each stakeholder - Patient, Member, Caregiver, Provider, Payer
Data driven insights for Payers, Providers, Pharmacies, PBMs to enable the transition to Value-Based Care
Connect disparate sources of structured and unstructured data to improve utilization management and adherence to therapy thereby reducing cost of care in a risk averse manner
Enable flexibility and choice via data driven insights for informed decisions in the selection of care choices
At EsperHealth our primary focus is on Payers and Pharmacy Services (Retail, Home Delivery, Specialty), which in turn enables organizations to address the toughest business challenges across the entire healthcare ecosystem of Payers, Providers, Pharmacy Benefit Managers (PBMs), Distributors and Manufactures.
Our approach combines advanced eXplainable AI (XAI) tooling within our platform with domain-specific knowledge engineering to deliver Functional Foundation ModelsTM based healthcare outcomes.
Functional Foundation ModelTM refers to a versatile and adaptable neural network-based framework that serves as a fundamental platform for addressing complex business problems or tasks within a specific domain. This term emphasizes both the practical functionality and foundational nature of the model in enabling a wide range of downstream applications and analytical insights, incorporating advanced techniques such as knowledge engineering, transfer learning and domain expertise integration.
Our solutions are focused on addressing challenges across all stakeholders within the healthcare ecosystem using the eXplainable AI (XAI) platform as the foundation.
A solution that automates the evaluation and adjudication of insurance claims, reducing processing times, minimizing errors, and improving claims accuracy and customer satisfaction.
Our solution enhances claims processing efficiency, accuracy, and compliance by leveraging AI-driven analytics, predictive modeling, and fraud detection techniques to identify patterns, anomalies, and potential risks, enabling faster, more accurate claims adjudication and resolution.
Enable segmentation of patient populations based on demographics, health profiles, and behavior to personalize care delivery, improve outcomes, and optimize resource allocation.
Predict the likelihood of patients discontinuing services or switching providers based on demographics, historical data, patient interactions, and health outcomes.
Improve patient adherence to treatment plans, medication regimens, and follow-up appointments based on historical data, patient characteristics, and behavioral patterns.
A solution that anonymizes sensitive data to protect privacy, comply with regulations, and mitigate the risk of data breaches.
Our solution safeguards sensitive information, reduces the risk of data exposure, and ensures regulatory compliance by replacing identifiable data elements with realistic but fictional values, preserving data utility for analytics and research while protecting individual privacy and confidentiality.
A solution that centralizes and automates compliance controls monitoring, tracking, and reporting to ensure adherence to regulatory requirements and internal policies.
Our solution provides real-time visibility into compliance status, identifies potential risks and violations, and enables proactive remediation actions, enhancing governance, risk management, and compliance (GRC) effectiveness while reducing compliance-related costs and exposures.
