New Mountain Capital has announced the merger of The Rawlings Group, Apixio’s Payment Integrity (PI) business, and VARIS to create a new technology-enabled platform for the healthcare industry.
This platform is designed to reduce healthcare costs by enhancing payment accuracy and identifying errors proactively.
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The merger brings together each company’s technology and decades of experience to establish a solution for health plans.
New Mountain Capital’s new entity offers a broad range of capabilities, including pharmacy payment integrity, subrogation, coordination of benefits, and complex claim solutions.
Administrative complexity, a significant driver of more spending in the US healthcare system, leads to an estimated $267bn in costs annually.
Efficient healthcare payment interventions could potentially cut these expenditures by $40bn to $60bn annually.
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By GlobalDataThe unified company aims to deliver superior healthcare outcomes, such as recovery of overpayments, higher payment accuracy, reduced medical spending, and savings for health plans.
With its technology and artificial intelligence (AI) enablement, the company is projected to meet the increasing demand for improved financial performance and quality in healthcare payments.
The combined entity stands out with its flexible delivery model, which allows clients to either configure the platform for their internal payment integrity teams or to fully outsource to a team of clinical experts.
It is expected to generate over $3bn in savings and cost avoidance a year, driven by a commitment to client service and quality, and supported by more than 500,000 concepts, algorithms, and analytic models.
The organisation will consist of nearly 1,900 technology, legal, coding, and clinical experts.
New Mountain Private Equity managing director and president Matt Holt said: “The new organisation will help reduce administrative waste while being a catalyst for lowering healthcare costs for payers, payviders, employers and consumers.
“This move is built upon our decades of healthcare expertise coupled with an accelerated investment in leveraging big data and AI with a maniacal focus to help bend the cost curve.”
David Pierre, former CEO of Signify Health, will lead as the CEO of the combined entity.
Pierre’s experience includes leading Signify Health to generate $1bn in revenue, its initial public offering in 2021, and its $8bn sale to CVS Health last year.
In addition, as part of the transaction, Datavant acquired the Connected Care platform and value-based care solutions of Apixio.
